BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION AT BANGALORE (URBAN)

DATED 16^THDAY OF NOVEMBER 2022

ORDER

SRI.H.JANARDHAN, MEMBER

1. This complaint has been filed by the complainant under section 35 of C.P. Act, 2019 seeking relief against the OP to refund Rs.3,499/- together with interest at 24% p.a. from the date payment, refund amount of Rs.2,29,138/- being the amount spent for the treatment (medical expenses) with interest at the rate of 24% p.a. and to pay a sum of Rs.5,00,000/- towards damages and compensation for the mental and physical trauma suffered by the complainant and direct the OP to pay an additional sum of Rs.50,000/- towards litigation expenses to the complainant   and such other reliefs.

2. The brief facts of the complaint are as follows:

The OP is providing various kinds of insurance coverage /policies for their customers and also OP have also engaged various agents, who approach the customers as per their requirements they collect  all the information, necessary documents from the customers and issue the policies.

The complainant during the month of August 2020, one agent of the OP by name Amrith Lobo has approached the complainant and recommended to buy CORONA KAVACH POLICY  to the entire family consisting complainant, his wife, two children and his mother. Being convinced by the words  of the agent, complainant agreed to buy the policy and agreed to pay to the said Corona Kavach policy including the complainant. The agent of OP collected documents from the complainant and also collected Rs.12,471/- as premium amount for all the 05 policies. The complainant has paid amount through cheque bearing no.001517 dt.20.08.2020 drawn on Kotak Mahindra Bank, Avenue Road branch, Bengaluru and OP has duly encashed the said cheque amount on 24.08.2020. After receiving  premium amount for the above said 05 policies, the OP has sent only 04 policies through e-mail among them only three policies were couriered to the address of the complainant. The complainant astonishing to note that even though OP had collected amount for all the 05 policies individually, he has sent only 04 policies pertaining to the complainant, his wife, his children and about 5^th policy i.e. complainant’s mother neither it was sent to the complainant nor OP agent has provided any details about the same and the OP agent kept remain silent and did not inform anything about complainant’s mother policy. The complainant even after lapse of considerable time, the complainant neither got any update  about 5^th policy nor he has got his money back from the OP. The complainant was an impression that all of his family members were covered under Corana Kavach policy, during the month of March i.d. 31.03.2021 the complainant’s mother Smt.Vijayalakshmi unfortunately tested positive for Corona Virus and taken to Bengaluru hospital at Jayanagar for treatment, at that juncture the complainant who was under the impression that he was done Corana Kavach policy with the OP for her mother  and communicated the same to the hospital, who in turn made an enquiry with the OP officials agent, who had in turn had no information about 5^th policy i.e. of complainant’s mother and told the complainant that he will enquire and get back to him, but he did not even bother to call back the complainant. After sometime the complainant contacted the said agent of OP, he gave a shocking news to him that there is no  policy exists in his mother’s name and upon enquiry about the reason for the same, the agent was not in a position to give any information to the complainant about not processing/ generating complainant’s  mother’s policy and requested the complainant to give sometime to collect the actual reason for the same and assured that he will get back with details shortly. Due to said act of the OP agent, the complainant having no other option has made all the medical expenses of his mother through his other resources. Unfortunately,  inspite of his best efforts he could not get best treatment for his mother and she succumbed to the deadly pandemic on 06.04.2021.  The complainant also spent sum of Rs.2,29,138/- for his mother’s treatment and the complainant could not bring back his mother home alive, who was 70 years of age. Though, the OP agent had collected all the necessary documents, information and also received sum of R.12,471/- as premium towards issuance of 05 policies including complainant’s mother, but to the best known to the OP agent he has covered only 04 persons i.e. complainant, his wife and two children except complainant’s mother. Though several reminders and approaches were made by the complainant, but knowing of the reasons the policy towards complainant’s mother was not generated, but best known to the OP has not reverted back  regarding status of the policy to the complainant and being aggrieved by the said act of the OP, the complainant has filed this complaint.

3. After issuance of the notice to the OP,  notice duly served to the OP, but OP remained absent. hence, OP is placed exparte.

4. The complainants filed his affidavit evidence and got marked exhibits P1 to P8.

5.     Complainant filed written arguments. Perused documents.

6.     The points that would arise for our consideration are as under:-

1. Whether there is deficiency in service on the part of the OP?
2. Whether the complainants are entitled for the reliefs sought?
3. What order?

7. Our answer to the above points are as under:

       Point No.1:- Negative.

      Point No.2:- Negative

      Point No.3:-As per the final order.

REASONS

8.  Point No.1 & 2: On perusal of the pleading, it is seen that the complainant has approached the OP for Corana Kavach Policy and towards which, OP agent has approached the complainant and  has  collected sum of Rs.12,471/-  as premium amount and assured that he has taken the said payment toward issuance of 05 policies to complainant, his wife, two children and his mother. After receiving of said premium amount through cheque bearing no.001517 dt.20.08.2020 of Kotak Mahindra Bank and the said cheque was encashed by the OP  on 24.08.2020 and after said cheque was encashed the complainant thought that 05 insurance policies would be generated, but the complainant received only 04 policies through e-mail among them only 03 policies were couriered to the address of the complainant. By seeing the said policy, the complainant was astonishing to note that  OP has collected the amount for all the 05 policies individually, but OP has sent only 04 policies pertaining to the complainant, his wife and 02 children and with regard to 5^th policy i.e. of complainant’s mother, neither  it was sent to the complainant nor any information  or details were provided by the OP. When equiry was made by the complainant with that regard, the officials of OP informed that they are going to revert back and  he was not communicated in that regard. Though the complainant has obtained Corana Kavach policy and has made payment on 20.08.2020 and which was encashed on 24.08.2020, but the complainant became silent for more than 07 months and finally when the complainant’s mother Smt.Vijayalakshmi, who was tested positive for Corona virus and took treatment in Bengaluru hospital at Jayanagar and the complainant had spent amount of Rs.2,29,138/- towards  complainant’s mother’s treatment. During that time the complainant submits that he was not able to get the policy benefits of the complainant’s mother. When the complainant is fully aware that he has not obtained 5^th individual policy  of his mother. Though the complainant could have raised the complaint with the OP stating that though he had made payment of Rs.12,471/- towards premium for the issuance of 05 policies but he has received only 04 policies except the policy of complainant’s mother. When the complainant had the knowledge that he has not received 5^th policy. When the cheque was given towards premium has been encashed on 24.08.2020, after which the complainant has waited and has not resorted to any action against the OP pertaining to the 5^th policy or  made any correspondence  or enquiry regarding 5^th policy. The complainant also has not produced any proposal form to show that he has made payment towards 05 policies including complainant’s mother and the said proposals have been accepted by the OP or reasons for rejection stated by the complainant in the complaint. The complainant has not produced any documentary proof to show that he has paid amount for issuance of 5^th  policies. The complainant utterly failed to show that he made 05 proposals  individually and in that he has not received 5^th policy well within time, but the complainant has neither resorted to raise complaint with the OP nor has made any correspondence with the OP regarding 5^th policy well within reasonable time. The complainant has not reverted back to OP for  non-issuance of 5^th policy, if he has paid premium towards 5^th policy. Only after the complainant’s mother has been admitted to the hospital on 31.03.2021 after lapse of 07 months alleges deficiency of service on the part of the OP, which is unbelievable and untenable. Without resorting to  any of legal formalities, the complainant alleges deficiency of service on the part of the OP. However, the burden of proof lies on the complainant as OP has not contested the case. Now the complainant has to  show that he has paid certain premium amount towards 5^th policy and has utterly failed to produce any voucher or proposal form in that regard to substantiate the case and the mere pleading that he had taken 5^th policy will not suffice. Hence, the complainant utterly failed to prove the deficiency of service on the part of the OP.  Hence, we answer the Point no.1 & 2 in the negative.

9.  Point no.3:- For the fore going reasons, we proceed to pass the following 

O R D E R

1. The complaint is dismissed without cost.
2. Furnish the copy of this order to both the parties, and return the spare pleadings and documents to the complainant.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open Commission on this 16^th  day of November, 2022)

Documents produced by the Complainant-P.W.1 are as follows:

Documents produced by the representative of opposite party – R.W.1 :  Nil.