NATIONAL INSURANCE COMPANY vs S.M.ABDUL KARIM

THIS appeal is directed against order dated 7th September, 1994 passed by the District Forum, Palamu at Daltanganj in complaint case No. 27 of 1994 in which the appellant here was the opposite party and the respondent here was the complainant before the District Forum.

THE facts of the case for the disposal of this appeal may be briefly noticed. THE complainant purchased four cows and got them insured by the opposite party for the period 17.12.93 to 16.12.94 under Policy No. 170203/ 48/93/94 and those cows were numbered marked as 0199,0173,0120 and 0123 for the purposes of the Insurance. One of the four cows i.e. cow No. 0199 fail ill on 20.12.93 regarding which the complainant informed the opposite party by his letter dated 27.12.93. THE said cow No. 0199 however died on 31.12.93 inspire of proper treatment. Information regarding which was given by the complainant in the office of the Branch Manager, the opposite party. THE insured thereafter submitted his insurance claim on 13.1.94 claiming Rs. 10,000/- as cost of the cow. THE Insurance Company by its letter dated 20.1.94 repudiated the claim stating that since the cow died within fifteen days from the date of the commencement of the risk, it was not covered by the policy and therefore the complainant was not entitled to get any amount. The complainant thereafter filed case before the District Forum stating inter alia that it was never made known to him by the opposite party that if any of the cow died within fifteen days from the date of the commencement of the policy, the risk was not covered by the policy and that no such information was given by the Insurance Company either orally or in writing.

On being noticed the opposite party filed written version admitting the broad factual matrix of the case and further stating inter alia that according to the terms of warranty attached to the policy no claim in respect of the animals covered by the policy shall be payable in the event of death of animals due to desease contacted within fifteen days from the date of the commencement of the risk and that this warranty contain special conditions attached to the Insurance Company which are specifically mentioned in the policy and therefore the claim of the complainant was repudiated in accordance with the terms of the warranty.

THE District Forum however rejected the plea taken by the Insurance Company and has directed the Insurance Company to pay Rs. 10,000/- in respect of the claim of the complainant and also to pay Rs. 500/-as compensation for the unnecessary harassment caused to the complaint due to denial of his claim on justifiable grounds. THE District Forum has also directed the opposite party to comply with the impugned order within a month failing which they will have to undergo imprisonment of three months and to pay a fine of Rs. 5,000/-. At the very outset it may be mentioned that the District Forum has passed a composite order which is not legally sustainable.

MOREOVER, it appears from the photostat copy of the insurance policy filed by the complainant before the District Forum that the policy contained special conditions mentioned in the warranty enclosed with the policy. But the complainant has not filed that warrant and it has been filed by the opposite party with its written version and it reads as follows :- "Notwithstanding any thing contained herein i.e the contrary it is hereby declared and agreed that:- 1. No claim in respect of animals covered by this policy shall be payable in the event of death of animals due to disease contracted within 15 days form the date of commencement of the risk. 2. No claim is respect of animals is payable unless the eartag is submitted along with the claim form. 3. No claim is payable if the caracass of the insured animal is not allowed to be inspected by the Company or its official representative. 4. No claim is payable unless coloured/ black and white photo of the caracass is submitted alongwith the claim form. Warranties 1. Warranted that photograph of the caracass should be submitted alongwith the claim papers. 2. Warranted that caracass should be verified by the insured or his authorised representative and intimation of claim should be lodged to the company well in advance before destruction."

Now it is apparent from condition No. 1 of that warranty that no claim in respect of that policy is payable in the case of death of animal due to disease contacted within fifteen days from the date of the commencement of risk. The opposite party also filed before the District Fo-rum photostat copy of the decision taken by the Insurance Company in the 17th Central Rural Insurance Committee (CIC) meeting held on 9.11.92. One of the decision taken by the Com-mittee in that meeting was that any claim which arises due to death of cattle other than by acci-dent during the first fifteen days from the incep-tion of policy will not be payable. It appears that the copy of this decision was sent to all D.Os and B.Os of the Insurance Company. The opposite party was bound to comply with this decision of the Central Rural Insurance Committee and hence the warranty was enclosed as special conditions contained in this warranty, the claim of the complainant was repudiated. It is evident that the claim of the complainant was repudiated by the Insurance Company promptly on 20.1.94 i.e. within 3 weeks of the death of the cow. Hence we find no deficiency in service on the part of the Insurance Company. If the complainant has got any objection to the decision of the Central Rule Insurance Committee, it may move a proper authority or Court for redressal of his grievances if so advised. But his claim is not maintainable under the Consumer Protection Act.

IN the result the appeal is allowed and the impugned order passed by the District Forum is hereby set aside and the complaint stands dismissed. There is, however, no order as to cost. Appeal allowed.