By Sri. A.S. Subhagan, Member:-
This is a Complaint preferred under Section 35 of the Consumer Protection Act 2019.
2. Facts of the case:- The Complainant is an agriculturist and he was having a cow vide tag No.988323420043 and the cow was insured with the Opposite Party No.1 through the Opposite Party No.2 for the period from 25.06.2020 to 24.06.2021 vide policy No.1009004720P104118035. The cow was milching and the petitioner was selling milk to the Vakery Milk Society. While so, on 01.03.2021, the cow holding tag No.988323420043 died due to Rabbis and the Complainant had submitted his claim form to the insurance company on 15.03.2021 with the Opposite Party No.1, after due compliance of all formalities as per the policy. The Complainant being the owner, not witnessed any dog bite to the cow and there was a history of a Rabid dog wandered throughout the locality at Kolery, biting several animals and apparently on 28.02.2021, there was symptoms of Rabbis and died on 01.03.2021. But unfortunately, the Opposite Party denied the insurance claim for flimsy reasons and without any basis. The Opposite Party No.1, as per the mail dated 02.08.2021, denied the insurance claim by stating the reasons that “as per the policy conditions the company’s liability is restricted to 50% of the sum insured or market value whichever is less, if the animal prior to death giving rise to a valid claim under the policy is not pregnant or four months less of pregnancy. The claim amount was hence deducted as the date of last calving in this case is 8 months back while lodging the claim”. Unfortunately, the claim was denied purposefully by omitting the policy conditions that the cow was milching at the time of death. In the exception clause of the policy, no such conditions are mentioned. Therefore, the denial of insurance coverage amounts to deficiency in service and unfair trade practice. Hence, the Complainant is entitled to get the full amount of the sum insured and the Opposite Parties are having no right to deduct anything as claimed by them. However, the Opposite Parties paid an amount of Rs.35,000/- which was received by the Complainant. Therefore, the remaining amount out of Rs.70,000/- ie, Rs.35,000/- is entitled to the Complainant and the Opposite Parties are having no right to withhold the said amount. Hence this complaint with prayers to direct the Opposite Party to pay the remaining amount of the market value of the sum insured of the cow to the tune of Rs.35,000/-, to pay Rs.20,000/- towards compensation, to pay Rs.20,000/- towards mental agony and to grant such other or further reliefs as the Complainant shall pray for and the Commission deems fit to grant.
3. Notices were served to the Opposite Parties for appearance. The Opposite
Parties appeared before the Commission and joint version was filed.
4. Contents of version in brief:- The Opposite Parties admit that the cow bearing
ear tag No.988323/420043 was insured with the Opposite Parties for the period starting from 25.06.2020 to 24.06.2021 as per policy No.1009004720P104118035. The sum insured of the cow was Rs.70,000/-. As per preamble of the policy, the Company’s liability is restricted to 50% of sum insured or market value whichever is less, if animal prior to death giving rise to a valid claim under the policy is not pregnant or four months less of pregnancy or not in milk production. As per the enrolment form submitted, the last date of calving is mentioned as 10 months back and the policy commenced on 25.06.2020. But the insured cow belonged to the Complainant was not pregnant at the time of claim. Therefore, the Complainant is not entitled to get the entire claim amount. Hence, the Opposite Parties settled the claim for Rs.35,000/- on 13.07.2021. The Opposite Parties submit that the Complainant is not entitled to get further sum of Rs.35,000/-, Rs.20,000/- towards compensation and cost of this complaint as claimed in the complaint.
5. The Complainant filed chief affidavit, Exts.A1 to A4 were marked from his side and he was examined as PW1. Affidavit was also filed by the Opposite Parties, Exts.B1 to B3 were marked from their side and Jithin Vijay, the Branch Manager of the Opposite Parties was examined as OPW1.
6. Considering the complaint, version, affidavit filed by both the Complainant and the Opposite Parties, the documents marked and the oral depositions of both the
parties, Commission raised the following points for consideration:-
- Whether there has been deficiency in service/unfair trade practice from the part of the Opposite Parties?
- Relief and cost.
7. Point No.1:- The case of the Complainant is that though the milching cow of
the Complainant was insured for Rs.70,000/- with the Opposite Parties, they paid only Rs.35,000/- being 50% of the insurance claim, on the death of the cow, which is deficiency in service/unfair trade practice for which he prays for giving a direction to the Opposite Parties for payment of the balance claim amount of Rs.35,000/-, compensation of Rs.20,000/- and Rs.20,000/- for mental agony. The contention of the Opposite Parties is that as per preamble of the policy “ the Company’s liability is restricted to 50% of sum insured or market value whichever is less, if animal prior to death giving rise to a valid claim under the policy, is not pregnant or four months less of pregnancy or not in milk production”. “ As per the enrolment form submitted, the last date of calving is mentioned as ‘10’ months back and the policy commenced on 25.06.2020. But, the insured cow belonged to the Complainant was not pregnant at the time of claim and therefore, the complainant is not entitled to get the entire claim amount. So, the Opposite Parties prayed before the Commission to disallow the Complaint with cost of the Opposite Parties.
8. It is the admitted fact that the cow of the Complainant was insured with the Opposite Parties for the period from 25.06.2020 to 24.06.2021 for a sum of Rs.70,000/-. It is also admitted that on death of the cow an amount of Rs.35,000/-, being 50% of the insured amount was paid by the Opposite Parties which was received by the Complainant. It is seen that the policy period was from 25.06.2020 to 24.06.2021 and the cow of the Complainant, which was insured, died on 01.03.2021. So, the death of the cow is seen to be in the policy period and as per Ext.A4 marked, which is the periodical Producer Abstract for the period 01.12.2020 to 28.02.2021 issued by the Vakery Ksheerolpadaka Sahakarana Sangham Ltd., reveals that the Complainant’s cow had milk production upto 28.02.2021 prior to the day to the death of the cow. So the cow referred in the complaint was a milching cow. Ext.A4 is not objected by the Opposite Party and the Opposite Parties have not taken and produced a Commission report to prove that the cow was not a milching one. In version, the Opposite Parties have stated that “As per preamble of the policy, the Company’s liability is restricted to 50% of sum insured or market value whichever is less, if animal prior to death giving rise to a valid claim under the policy is not pregnant or four months less of pregnancy or not in milk production. So, here it is clear that the cow was not pregnant and as such four months less of pregnancy was not relevant but the last part of the preamble of the policy “or not in milk production” is the material fact to be considered in this case. Only 50% of insurance claim is eligible to complaint only if the cow was not in milk production. In the present case the insured cow was milk producing one and hence the denial of 50% of the claim cannot be accepted, which is deficiency in service/unfair trade practice. So, here there has been deficiency in service/unfair trade practice from the part of the Opposite Parties for which the Opposite Parties are liable. Another contention of the Opposite Parties is that “ As per the enrolment form submitted, the last date of calving is mentioned as ‘10’ months back and the policy commenced on 25.06.2020. But the insured cow belonged to the Complainant was not pregnant at the time of claim”. On verification of Ext.B3 it is seen that the cow was calved ‘8’ months back. Moreover, in re-examination, OPW1 has stated that “policy condition {]Imcw {]k-hn¨p Ign-ªm 12-þ14 months FSp¡pw ASp¯ pregnancy Dm-Ip-hm³”. So this contention of the Opposite Party is seen unsustainable. Therefore, point number one is proved in favour of the Complainant.
9. Point No.2:- As point No.1 is proved in favour of the Complainant, he is entitled get relief as prayed for but the amount claimed as compensation and for mental
agony is seen exorbitant.
In the result, the complaint is partly allowed and the Opposite Party is ordered :-
- To pay Rs.35,000/- (Rupees Thirty Five thousand only) being the remaining 50% of the insurance claim.
- To pay Rs.15,000/- (Rupees Fifteen thousand only) towards compensation and
- To pay Rs.5,000/- (Rupees Five thousand only) for mental agony.
The above amount shall be paid by the Opposite Parties to the Complainant
within one month from the date of this order, failing which the amount will carry interest at the rate of 8% per annum.
Dictated to the Confidential Assistant, transcribed by him and corrected by
me and pronounced in the Open Commission on this the 15th day of November 2022.
Date of filing: 22.09.2021.
PRESIDENT: Sd/-
MEMBER : Sd/-
MEMBER : Sd/-
APPENDIX.
Witness for the Complainant:
PW1. Biju T. M. Complainant.
Witness for the Opposite Party:
OPW1. Jithun Vijay. Branch Manager, United India Insurance Company Ltd.
Exhibits for the Complainant:
A1. Copy of Cattle Insurance Policy.
A2. Copy of Claim form. dt:15.03.2021.
A3. Copy of e-mail. dt:02.08.2021.
A4. Copy of Producer Abstract.
Exhibits for the Opposite Party:
B1. Copy of Cattle Insurance Policy.
B2. Copy of Claim form. dt:15.03.2021.
B3. Copy of Veterinary Certificate.
PRESIDENT : Sd/-
MEMBER : Sd/-
MEMBER : Sd/-
