Haryana

Karnal

CC/171/2021

Sneh Bala - Complainant(s)

Versus

Patanjali Ayurved Limited - Opp.Party(s)

Amit Shrma

04 Dec 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                      Complaint No. 171 of 2021

                                                      Date of instt.19.03.2021

                                                      Date of Decision:04.12.2023

 

Sneh Bala wife of late Shri Kiran Kumar Bhalla resident of house no.431, Sector-9, Part-II, Urban Estate, Karnal.

 

                                               …….Complainant.

                                              Versus

 

1. Patanjali Ayurved Limited through its Managing Director/CEO, Paranjali Food & Herbal Park, village Padartha, Laksar Road, Haridwar, Uttarkhand.
2. Dev Lakshmi International through its proprietor Sahil Yadav, near Pal Sweets, Main Chowk, Sector-9, Karnal, Haryana. Mobile no.8708719457.

 

…..Opposite Parties.

       

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.

              Shri Vineet Kaushik…….Member

              Dr. Suman Singh……Member

 

Argued by:  Shri Amit Sharma, counsel for the complainant.

                    Shri Vikas Yadav, counsel for the OP no.1.

                    OP no.2 given up.

 

                    (Dr. Suman Singh, Member)

ORDER:                     

          

                 The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that the husband of complainant had died on 27.11.2020 during his treatment of covid-19 in Paras Hospital, Panchkula. He was admitted in Paras Hospital on 21.11.2020 after his test for Covid-19 was found positive. The complainant’s husband had enrolled himself in a scheme which is known as “Swadeshi Samridhi Yojna” of the OPs. OPs issued a card by the name of “Swadeshi Samridhi Yojna”, vide no.2601500010032140. OPs have taken special initiative to provide Swadeshi Samridhi Nishtha Sahyog (Assistance) to card holder. The card holder or card holder’s nominee will get upto Rs.five lakhs in case of death or Rs.2.50 lakhs in case of permanent disability due to accident. The benefit of abovesaid scheme had also covered the death occurred by covid-19 till 18^th December, 2020. OPs withdrew the benefit from 18^th December, 2020 by issuing a notification on their website that “the benefits of the Swadeshi Nistha Sahyog Rashi for the Swadeshi card holder has been withdrawn from 18^th December, 2020. Swadeshi Nistha Sahyog will be provided only if the member/card holder has purchased a minimum of Rs.6000/- in last 180 days from the date of death/accident. The husband of complainant had made a purchase of Rs.14682/- from OP no.2, which is a local merchant of OP no.1 in last six months starting from June, 2020 to November,2020. This scheme is available to the members of age group 1-75 years only as per the conditions mentioned on the website of OP no.1. On 22.12.2020, her son had sent mail to the OP no.1 regarding the death claim of Rs.five lakhs alongwith all the relevant documents. But OP no.1 declined the claim of the complainant on the ground that deceased not eligible for the Swadeshi Nistha Sahyog Rashi due to age factor as his age is mentioned as 78 years in covid-19 test report whereas the original age of the deceased was 70 years at the time of death and it is clearly mentioned in aadhar card and death certificate. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OP no.1 appeared and filed its written version raising preliminary objections with regard to maintainability; territorial jurisdiction and concealment of true and material facts. On merits, it is pleaded that the office of the Ombudsman is the appropriate authority to adjudicate the present complaint. The OP has launched an insurance scheme under name Swadeshi Samridhi Yojna wherein the insured is provided a cover of Rs.five lakhs as Swadeshi Nistha Sahyog Rashi, if the death takes place due to covid-19. The pre-requisite conditions to avail the benefit of the said scheme are as follows:-

1. Death from covid-19 is cover under insurance policy from 15 August, 2020.
2.  Age Limit 1 to 70 years.
3. Purchasing should be more than or equal to Rs.6000/- in last 6 months or within 180 days from SS Card.

It is further pleaded that the mandatory documents required upon which the claim of the insured is assessed is a follows:-

1. Attested copy of Death Certificate
2. Testing reports of Covid-19 by Government authorized laboratory.
3. Corona positive medical test report is mandatory within 15 days of death.
4. RTPCR Report of last 72 hours from the date of death.
5. Hospital report stating cause of death to be covid-19.

                From the bare perusal of the above mentioned conditions, the Covid-19 test reports from a government authorized laboratory alongwith RTPCR are the mandatory documents and the claim is strictly assessed on the basis of these documents only. But in the present case, complainant failed to place on record the RTPCR test report and the particulars of the Covid-19 test report does not corresponds with that of the identity documents of the late husband of the complainant and hence prima facie it appeared that fabricated Covid-19 report has been placed on record and consequently the claim of the complainant was liable to be rejected. It is further pleaded that complainant unable to present the hospital report stating the patient death was due to Covid-19 only. It is further pleaded that the “Swadeshi Samridhi Yojna” was applicable only to the people, who possess the age of 1-70 years whereas in the covid-19 test report the ate of late husband of complainant was mentioned as 78 years and hence in no way the claim of the complainant can be taken into consideration and is straightway liable to be dismissed as it does not fulfill the requisite mandatory conditions.

3.             OP no.2 given up by the learned counsel for the complainant being unnecessary party by suffering his separate statement dated 17.02.2022.

4.             Parties then led their respective evidence.

5.             Complainant has tendered into evidence her affidavit Ex.CW1/A, copy of death summary Ex.C1, copy of death certificate Ex.C2, copy of Swadeshi Samridhi card Ex.C3, copy of screenshot claim withdrawn Ex.C4, copy of purchased history Ex.C5, copy of screenshot of age in condition Ex.C6, copy of exchange mail Ex.C7, copy of aadhar card of deceased Ex.C8, copy of death certificate Ex.C9, copy of aadhar card of complainant Ex.C10, copy of age correction document by KCGMCH, Karnal Ex.C11 and closed the evidence on 25.04.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OP no.1 has tendered into evidence affidavit of Mayank Bahuguna Ex.OP1/A and authority letter Ex.OP1 and closed the evidence on 08.06.2023 by suffering separate statement.

 7.            We have heard learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

8.             Learned counsel for the complainant, while reiterating the contents of the complaint and vehemently argued that husband of complainant had died on 27.11.2020 during the treatment of Covid-19 in Paras Hospital, Panchkula. He was admitted in Paras Hospital on 21.11.2020 after his test for Covid-19 was found positive. The complainant’s husband had enrolled himself in a scheme which is known as “Swadeshi Samridhi Yojna” of the OPs. OPs issued a card in this regard. OPs have taken special initiative to provide Swadeshi Samridhi Nishtha Sahyog (Assistance) to card holder. The card holder or card holder’s nominee will get upto Rs.five lakhs in case of death or Rs.2.50 lakhs in case of permanent disability due to accident. The benefit of abovesaid scheme had also covered the death occurred by covid-19 till 18^th December, 2020. OPs withdrew the benefit from 18^th December, 2020 by issuing a notification on their website. Swadeshi Nistha Sahyog will be provided only if the member/card holder has purchased a minimum of Rs.6000/- in last 180 days from the date of death/accident. The husband of complainant had made a purchase of Rs.14682/- from OP no.2 from June, 2020 to November,2020. This scheme is available to the members of age group 1-75 years only. On 22.12.2020, the son of complainant had sent mail to the OP no.1 regarding the death claim of Rs.five lakhs alongwith all the relevant documents. But OP no.1 declined the claim of the complainant on the ground that deceased not eligible for the Swadeshi Nistha Sahyog Rashi due to age factor as his age is mentioned as 78 years in covid-19 test report whereas the original age of the deceased was 70 years at the time of death and it is clearly mentioned in aadhar card and death certificate and lastly prayed for allowing the complaint.

9.             Per contra, learned counsel for the OP no.1, while reiterating the contents of written version, has vehemently argued that the office of the Ombudsman is the appropriate authority to adjudicate the present complaint. The OP has launched an insurance scheme under name Swadeshi Samridhi Yojna wherein the insured is provided a cover of Rs.five lakhs as Swadeshi Nistha Sahyog Rashi, if the death takes place due to covid-19. He further argued that the as per pre-requisite conditions to avail the benefit of the said scheme i.e. Death from covid-19 is cover under insurance policy from 15 August, 2020; Age Limit 1 to 70 years; Purchasing should be more than or equal to Rs.6000/- in last 6 months or within 180 days from SS Card are mandatory. He further argued that Attested copy of Death Certificate; Testing reports of Covid-19 by Government authorized laboratory; Corona positive medical test report within 15 days of death and RTPCR Report of last 72 hours from the date of death and Hospital report stating cause of death to be covid-19 are mandatory documents to assess the claim of the insured but in the present case, complainant failed to place on record the said documents and consequently the claim of the complainant was liable to be rejected. He further argued that “Swadeshi Samridhi Yojna” was applicable only to the people, who possess the age of 1-70 years whereas in the covid-19 test report the late of late husband of complainant was mentioned as 78 years and hence complainant is not entitled to any claim and lastly prayed for dismissal of the complaint.

10.           We have duly considered the rival contentions of the parties.

11.           Admittedly, the husband of complainant enrolled himself  under the scheme of “Swadeshi Samridhi Yojna” launched by OPs. It is also admitted that card holder or card holder’s nominee will get upto Rs.five lakhs in case of death or Rs.2.50 lakhs in case of permanent disability due to accident. It is also admitted that the benefit of abovesaid scheme had also covered the death occurred by covid-19 till 18^th December, 2020.

12.           The OP no.1 has alleged that complainant has failed to place on record the RTPCR test report and the particulars of the Covid-19 test report and also unable to present the hospital report stating the patient death was due to Covid-19 only. The onus to prove its version was relied upon the OP but OP has miserably failed to prove the same by leading any cogent and convincing evidence. Rather, complainant has placed on file death summary issued by Paras Hospitals, Panchkula Ex.C1 wherein it is clearly mentioned that Covid-19 RTPCR positive on 22.11.2022 and cause of death is mentioned as “Bilateral Pneumonia Type-1 Respiratory Failure Septic Shock Cardio Respiratory Arrest”.  Hence, it is well proved on record that husband of complainant died due to Covid-19. Thus, plea taken by the OP has no force.

13.           The OP no.1 has further alleged that at the time of death husband of complainant was 78 years old and as per “Swadeshi Samridhi Yojna” the people, who possess the age of 1-70 years, is only entitled for the benefit of the said scheme. In rebuttal, complainant has placed on file death summary issued by Paras Hospitals, Panchkula, wherein the age of patient/husband of complainant clearly mentioned as 70 years. Complainant further placed on file, copy of aadhar card of deceased Kiran Kumar Bhalla wherein the date of birth mentioned as 15.04.1950 and complainant has also placed on file death certificate issued by Municipal Corporation Panchkula, Government of Haryana wherein the age of deceased is mentioned as 70 years. Complainant has also placed on file document Ex.C11 regarding the correction of age of deceased Kiran Kumar Bhalla wherein the age of deceased Kiran Kumar Bhalla is mentioned as 70 years. Hence, in view of the above, it is well proved on record that at the time of death life assured was 70 years old. Thus, plea taken by the OP has no force.

14.           As per “Swadeshi Samridhi Yojna” the sum insured is Rs.5,00,000/-,  hence  complainant being nominee of insured is entitled for the said amount alongwith interest, compensation for mental harassment and litigation expenses etc.

15.           Thus, as a sequel to abovesaid discussion, we allow the present complaint and direct the OP no.1 to pay Rs.5,00,000/- (Rs. five lakhs only) to the complainant alongwith interest @ 9% per annum from the date of denial of the claim till its realization. We further direct the OP no.1 to pay Rs.25,000/- to the complainant on account of mental agony and harassment and Rs.11,000/- towards the litigation expenses. This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:04.12.2023     

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)

                     Member                        Member