The main legal point established is that an insurance company must justify the repudiation of a legitimate claim, and the completion of required formalities is essential for the complainant to be entitled to the insured amount.

ORDER :

Mr. Justice B.S. Verma, President-This appeal under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 4.2.2013 passed by the District Forum, Uttarkashi in consumer complaint No. 17 of 2010.

2. Briefly stated the facts giving rise to the appeal are that for the purpose of earning his livelihood and maintaining his family, the complainant had taken a loan of Rs. 50,000 from Deerghakar Sahkari Samiti, Devdung, Uttarkashi on 25.1.2007 for purchase of one pair “Hindi matter omitted” of mule and upon availing the loan, the complainant purchased one pair of mule. After getting the mules medically examined from the Veterinary Officer, Veterinary Hospital, Purola, District Uttarkashi, the same were got insured with the appellant for sum of Rs. 25,000 each for the period from 5.3.2007 to 4.3.2010 vide policy No. 321907/47.6.50/00000793. Out of the insured two mules, one mule bearing tag No. NIA99/1884 died on 22.10.2007 on account of sudden illness. The complainant gave the intimation regarding death of the insured mule to the Samiti as well as the Insurance Company. The complainant also requested the Veterinary Officer to conduct the post-mortem of the dead mule. The Veterinary Officer visited the spot and on 23.10.2007 and conducted the post-mortem of the dead mule and at the time of conducting the postmortem of the dead mule, the Veterinary Officer found the tag No. NIA99/1884 pierced in the ear of the dead mule, which the Veterinary Officer handed over to the complainant after cutting the same from the ear of the dead mule. After 15-20 days’, the investigator of the Insurance Company visited the spot, who took the signatures of the complainant and other persons on some blank papers on the premise that the claim would be settled. The complainant submitted the claim form and completed all the required formalities. The Insurance Company, however, repudiated the claim vide letter dated 14.1.2008 on the ground that as per the report of the investigator, the death of the insured mule is not established. Thus, alleging deficiency in service, the complainant filed a consumer complaint before the District Forum, Uttarkashi.

3. The appellant – Insurance Company filed written statement before the District Forum and pleaded that the insured mules were allotted tag No. NIA99/1884 and NIA99/1802 for their identification; that the intimation regarding death of the mule was received on 29.10.2007 through letter dated 22.10.2007 of the Samiti and the claim form and ear tag were received on 27.11.2007; that as per the intimation given by the complainant, the mule had died on 5.10.2007, whereas in the claim form, the date of death of mule has been mentioned as 22.10.2007; that the investigator visited the spot on 2.11.2007; that the complainant in his statement stated that the mule had died on 22.10.2007; that one mule cannot die two times; that as per the terms and conditions of the insurance policy, upon proof of death of the insured mule and completion of required formalities, the complainant is entitled to 80% of the insured amount; that since the death of the insured mule is not established and hence the complainant is not entitled to any amount; that the consumer complaint is barred by limitation; that the claim has rightly been repudiated and that there is no deficiency in service on their part.

4. The Samiti, which was impleaded as opposite party No. 1 before the District Forum and which has not been impleaded as party in the present appeal preferred by the Insurance Company, filed written statement before the District Forum and pleaded that the intimation regarding death of the mule was duly conveyed to the Insurance Company and that there is no deficiency in service on their part.

5. The District Forum, after perusal of the record, allowed the consumer complaint vide impugned order dated 4.2.2013 and directed the appellant – opposite party No. 2 to pay compensation of Rs. 20,000 to the respondent – compla