State Consumer Disputes Redressal Commission
United India Insurance Company Ltd. vs Bishan Singh & Another on 19 January, 2022
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND, DEHRADUN
FIRST APPEAL NO. 77 / 2017
United India Insurance Co. Ltd.
Branch office Almora
Through Regional office
Ratan Palace, Kaulagarh Road, Dehradun
Through its Regional Manager
......Appellant / Opposite Party No. 1
Versus
1. Sh. Bishan Singh S/o Sh. Kheem Singh
R/o Village Kharkanatoli (Kharku)
P.O. Guler, Tehsil Kapkot, Bageshwar
.......Respondent No. 1/ Complainant
2. Branch Manager
Uttarakhand Gramin Bank
Branch Bharadi, Bageshwar
.......Respondent No. 2/ Opposite Party No. 2
Sh. Suresh Gautam, Learned Counsel for the Appellants
Sh. R.M. Nautiyal, Learned Counsel for Respondent No. 1
None for Respondent No. 2
Coram: Ms. Kumkum Rani, Judicial Member II
Mr. Bhagwat Singh Manral, Member
Dated: 19/01/2022
ORDER
(Per: Ms. Kumkum Rani, Judicial Member II):
In the present appeal, the appellant has challenged the impugned judgment dated 28.02.2017 passed by the District Consumer Disputes Redressal Forum, Bageshwar in consumer complaint No. 31 of 2016 titled as Sh. Bishan Singh vs. United India Insurance Co. Ltd. & Anr., wherein and whereby the District Consumer Forum was pleased to allow the complaint of the complainant-respondent No. 1 for a sum of Rs. 90,000/-2
with interest @ 6% per annum alongwith damages Rs. 5,000/- and for costs of suit Rs. 5,000/-.
2. Briefly stated, the respondent No. 1-complainant has filed a consumer complaint before the District Consumer Forum, Bageshwar claiming a compensation of Rs. 90,000/- within interest, damages and litigation charges on account of death of Mule, which was insured with the opposite party No. 1-United India Insurance Co. Ltd. As per the complaint, the insurance company-appellant repudiated the claim of the complainant- respondent No. 1 on the ground that the complainant has not cooperated the insurance company during investigation proceedings of Mule; the Mule was buried without informing the insurance company and did not provide the relevant documents as per the written letter of the insurance company.
3. The Insurance Company-appellant contested the case on the ground that the District Consumer Forum awarded the quantum against the terms and conditions of the insurance policy because as per the terms and conditions of the insurance policy the claim is to be paid only to the extent of 80%, in case of Mule, but the District Consumer Forum has awarded the total insured sum of the Mule to the complainant, which violated the terms and conditions of the insurance policy. It is also averred in the written statement of the insurance company that as per the terms and conditions of the insurance policy, the insured could not bury the animal without informing the insurance company, so the District Consumer Forum wrongly allowed and awarded the claim of the complainant.
4. In the appeal in hand, it is narrated herein that the District Consumer Forum passed the impugned judgment against the fact and merits of the case and it has failed to appreciate the evidence on record, which clearly proved that the complainant had failed to inform the insurance company before the animal was buried, which is clear violation of the terms and First Appeal No. 77 / 2017 3 conditions of the insurance policy. It is further narrated that as per the terms and conditions of the insurance policy, the respondent No. 1- complainant must provide the chance to inspect the body of the dead animal, but without informing the insurance company, the insured buried the dead animal, therefore, the insurance company has repudiated the claim on the genuine grounds. It is also stated herein that the liability of the insurance company is to the extent of 80% of the sum insured or 80% of the market value, whichever is less as per the special conditions of the insurance policy for non-scheme insurance, but the District Consumer Forum has wrongly allowed the claim of the complainant and incorrectly held that the appellant is deficient in service, hence the appeal be allowed and the impugned order dated 28.02.2017 passed by the District Consumer Forum is liable to be set aside and the complaint be dismissed accordingly.
5. We have heard both the parties and perused the record.
6. Learned counsel for the appellant - insurance company has strongly argued on the point that as per the terms and conditions of the insurance policy, the insured amount to the extent of 80% in case of Mule could be awarded, but the District Forum awarded total insured sum to the respondent No. 1-complainant. Learned counsel has drawn our attention on paper No. 7 (Yak/Mule/Pony Insurance Policy), wherein condition Nos. 4 & 8 provide for:-
4. The insured shall give immediate notice in writing to the Company of any illness or lameness or accident or injury to any animal hereby insured.
8. On the death of any animal hereby insured the Insured shall, give immediate notice thereof to the Company at the Office which has issued the Policy and notice shall have been received by the Company.
7. We have perused the impugned judgment, wherein the learned District Consumer Forum in para No. 10 has held that the appropriate First Appeal No. 77 / 2017 4 information about the death of Mule was given to the insurance company -
opposite party No. 1 and opposite party No. 2 - Branch Manager, Uttarakhand Gramin Bank and as well as Veterinary doctor, Kapkot. No contrary evidence has been submitted on behalf of the insurance company to this respect. So far as the payment of insured amount to the extent of 80% of Mule is concerned, the insurance company has submitted paper No. 8 of the record (Insurance Policy) which shows that under the heading of Special Conditions (condition No. 4) clearly highlights that the payment of 80% of the sum insured in respect of the Non-Scheme Animals shall be indemnified. The above conditions are reproduced as under:-
Special Conditions
1. xxxxx
2. xxxxx
3. xxxxx
4. In the event of a claim, the Policy will indemnify the Insured:
i) In respect of Non-Scheme Animals for 80%
of the Sum Insured or 80% of the Market Value at
the time of death as certified by the Veterinary
Surgeon, whichever is less.
ii) In respect of Scheme Animals for 100% of
the Sum Insured i.e. on Agreed Value basis subject to the condition that an undertaking is furnished by the Bank that the subsidy element included in the Sum Insured shall be utilized for purchase of a new animal to be substituted and included in the Policy for insurance on payment of necessary premium.
5. xxxxx
6. xxxxx
8. Here it is to be mention that the said insurance policy was given to the complainant wherein it is clearly provided that in the event of a claim, the policy will indemnify in respect of Non-Scheme Animals for 80% of the sum insured or 80% of the market value at the time of death as certified by the Veterinary Surgeon, whichever is less.First Appeal No. 77 / 2017 5
9. It is undisputed that the Mule of the complainant was insured for a sum of Rs. 90,000/- with the appellant - insurance company and the complainant has paid the appropriate premium. With the premium receipts, the special terms and conditions of the insurance policy are enclosed, so we cannot say that the terms and conditions were not in the knowledge of the complainant while he took the insurance policy of his Mule. As per the insurance policy, the Mule of the complainant was insured for Rs. 90,000/-.
The insurance company did not file any document before the Appellate Court in the regard that as per the Veterinary Surgeon, the market value of the dead Mule was less than Rs. 90,000/-.
10. On the appreciation of the material evidence available on record of the appeal, we are of the considered view that the Mule of the complainant was insured for a sum of Rs. 90,000/- and as per the above mentioned special condition, the insurance company will indemnify the insured to the extent of 80% of the sum insured in respect of Non-Scheme Animals. A perusal of the impugned judgment dated 28.02.2017 of the District Consumer Forum, reveals that the District Consumer Forum has awarded the total insured amount, i.e. Rs. 90,000/- of the dead Mule. Such finding of the learned District Consumer Forum cannot be said to be appropriate because the claim of total sum insured Rs. 90,000/- was awarded in breach of the conditions of insurance policy.
11. Accordingly, we are of the view that the complainant is entitled 80% of the insured amount Rs. 90,000/- {i.e. Rs. 72,000/- (Rupees Seventy Two Thousand only)} alongwith interest @6% from the date of filing the consumer complaint till actual realization with Rs. 5,000/- for compensation and Rs. 5,000/- for costs of suit.
12. Thus, we hold that the impugned judgment passed by the District Consumer Forum is not according to the terms and conditions of the First Appeal No. 77 / 2017 6 insurance policy and the claim is liable to be modified to the extent of 20% of the sum insured. Accordingly, the impugned judgment is to be modified to such extent and the appeal is liable to be allowed partly.
13. The appeal is allowed in part. It is hereby ordered that the appellant
- insurance company shall pay 80% of the insured amount, i.e. Rs. 72,000/- alongwith simple interest @6% per annum from the date of filing the consumer complaint till its actual realization. It is further ordered that the appellant - insurance company shall pay Rs. 5,000/- as compensation for mental agony and Rs. 5,000/- for litigation expenses to the complainant- respondent No. 1. The impugned judgment is rectified accordingly. Costs easy.
14. The record of the District Consumer Forum, if any, be returned as per law after expiry of statutory period.
(BHAGWAT SINGH MANRAL) (MS. KUMKUM RANI)
First Appeal No. 77 / 2017