JUDGMENT

            Complainant has filed this consumer complaint U/s.35 of C.P. Act, 2019 seeking following reliefs;

            “Direct the opposite parties No.1 & 2 to pay Rs.5,00,000/- the sum assured in the Swadeshi Samridhi Card along with 12% interest from the date of due till the date of payment and also pay Rs.1,00,000/- towards mental agony and harassment and Rs.20,000/- towards litigation fees”.

            The brief fact of the case is that, Late Somanath Swain the husband of the complainant was the card holder of Swadeshi Samridhi Card scheme floated by the opposite parties on payment of the necessary charges and the said card was issued on 24.01.2019. As per the term and conditions of the card, the inured got eligibility for an insurance coverage of Rs.5 lakhs on death of the card holder. Unfortunately Somanath Swain suffered from covid-19 and succumbed to death in the said disease on 27.11.2020. The complainant as the wife and nominee of the deceased Somanath Swain lodged her insurance claim of Rs.5 lakhs immediately after death of her husband with the opposite parties No.1 & 2 through the opposite party No.3 along with all necessary documents. As per request by the complainant opposite party No.3 sent a reminder to opposite party No.2 on 08.7.2021 through email. After receiving the email the opposite party No.2 replied on 13.7.2021 by denying the claim settlement and the reason given was that the said scheme was completely withdrawn by Patanjali since 18.12.2020. The counsel for complainant has relied on the judgment of Hon’ble Apex Court in W.P.(C) No.539/2021 wherein Hon’ble Supreme Court has been plead to observe as under;

            “Grievance redressal: In case of any grievances with regards to certification of the death, as prescribed in the MoHFW and ICMR guidelines mentioned above a Committee at district level consisting of Additional District Collector, Chief Medical Officer of Health (CMOH), Additional CMOH/Principal or HOD Medicine of a Medical College (if one existing in the district) and a subject expert, will propose necessary remedial measures, including issuance of amended Official Document for COVID-19 death after verifying facts in accordance with these guidelines. In case the decision of the Committee is not in favour of the claimant, a clear reason for the same shall be recorded.”

            “3. ii. As per the study by Indian council of Medical Research (ICMR), 95%  i. deaths take place within 25 days of being tested covid positive. To make the scope broader and more inclusive, deaths occurring within 30 days from the date of testing or from the date of being clinically determined as a cOVID-19 case, will be treated as ‘deaths due to COVId-19, even if the death takes place outside the hospital/in-patient facility.

            iii. However, a COVID-19 case, while admitted in the hospital in-patient ii. Facility, and who continued as the same admission beyond 30 days, and died subsequently, shall be treated as a COVID-19 death.”

            Complainant has also relied on the decision of Hon’ble State Commission, where in Hon’ble State Commission has been pleased to held that “complainant has proved the deficiency in service and unfair trade practice on the part of the OP – In view of the above discussion, allowed the complaint directing the OP to pay.”

            Opposite parties have appeared and filed their written version as stated below;

            The Patanjali Ayurved Limited launched a voluntary scheme under the name of “Swadesi Samriddhi Yojana” wherein the “Sahyog Rashi” of Rs.5 lakh is provided in the case of accidental death, however keeping in the view the unprecedented situation arising out of Covid-19 pandemic, Patanjali Ayurved Limited extended the benefits of the scheme from 15.8.2020 to the death taking place due to Covid-19 and provided the existing customer with a cover of Rs.5 lakh as ‘Swadeshi Samridhi Nishtha Sahyog Rashi’ if the death takes place due to Covid-19. However there were certain pre-requisite conditions and documents to avail the benefit of the said scheme which are as follows: (a) Death from covid-19 is covered under insurance policy from 15 August, 2020, (b) Age Limit- 1 to 70 yrs., (c) Purchasing should be more than or equal to Rs.6,000/- in last 6 months or within 180 days from Swadeshi Samridhi Card (from the date of death). The mandatory documents required upon which the claim of the insured is assessed is (a) attested copy of death certificate, (b) testing report of Covid-19 by Govt. authorized laboratory, (c) Corona Positive medical test report is mandatory within 15 days of death, (d) RTPCR report of last 72 hours from the date of death, (e) Hospital report stating cause of death to be Covid-19.   The complainant failed to place on record the RTPCR test report and other relevant documents as mentioned above and hence, prima facie it appears that the complainant in order to mislead this court, came up with a concocted and fabricated death certificate which is submitted to the respondents and therefore, due to the above mentioned reasons, the claim of the complainant is liable to be rejected out rightly.

            Counsel for opposite parties submitted that Nishtha Sahyog Rashi scheme has been completely withdrawn w.e.f.18.12.2020 and further contention of counsel for opposite parties is that complainant has to submit all the documents before opposite parties for consideration.

            We have gone through the consumer complaint and heard counsel for both parties and the citation referred above. It is not disputed that the husband of complainant expired on 27.11.2020 during Covid-19 and as on 27.11.2020 the policy as well as the Nishtha Sahyog Rashi scheme was in force. Taking into consideration the submission of both sides we held that the complainant is a consumer as defined U/.2 (7) of Consumer Protection Act as he has paid the amount for the card and accepted the offer of opposite parties and purchased more than Rs.6,000/- in six months and non settlement of claim on the ground that scheme has been withdrawn on 18.12.2020 i.e. after the death on 27.11.2020 is unfair trade practice and amounts to deficiency in service.

            We therefore direct the opposite parties to reconsider the case of complainant and pay the insured amount. The complainant shall file all the required documents as required and available with complainant within 30 days from the date of receipt of the order. The opposite parties shall decide the claim within 45 days from the date of receipt of the documents from complainant. With the aforesaid observation and direction the consumer complaint is disposed of. No cost.