By Sri.Ananthakrishnan P. S, President:
This is a complaint filed under section 12 of the Consumer Protection Act 1986.
2. The Complainant’s case in brief is as follows:-
The Complainant is a dairy farmer. He purchased a cow and insured the cow with the Opposite Party company for Rs.50,000/-. The cow was pregnant for 7 months at that time. In the month of June 2018, it shows some illness. It’s stomach became enlarged and had some difficulty to lay and stand. There was obstruction in it’s anus which blocks free flow of dung. Doctor treated the cow. But, he could not save the cow. On post mortem, it was found that there was an obstruction in the large intestine of the cow which blocks the dung and it died due to the enlarged stomach. Thereafter he put a claim before the Opposite Party, insurance company. But, they rejected the reason for the death stated in the post mortem report and disallowed the claim which causes mental stress to the Complainant. Hence, this complaint to get the insurance claim and Rs.1 lakh towards compensation.
3. The Opposite Party filed version which in short is as follows:-
They admitted the death of the cow of the complainant. But, according to them, the Complainant is not a consumer. He purchased this cow for commercial purpose. The Complainant failed in maintaining the cow in a proper and healthy manner. He suppressed the pregnancy of the cow, a material fact when he took the insurance. They denied that the cause of death of the cow was due to the infection at the end of large intestine and block in the anus which leads to an enlarged stomach. There is no deficiency in the service of Opposite Party. The cause of death of the cow is resultant from intestinal hypo motility and pre partum changes in the position of abdominal organs as a result of the foetal size, because, cow was eight months pregnant at the time of death. So this Opposite Party is not at all liable for pregnancy/delivery related contingencies of the cow as per the stipulation under the policy contract of insurance. An insurance policy will not cover the animal having 7 months and more pregnancy duration and if at all insured, the insurance policy will not cover the pregnancy/delivery related contingencies of the animal. Since, the death of the cow is due to pregnancy/delivery related contingencies, this Opposite Party is not liable to pay the claim. Hence this complaint is to be dismissed.
4. On the above contentions, the points raised for consideration are:-
1. Whether the Complainant is a consumer?
2. Whether there is any deficiency of service on the part of
Opposite Party?
3. Reliefs and Cost.
5. The evidence in this case consists of oral testimonies of PW1, PW2 Ext.A1 to A11 and Ext.B1 to B4. No oral evidence from the side of Opposite Party. Heard both parties.
6. Point No.1:- According to the Opposite Party, the Complainant purchased the cow for commercial purpose and so, he is not a consumer as per Consumer Protection Act. The specific case of Complainant is that he is a dairy farmer and is depending upon the income derived from selling of milk. The Complainant, when he examined as PW1 also deposed this fact. There is no contra evidence. There is no material to prove that the Complainant is dealing with the cow for commercial purpose and thus he is not a consumer. So it is to be held that the Complainant is a consumer. So, this point is answered in favour of Complainant.
7.Point No.2:- It is an admitted fact that the Complainant insured the cow with the Opposite Party for Rs.50,000/- and this cow died during the insurance period. It is also an admitted fact that when the Complainant took the insurance policy and during the death, cow was pregnant. Ext.A4 is the copy of post mortem report and Ext.B2 is it’s original. As per Ext.A4/B2, the death of the cow is due to asphyxia and shock due to intestinal impartial resulting from adhesion and inflammation of colon.
8. The Opposite Party’s specific case is that the Complainant suppressed a material fact that his cow was pregnant at the time of taking insurance policy. Their further case is that the death of the cow was due to a problem connected with pregnancy/delivery. Therefore the counsel for the Opposite Party contented that the Complainant suppressed a material fact and since, the cow died due to the problem connected with pregnancy/delivery, they are not liable to give the insurance claim. But the specific case of Complainant is that the death of cow was not due to the pregnancy/delivery problem. It is evident from post mortem report that the cow died due to Asphyxia and shock due to intestinal impartial resulting from adhesion and inflammation of colon. PW2 is the doctor who signed Ext.A1/B3, proposal form, Ext.A3, claim form and conducted the post mortem. PW2 never stated anywhere that the death of cow was due to a problem connected with pregnancy/delivery. He deposed that there was severe obstruction in the intestinal track of the cow. Therefore the case of the Opposite Party that the death of the cow was due to a problem related to pregnancy or delivery is to be rejected and it is to be held that the death of the cow was not due to thepregnancy/delivery problem.
9. The counsel for Opposite Party contented that the Complainant suppressed the fact of pregnancy in the proposal form and as per the conditions of the policy the pregnant cow cannot be insured and if insured, the death of the cow should not be due to pregnancy/delivery problem. As we found that the cow was died not due to pregnancy/delivery problem and the contention of the Opposite Party with regard to this fact was rejected. Ext.A1 is the copy of Proposal Form and Ext. B3 is it’s original. Ext.B3 shows that a pregnant cow above 7 months may not be insured. But, it is not stated in Ext.B3 that the pregnant cow above 7 months shall not be insured. The only condition is that if it is insured, the death of the cow should not be any ailment connected with pregnancy/delivery problem. So also there is no column in the proposal form to write whether the cow is pregnant or not. So as per the policy condition, there is no bar to insure the cow who is pregnant for more than 7 months. The only condition here is that the death should not be due to any pregnancy/delivery problem. Since we already held that the death of the cow was not due to the pregnancy/delivery problem, the Opposite Party is liable to give the insurance claim to the Complainant. But they simply denied it. Ext.A10 is the denial Letter. Ext. A10 shows that the claim is rejected for the reason that the death of the cow is due to pregnancy related contingencies. We don’t understand from where the Opposite Party reached into this conclusion. PW2 who treated the cow, signed Ext.A3 claim form, issued Ext.A5 valuation certificate and conducted the post mortem never stated anywhere to come into a conclusion that the death of the cow is due to pregnancy related contingencies. Ext. A6 is the treatment certificate. So, there is deficiency of service on the part of Opposite Party. PW2 issued Ext.A5 valuation certificate. He assessed the value of the cow as Rs.50,000/-. So the Opposite Party is liable to give the insurance claim of Rs.50,000/- and compensation to the Complainant since, they denied the claim without a valid reason.
10. The complainant wants to get Rs.1,00,000/- as compensation. It is exorbitant. But, even if here, the documentary evidence including the post mortem report never stated that the death of the cow was due to a problem related to pregnancy or delivery, the Opposite Party rejected the claim for the reason that the death is due to pregnancy related contingencies. In these circumstances, we are compelling to support the view of the Complainant in the complaint that the present stand being taken by the Opposite Party is how to reject the deserving claims. So, Opposite Party is liable to give compensation of Rs.50,000/- to the Complainant. So this point is answered in favour ofcomplainant.
11. Point No.3: Since Point No.1 & 2 are found in favour of the Complainant, he is entitled to get the reliefs as discussed above.
In the result, complaint is allowed and the Opposite Party is directed to pay Rs.50,000/- (Rupees Fifty Thousand Only) towards insurance claim and Rs.50,000/- (Rupees Fifty Thousand Only) as compensation to the complainant within 30 days from the date of receipt of this Order.
Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 27th day of July 2022.
Date of Filing:-30.07.2018.
PRESIDENT :Sd/-
MEMBER :Sd/-
APPENDIX.
Witness for the complainants:-
PW1. Sukumaran. Agriculture.
PW2. Dr. K. S. Preman. Senior Veterinary Surgeon.
Witness for the Opposite Party:-
Nil.
Exhibits for the complainants:
A1. Copy of Proposal cum Veterinary Certificate. Dt:23.04.2018.
A2. Courier Receipt. Dt:19.06.2018.
A3. Copy of Cattle Claim Form. Dt:16.06.2018.
A4. Copy of Post-Mortem Report. Dt:16.06.2018.
A5. Copy of Valuation Certificate.
A6. Copy of Treatment Certificate. Dt:16.06.2018.
A7. Copy of Cattle Claim Form. Dt:16.06.2018.
A8. Copy of Policy Schedule. Dt:10.05.2018.
A9. Copy of Letter. Dt:09.07.2018.
A10. Copy of Repudiation Letter. Dt:27.06.2018.
A11. Copy of Courier Receipt. Dt:12.07.2018.
Exhibits for the opposite party:-
B1. Letter by Complainant. Dt:09.07.2018.
B2. Post-Mortem Report. Dt:16.06.2018.
B3. Proposal cum Veterinary Certificate. Dt:23.04.2018.
B4. Policy Schedule. Dt:10.05.2018.
PRESIDENT :Sd/-
MEMBER :Sd/-
/True Copy/
Sd/-
ASSISTANT REGISTRAR
CDRC, WAYANAD.
