DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
Dated this the 12th day of May, 2023
Present : Sri. Vinay Menon V., President
: Smt. Vidya A., Member
: Sri. Krishnankutty N.K., Member Date of Filing: 01/10/2020
CC/185/2021
Rahmath,
W/o. Saleem,
Vena House,
Pallimedu, Kunissery P.O.
Palakkad – 678 681 - Complainant
(By Adv. M. Alimuthu)
Vs
HDFC Ergo GIC Ltd.,
6th Floor, Leela Business Park
Andheri, Kurla Road,
Andheri East, Mumbai – 400 059 - Opposite parties
(O.P. by Adv. M/s Ullas Sudhakaran
& Saji Issac)
O R D E R
By Sri. Vinay Menon V., President
- Complainant claims to the widow, nominee and one of the legal heirs of one deceased Saleem, who died on 16/06/2020 due to heart disease. The deceased had availed two Sarv Suraksha Plus insurance policies while purchasing a car under hypothecation.
One policy bearing number 2950 2015 1960 2500 000 covered 07/10/2016 to 06/10/2021. While still under the coverage of first policy, a subsequent policy was availed topping up the first one.
The second policy bearing number 2950 2033 2550 7300 000 covered 28/02/2020 to 27/02/2025. Incidents that were covered under the policies were (1) loss of job; (2) Accidental death; (3) Permanent Total Disability/Permanent Partial Disability; (4) Accidental Hospitalisation; (5) Critical Illness; (6) Credit Shield Insurance; (7) Garage Cash; and (8) House holder’s Coverage.
On the date of death of the complainant’s husband, 16/06/2020, two policies were alive. Therefore the complainant and other two legal heirs are entitled to Critical Illness and Credit Shield Coverage under both the policies, totaling Rs. 12,00,000/-. But the opposite parties have not cared to honour the claim of the complainant. Aggrieved thereby, this complaint is filed by the complainant for herself as well as for and on behalf of the two children of the deceased Saleem.
- O.P. entered appearance and filed version. The contested the pleadings. Eventhough the O.P. admitted the availing of policy and its subsequent rejection. The O.P. pleaded that the complainant had submitted claim under Policy number 2950 2033 2550 7300 000, benefits under Critical illness could be granted only when the illness developed during the subsistence of the policy period and the insured survives a minimum of 30 days from the date of diagnosis. Coverage for the first heart attack of specified severity required fulfilling of a number of criteria which are pleaded. Eventhough the opposite parties had sought for details as per two letters, the complainant had failed to produce the said documents.
Since no claim was submitted under policy number 2950 2015 1960 2500 000, this policy was not considered.
- Issues that were framed are as below:
- Whether the complainant had submitted all documents necessary for processing the claim of the complainant under ‘Critical Illness Coverage’?
- Whether the complainant is entitled to get the benefits under ‘Credit Shield Insurance’ as per the terms and conditions of that policy?
- Whether there is any deficiency in service/unfair trade practice on the part of the O.P.?
4. Whether the complainant is entitled to any reliefs sought for?
5. Any other Reliefs?
5. (i) Evidence on the part of complainant comprised of proof affidavit and marking of Exts. A1 to A5.
(ii) Even after granting time, O.P. did not file proof affidavit or mark any documents.
Issue No. 1 & 2
6. Considering the fact that the O.P.s had adduced no evidence, it is only necessary to adjudicate whether the complainant had taken steps to prove a prima facie case in accordance with the Issues framed.
7. Evidence of the complainant comprised of Exts. A1 to A5. Exts. A1 is the death certificate. Exts. A2 and A3 are Policy certificates unaccompanied by policy terms and conditions and schedules. Exts. A4 and A5 are medical records to show that the complainant’s husband had undergone treatment.
8. It goes without saying that burden of proof is on the complainant to prove his/her case. Once the pleadings are over and Issues are framed, it is the bounden duty of the complainant to ponder the plan of action and execute such plan so that the complainant can prove a prima facie case.
9. The opposite parties had filed version opposing the complainant pleadings. Thereafter issues were framed by the Commission. Enough time was granted for the complainant to take steps. But the complainant had failed to take steps to have documents called for. Had the complainant been expecting a windfall by way of the opposite parties producing their documents, their plans failed to take-off as the evidence of O.P.s were closed since they failed to file proof affidavit within the time granted. Merely because the opposite party has failed to adduce any evidence, we are not willing to conclude that the evidence adduced by the complainant stands uncontroverted.
10. Exts. A1 would prove the fact and date of death. Exts. A2 and A3 would prove the existence of the policies, but not the terms and conditions. Exts. A4 and A5 would prove that the deceased was suffering from inter-alia, cardiac ailments.
But the Issues framed were unambiguous and to the point. None of the evidence adduced would answer Issue nos. 1 and 2.
11. Hence we hold that the complainant has failed to prove a prima facie case.
Issue Nos. 3, 4 & 5
12. Apropos the conclusion in Issue Nos.1 and 2, we hold that there is no deficiency in service on the part of the opposite party. The complainant is not entitled to any reliefs. With this conclusion, this complaint is dismissed.
13. In the facts and circumstances of the case, the parties are directed to suffer their respective costs.
Pronounced in open court on this the 12th day of May, 2023.
Sd/-
Vinay Menon V
President
Sd/-
Vidya.A
Member
Sd/- Krishnankutty N.K.
Member
APPENDIX
Exhibits marked on the side of the complainant :
Ext.A1 – Copy of death certificate bearing key no. D0060877-2006181
Ext.A2 – Copy of Certificate of Insurance bearing policy no. 2950 2033 2550 7300 000
Ext.A3 – Copy of Certificate of Insurance bearing certificate no. 2950 2015 1960 2500 000
Ext.A4 - Copy of medical certificate
Ext.A5 – Original certificate dated 08/10/2020 issued from Crescent Hospital.
Exhibits marked on the side of the opposite party: Nil
Court Exhibit: Nil
Third party documents: Nil
Witness examined on the side of the complainant: Nil
Witness examined on the side of the opposite party: Nil
Court Witness: Nil
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.
