BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION AT BANGALORE (URBAN)

DATED 31^ST DAY OF OCTOBER 2022

ORDER

SMT.M.SHOBHA, PRESIDENT

1. The complaint has been filed under Section 35 of C.P.Act (hereinafter referred as an Act) against the OP for the following reliefs against the OP:-

1. Direct the OP1 to pay sum insured or claim amount of Rs.70,000/- being the amount with interest at the rate of 24% from the date of death cow dated 16.07.2020 till realization;
2. Direct the OP to pay a compensation of Rs.3,00,000/- to the complainant for the deficiency in service, mental agony, financial loss, harassment, hardship, given by the OP to the complainant.
3. Grant such other relief/s.

2. The case set up by the complainant in brief is as under:-

The complainant has purchased HFL Cow in May 2020 from the loan obtained from Canara Bank and the same is insured under Micro Insurance product Cattle insurance policy with the OP, vide policy No.0731004720P103425646 and it is valid from 30.06.2020 to 29.06.2023.  She has paid premium in time to the OP and thereafter the OP has issued the policy in favour of the complainant and the policy is in force till today.  

3. It is further case of the complainant that the cow suddenly died on 16.07.2020.  Immediately the complainant has informed to the OP.  The OP office person came and take the report.  The veterinary doctor has conducted the postmortem examination and medical report was also submitted in time but even today OP has not settled the claim amount.  
4. It is further case of the complainant that she is paying monthly installment regularly to the bank till the death of the cow.  She has maintained a bank account in canara bank and she has supplied milk in dairy.  The dairy office has credited the milk amount to the canara bank but the bank did not permit her to withdraw the amount.  In view of this it is very difficult for her to meet the day to day needs.  The bank after knowing all these incidents have not stopped deducting amount from the complainant’s account.  Further the bank have instructed the complainant to pay the loan amount with interest to the bank. 
5. The activities of the OP clearly shows the deficiency of service.  As per the terms of the policy the OP has to settle the claim within 15 days of the death of the cow but even after lapse of 1½ years the OP have not settled the insurance amount.  It is a clear violation of terms of the policy and deficiency of service and also unfair trade practice and it is not according to the law.
6. It is further case of the complainant that the policy is still under force and the cow died within the policy period.  By overlapping or neglecting all the procedure and the practice the OP has committed deliberate negligence in rendering service.  
7. The complainant has got issued a legal notice through her counsel and requested the OP to pay the amount as per the terms of the policy. But they have not paid the amount.  The OP after receipt of the legal notice have also replied the notice.  They have neither complied the demand made by the complainant nor made any payments to the complainant.  The complainant has suffered mentally for the indifferent attitude shown by the OP.  The OP has exposed the complainant to hardships.  The family members of the complainant are deprived of any income.  The OP has not bothered to pay the claim amount.  Hence the complainant has filed this complaint.  The complainant filed the complaint against OP No.1 and 2 i.e., No.No.2 is the Canara Bank and she deleted the OP2 as per the order dated 26.04.2022.  The complainant proceed only against the OP1.
8. In response to the notice, OP appears and files version stating that the complaint is not maintainable and liable to be dismissed. 
9. The OP has taken the contention relating to the contents in para 3 to 12 that they are all matter of records and he has denied the part of the allegations made in the complaint relating to deficiency of service and negligence on their part.  
10. The OP has admitted that he had issued micro insurance product cattle insurance policy No.0731004720P103425646 for a period from 30.06.2020 to 29.06.2023 for the sum insured Rs.70,000/- through M/s Canara Bank, Samandur account Bhagya under strict terms and conditions mentioned in the policy.
11. It is further contention taken by the OP that they have received claim petition from the Canara Bank, Samandur, for the death of the cow belonging to the complainant bearing tag No.948833 and the same was examined.  It was noticed that even though as per records submitted by the bank the death of the cow had occurred on the 16^th day of the policy.  The animal died on 15.07.2020 as per the statement of insured and the animal had contracted the illness within 15 days from the date of inception of the policy.  The death of the cow was not registered or intimated to the Village Authority.  Moreover the Health Certificate issued by the bank was dated 21.05.2020 and as per the investigation conducted it was observed that the animal was expired much before the commencement of the policy or within 15 days of the issuance of the policy and contacted the decease.
12. It is further contention taken by the OP that the policy conditions stipulates that “diseases contracted prior to the commencement of risk and any claim arising out of disease or illness contracted by the animal during the first 15 days from the commencement of the policy are excluded.”  Since the claim fall under the exclusion clause as the death of the cow occurred within 15 days from the date of commencement of the policy, the claim was not admissible and the same was intimated to the canara bank, Samandur Anekal Taluk.  
13. It is further case of the OP that with reference to the claim of the complainant they have acted as per the strict terms and conditions of the policy and there is no deficiency of service on their part at any point of time.  Since the claim was not payable as per the terms and conditions of the policy the same was intimated to the complainant.  Under these circumstances they are not liable to pay Rs.70,000/- along with interest at 24% and Rs.3,00,000/- as compensation for the alleged deficiency of service, mental agony, financial loss, harassment, hardship to the complainant.  
14. It is further contention taken by the OP that after scrutiny inspection and review of the documents of the case it was found that the claim of the complainant was not admissible and hence the claim was repudiated by this OP.  There is no deficiency of service, since they had acted as per the terms and conditions of the policy, and non admission of the entire claim of the complainant will not amount to deficiency of service on the part of the OP.  Hence the complaint is not maintainable and liable to be rejected.  There is no cause of action and the alleged cause of action is false.  Hence the OP prays for rejection of the complaint with cost.   
15. The complainant has filed her affidavit evidence and relies on 15 documents.  Affidavit evidence of official of OP has been filed and OP relies on 2 documents.
16. Heard the arguments.  Perused the written arguments of both the parties and citations.
17.  The following points arise for our consideration as are:-

1. Whether the complainant proves deficiency of service on the part of OP?
2. Whether the complainant is entitled to relief mentioned in the complaint?
3. What order?

18. Our answers to the above points are as under:

       Point No.1:  Affirmative

      Point No.2: Affirmative in part

      Point No.3: As per final orders

REASONS

19. Point No.1 : The complainant in support of her contention has filed her affidavit evidence and reiterated all the allegations made in the complaint.

20. The main contention of the complainant is that she has purchased HFL cow in the month of May 2020 from the loan obtained from Canara Bank and the same is insured under Micro insurance product cattle insurance policy with the OP vide Policy No.0731004720P103425646 and it is valid from 30.06.2020 to 29.06.2023 and she has paid premium in time to the OP. The OP has issued policy in her favour and she has produced the policy as Ex.P1 and payment receipt as Ex.P2 and bank statement as per Ex.P3.

21. The main grievance of the complainant is that on 16.07.2020 the cow died suddenly.  She has immediately intimated the same to the OP. Thereafter the OP office person came and prepared the report. The veterinary doctor has conducted the postmortem examination and the same was submitted to the OP in time.  Inspite of the submission of all the documents the OP has not settled the claim amount.  She has also produced the postmortem report issued by the veterinary doctor Anekal veterinary hospital as Ex.P4 and treatment certificate as Ex.P5. The complainant has also produced copy of Form No.1 with Form No.3, the postmortem report as Ex.P6 and P7.

22. When the OP has not settled the claim the complainant has again approached the veterinary doctor for issue of the copy of the postmortem report. She has given a representation to the doctor as Ex.P8.  The complainant has also reported the death of the cow to the Secretary, Milk dairy, Maranayakanahalli, and they have issued the certificate stating that the cow died on 16.07.2020 at 10.30 am and he has personally verified the cow and confirmed the death of the cow. The complainant has also got issued a legal notice to the OP when he has failed to settle the claim as Ex.P10 and it was duly served on the OP. as per Ex.P12 the postal acknowledgement.  The OP has also issued a reply as Ex.P11, denied the claim of the complainant stating that as per the terms of the policy the cow died within 15 days of the inception of the policy. Hence they have rejected the claim.

23. On the other hand, the main contention taken by the OP is that they have issued the policy. The cow was insured under Micro insurance product cattle insurance policy No.0731004720P103425646 for the period 30.06.2020 to 29.06.2023 and the sum insured was Rs.70,000/-. It is further case of the OP that they have received the claim from the Canara bank Samandur, for the death of the cow belonging to the complainant. Even though as per records submitted by the bank, the death of the cow was occurred on 16^th day of the policy and the animal died on 15.07.2020 as per the statement of the insured and the animal had contacted the illness within 15 days from the date of inception of the policy.  

24. It is further objection raised by the OP is that the death of the cow was not registered or intimated to the Village Authority. As per the investigation conducted, it was observed that the animal was expired much within 15 days of the commencement of the policy.  As per exception 2 of the policy as the death of cow occurred within 15 days from the date of the commencement of the policy the claim was not admissible and the same was intimated to the canara bank and also to the complainant. This OP have acted as per the strict terms and conditions of the policy and there is no deficiency of service on their part at any point of time.  They have rejected the claim of the complainant after scrutiny, inspection and review of the documents of the case.  In support of their contention, the OP have produced the copy of the policy as Ex.R1 and it is same copy of Ex.P1. In addition to this they have also produced the representation given by the complainant as Ex.R2.

25. It is undisputed fact that the cow was insured with OP for the insured amount of Rs.70,000/-.  As per the medical report and the postmortem report and the certificate issued by the Secretary, Milk Dairy, Maranayakanahalli, the death of the cow occurred on 16.07.2020 at 10.30 am. The same time is mentioned in the postmortem report issued by the veterinary doctor.  The complainant has also stated that the cow died on 16.07.2020 and not on 15.07.2020.  But the representation given by her to the OP as Ex.R2 the date of death was mentioned on 15.07.2020. The OP relied on the date mentioned in the Ex.R2, has come to the conclusion that the cow died on 15.07.2020 and hence they have rejected the claim of the complainant.

26. The OP have rejected the claim of the complainant as per the terms of the policy i.e., exception 2 which clearly states as follows;

Diseases contracted prior to commencement of risk. And provided always that – any claim arising out of disease or illness contracted by the animal during the first 15 days from the commencement date of policy.  This exclusion shall not however, apply if insurance is in existence for a continuous period of 12 months without any break.

27.  Ex.P1 is the copy of policy produced by the complainant and Ex.R1 is the same policy produced by the OP and it is an undisputed document. It is also undisputed fact that the death of the cow occurred within the policy period and the policy was in force from 30.06.2022 to 29.06.2023 and there was no any break in the policy and it is continuously in force.  On this background we have gone through exception 2 of the policy Ex.P1 and the postmortem report issued by the doctor Ex.P6 and P7 and the treatment certificate issued by the doctor as Ex.P5.  Ex.P4 is the certificate issued by the veterinary doctor. All these documents clearly discloses that the cow was well maintained and healthy and the cause of death is acute severe bloat. As per the opinion of the doctor the cow was worth Rs.70,000/-,

28. It is clear from the medical report that the cow was not suffering from any illness or disease.  The cow was not suffering from any illness and the death of the cow is sudden. The cause of death is due to ingestion of large amount of grain fodder and grass. The death occurred accidently leading due to acute severe bloat in turn leading to pressure on lungs – leading to asphyxia and died.  

29. The learned counsel for the complainant has also relied on the decision reported in the New India assurance company Ltd., -vs- M/s Valecha Agri-Venture. The Hon’ble State Commission has partly allowed the appeal preferred by the appellant insurance company confirming the order passed by the District Commission.  The facts and circumstances in the decision cited by the complainant and the facts and circumstances in this case are similar.  The Hon’ble State Commission has come to the conclusion that the order passed by the District Commission is proper and correct and confirmed the order in part.  The Hon’ble State Commission has only set aside the compensation awarded by the district commission to the complainant since the complainant in the said case was a private limited company and a juristic person and hence the question of the suffering of the mental agony and harassment will not apply.  

30. We have gone through the decision.
31. In this case it is evident from the records Ex.P1 to P3 that the complainant obtained the insurance policy and the assured amount was Rs.70,000/- and she has paid the premium on 06.07.2020 vide receipt Ex.P2.  The amount credited to the bank as per Ex.P3 by the complainant  is clearly reflected in Ex.P3, the policy Ex.P1 is in force for a period of 3 years. The exception 2 of the policy will not apply if the insurance is in existence for a continuous period of 12 months without any break.  In this case there is no break in the policy and it is in contentious force even today for a period of three years.  As per the report submitted by the doctor and opinion of the doctor the cow was not suffering from any illness or disease and it was died due to consumption of large amount of grain fodder and grass, which leads to acute severe bloat, which leads to pressure on lungs and further leads to asphyxia and the death was occurred due to this reason.  

32. There is no dispute about the death of the cow and the identity of the cow by the OP and the doctor.  It is also not in dispute that the cow was worth Rs.70,000/- as per the opinion of the doctor who performed the postmortem examination and the animal was in good health prior to its death.  

33. The OP has repudiated the claim on the ground that the animal contacted the disease within 15 days from the date of inception of the policy.  It is clear from the above documents and the discussion that the cow was not suffering from any disease or illness and death was occurred suddenly for the cause stated in the postmortem report.  Under these circumstances, the complainant has clearly established that the cow died suddenly and it was not suffering from any illness or disease. She has reported the death immediately to the OP and the OP official has visited the spot and collected the report and also received the postmortem report from the doctor the secretary of milk dairy also issued a certificate confirming the death of the cow on 16.07.2020 at 10.30 pm.  The death was occurred during the existence of the policy and the policy is in existence for a period of three years without any break, hence the claim rejected by the OP is not proper and correct.

34. Even though the claim made by the complainant do not fall under the exception 2 of the policy, as per the contention taken by the OP, the OP has simply rejected the claim made by the complainant.  Even though the policy was in force and the death of the cow was occurred within the policy period, it is the duty of the OP to pay the insured amount of Rs.70,000/- to the complainant.  The conduct of the OP in not entertaining the claim of the complainant amounts to deficiency of service and unfair trade practice. Hence the complainant is entitled for the claim made by her in the complaint. Therefore, we answer point No.1 in affirmative.

35. POINT NO.2: The complainant has claimed the sum insured Rs.70,000/- with interest @ 24% from the date of commencement of the policy, till the filing of the complaint 12.04.2022 amounting to Rs.33,600/-.  In addition to this the complainant has claimed Rs.3,00,000/- compensation for loss mental agony and bank interest and penalty.  

36. It is undisputed fact that the cow was worth Rs.70,000/- at the time of the insurance and it is also supported by the certificate issued by the veterinary doctor as per Ex.P4.  Hence the complainant is entitled for the sum insured Rs.70,000/-. Even though the cow died on 16.07.2020, the OP has not settled the claim of the complainant and they have dragged the complainant to this Commission by filing this complaint.  Hence the complainant is entitled for the interest at the rate of 12% p.a., from 16.07.2020 to 12.04.2022 amounting to Rs.33,600/-.

37. The complainant has claimed compensation of Rs.3,00,000/- for mental agony and financial loss and harassment caused by the OP. As per the instruction of the OP the bank authorities have not at all released the amount credited by the complainant till today. In view of this the complainant and her family members are suffering from financial crises. If the OP has settled the claim immediately after the death of the cow the complainant and her family members would not have suffered financial crises and harassment as they are depending on the income of the milk supplied to the dairy. If the amount is not at all released there is no other income for the complainant and her family for their livelihood. Inspite of issue of the legal notice and repeated request made to the OP the OP have not settled the claim and they have repudiated the claim, without any valid reason.  Under these circumstances, we feel it is necessary to award compensation of Rs.50,000/- to the complainant since the compensation of Rs.3,00,000/- claimed by the complainant is highly exorbitant.  The complainant is also entitled for litigation expenses of Rs.10,000/-. Hence the complaint is liable to be allowed in part. Therefore, we answer point No.2 partly in affirmative.

38. Point No.3:- In view the discussion referred above, it is necessary to direct the OP to pay the insured amount of Rs.70,000/- with interest of Rs.33,600/- and the compensation of Rs.50,000/- with litigation expenses of Rs.10,000/- to the complainant within 60 days from the date of this order. If the OP is failed to pay the amount within 60 days, then the OP is further directed to pay an interest of 12% p.a., on Rs.70,000/- from the date of this order till realization.  Hence we proceed to pass the following;

O R D E R

1. The complaint is allowed in part.
2. OP is directed to pay the insured amount of Rs.70,000/-  and interest of Rs.33,600/-  and the compensation of Rs.50,000/- with litigation expenses of Rs.10,000/- to the complainant within 60 days from the date of this order. Failing which the OP shall pay interest at 12% p.a., on Rs.70,000/- from the date of this order till realization.
3. Furnish the copy of this order and return the documents to the complainant with extra pleadings.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open Commission on this 31^st day of October, 2022)

Documents produced by the Complainant-P.W.1 are as follows:

Documents produced by the representative of opposite party – R.W.1;