DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the 11^th day of  January,  2022

Present    :  Sri.Vinay Menon V.,  President

                  :  Smt.Vidya A., Member                                                 Date of Filing: 26/12/2018 

     CC/181/2018

P.V. Rethnakumari,

D/o K.V. Govinda Warrier,

Puthenvariyam, Chethalloor P.O.,

Mannarkkad College(via),

Palakkad – 678 583.

(By Adv. Kannaraj K.R., Legal Aid Counsel)                           -           Complainant

                                                                                      Vs

1.         CRC for Persons with Disabilities,

            Disabilities Services and Support

Organisation in Kozhikode,

            Near Kozhikode Medical College,

Kerala, India.

2.         Department of Social Justice,

            Civil Station, Palakkad – 678 001.

3.         The New India Assurance Co. Ltd.,

            Divisional office, Palakkad, N.S. Towers,

            1^st Floor, Near Stadium Bus Stand,

Coimbatore Road.                                                       -          Opposite parties

              (OP1 no representation,

             O.P.2 by M. Ramesh, Addl. G.P.

              O.P3 by Adv. K.V. Sujith)                              

O R D E R 

By Smt.Vidya A., Member

1. The complainant is a polio victim, suffering from various ailments of spine, knees, etc. And financially challenged as well. On 24.09.2016, she happened to hear a transmission regarding Swalambhan Health Insurance scheme. She, after intensive search, availed an application form from the 1^st opposite party and got registered after payment of premium of Rs. 357/- on 26.02.2017. But till date nothing further has transpired. Insurance Policy was not issued in her favour. She sought for return of the amount remitted as premium along with interest and attending supplementary reliefs.
2. 1^st opposite party has not filed any version, there was no representation from them either. The 2^nd opposite party filed version, claiming that they have no role to play in the implementation of the scheme.  The Scheme was not implemented. The 2^nd party was never a part of the implementation of the Scheme and the 2^nd opposite party had not publicized the Scheme. They sought for dismissal of the complaint.

3.         As it came to light that it was National Insurance Co. Ltd, who was the insurance partner in the Scheme, they were impleaded as additional 3^rd opposite party.

                                    They contended that the allegations against them were baseless and they had tried to refund the premium, but for the availability of bank account number of the complainant. On 11.11.2020, they had again issued a registered letter seeking for bank details of the complainant. They also sought for dismissal of complaint.

4.         The following points are framed for contesting.

1.         Is there any negligence in service on the part of O.P.1, O.P.2 or O.P.3 in not providing the cover under “Swalambhan” Health Insurance Scheme to the complainant.?

2.         Is there any negligence on the part of O.P.3 in not returning the premium amount?

3.         Reliefs and cost, if any.

5.         Evidence comprised of Proof affidavit of complainant and Exhibits A1 and A2 on the part of the complainant and proof affidavits and Exhibits B1 series  on the part of the opposite party.

            Point No. 1

6.         That she paid Rs. 357/- to the 1^st opposite party and the Insurance partner, the 3^rd opposite party is the unequivocal case of the complainant. The said amount was paid as premium for a Health Insurance Scheme, which was not implemented. The project was later shelved. That being so, agencies of the Government which implements its Schemes cannot be cast with  liability.  Even though at the time of argument the counsel for the complainant alleged that the scheme is still in vogue, no evidence to that effect was produced.  Hence that argument cannot be accepted.

                        Hence, we don’t  not find any deficiency in service on the part of the opposite parties 1 to 3 in not giving cover to the complainant under the  “Swalambhan” Health Insurance Scheme.

Point No. 2

7.         The 3^rd opposite party received the said premium from the complainant on 26.02.2017. Eventhough they had averred in their pleading that they had informed the complainant regarding their readiness and willingness to effect repayment of the premium, they have not adduced any documents or tapal registers evidencing issuance of any communications. The only evidence is the registered letter (Ext.B1) issued on 11.11.2020, after receipt notice of the proceedings before this Commission.

8.         Resultantly,  we have no hesitancy to hold that the 3^rd opposite party was negligent in not taking earnest attempts to have the premium reimbursed. We opine that the 3^rd opposite party had greater responsibility to show fiscal  discipline than what they have shown, being in a fiduciary relationship with the complainant.

9.         We, therefore hold that there is   negligence and deficiency in service on the part of the 3^rd opposite party.   

            Point No. 4

10.       In view of the findings in issue number 1, we hold that the complainant is entitled to the following reliefs considering the facts and circumstances of the case.

(1)                    The complainant is entitled to reimbursement of Rs. 357/- (Rupees Three hundred and fifty seven only) together with interest at the rate of 10% from 26.02.2017 till date of repayment.

(2)       The complainant is entitled to a compensation of Rs. 10,000/- (Rupees Ten  thousand only) for mental pain and agony owing to inordinate delay.

(3)       The complainant is entitled to a cost of Rs. 5,000/- (Rupees Five thousand only).

The 3^rd opposite party shall comply with this Order by effecting payment  of the aforesaid amounts within 45 days from the date of receipt of a copy of this Order.

                        Pronounced in the open court on this the 11^th  day of January, 2022.

                                                                                                    Sd/-

                                                                              Vinay Menon V.

                                                 President

 Sd/-

Vidya A.

                    Member      

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1 –  Original of Medical Certificate dated 26.11.1997 issued to the Complainant.

Ext.A2 –  Copy of the application form bearing no. 922/26.02.2017 for Swalamban

                 Health Insurance Scheme.

Exhibits marked on the side of the opposite party

 Ext. B1 series – Communication dated 11/11/2020 issued by the 3^rd opposite party to the complainant along with postal acknowledgement.

Witness examined on the side of the complainant

NIL

Witness examined on the side of the opposite party

NIL

Cost :  Rs. 5,000/- allowed

NB : Parties are directed to take back all extra set of  documents submitted in the Proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.