Consumer Issues
NCDRC asks Reliance General Insurance, Alankit Health Care to pay Rs3.5 lakh mediclaim

While asking the insurer and its agency to pay Rs3.5 lakh mediclaim, the apex consumer forum directed Federal Mogul Goetze, the employer, to pay Rs30,000 compensation and keep renewing the complainant’s policy till he needs it

The National Consumer Disputes Redressal Commission (NCDRC) ordered Reliance General Insurance Co Ltd (RGI) and Alankit Health Care Ltd to jointly pay Rs3.5 lakh to Bangalore-based GR Yoganarsimha, for denying his mediclaim.

 

In the judgement given on 15th January, the apex consumer forum also ordered Federal Mogul Goetze, former employee of Yoganarsimha, Rs20,000 for mental agony and Rs10,000 towards cost.

 

Yoganarsimha, who worked as a deputy general manager with Federal Mogul Goetze, continue to avail the company’s Group Health Insurance by paying premium even after his retirement in 2003. The insurance was released by Reliance General Insurance and Alankit Health Care was the authority to settle medical claim. Both RGI and Alankit settled all medical claims of Yoganarsimha till November 2009 on regular basis.

 

However, they refused to settle claims for medical bills of Rs43,402 and Rs1.72 lakh towards dialysis and Rs2.5 lakh towards renal transplantation raised by Manipal Hospital in 2010. 

 

Following this refusal, Yoganarsimha filed a complaint with the district forum in 2011. Partially allowing the compliant, the district forum directed both RGI and Alankit to pay Rs43,402 with an interest of 12%. “the insurance, as applicable to the Complainant, is Rs12.5 lakh relating to major ailments, for the period from 29 June 2009 to 30 June .2010. It is held that Rs43,402 is not proper. The Opposite Parties 1 and 2 are directed to pay Rs43,402 to the Complainant with interest at 12% p.a. from 9 January 2010, until actual payment. The Complainant shall be entitled to make fresh claim and request to renew the insurance policy, as discussed above,” it said in an order.

 

As per the directions from the district forum, Yoganarsimha submitted a claim along with a demand draft (DD) of Rs14,000 to Federal Mogul Goetze and asked the company to forward it to RGI and Alankit. However, it was returned unopened. Yoganarsimha, then took a fresh DD of Rs14,000 and handed over to the company. Federal Mogul Goetze sent the DD to Yoganarsimha stating that he should make his own arrangements for insurance coverage.

 

While Federal Mogul Goetze renewed policies of other retired employees, it refused to do same for Yoganarsimha, who contended that it is hostile discrimination.

 

In pursuance of the order of District Forum, Yoganarsimha made efforts to claim the remaining amount, however, all three, RGI, Alankit and Federal Mogul Goetze did not settle the claim. Yoganarsimha then filed another complaint (No. 1157/2011) before the District Forum with the prayer for renewal of insurance policy from 1 July 2010 to 30 June 2011 and pay claims towards the renal transplant (Rs2.5 lakh) and towards dialysis (Rs1.72 lakh), with compensation of Rs50,000 for deficiency and mental agony.

 

However, the District Forum dismissed the complaint. Even the State Commission dismissed Yoganarsimha’s first appeal, by making an observation as, “the remedy sought by the complainant/appellant is in the form of declaratory to renew the policy and make payments cannot attract the provisions of the C.P. Act.”

 

During the hearing before the NCDRC, both RGI and Alankit remained absent. The apex forum observed that Federal Mogul was trying to wriggle out from the litigation and shell out its burden on RGI and Alankit. It contended that it is not the insurance company, but both RGI and Alankit are the ones who have stopped the renewal.

 

Federal Mogul contended that, Yoganarsimha neither paid any service charges to the company, nor has the company collected any money from him for sending the amount to RGI and Alankit. “Earlier, the company was doing service as a postman freely, but now do not want to extend that service. Hence, Yoganarsimha is not a consumer of the company and there is no deficiency from it. If there is any discrimination, then the remedy of Yoganarsimha is elsewhere, to get renewed the policy in question,” Federal Mogul claimed.

 

However, the NCDRC said that it was not impressed by this argument of counsel for Federal Mogul. “The letters written by the Yoganarsimha clearly establish that in accordance with the order of District Forum, dated 8.3.2011, he made several possible efforts for his claim and the renewal of policy. But, Federal Mogul did not heed to the same, and tried to escape from his responsibility towards the retired employee. It was a Group Insurance Scheme and after retirement, since 2003, Federal Mogul used to receive premium from Yoganarsimha and the policy was renewed from time to time. Federal Mogul forwarded the premium for renewal of other employees; except Yoganarsimha, after 2010. In our view, this is a deficiency in service and it is absolutely discrimination and intentional act of Federal Mogul,” the apex forum said.

 

Yoganarsimha wrote a letter to the Federal Mogul on 21 July 2010 for “Continuation of MIHS for year 2010-2011” and the reply received by Federal Mogul stated its goodwill gesture and the coverage up to Rs3.5 lakh. The relevant text reproduced as follows:

 

 “Notwithstanding the above, we write to inform you that, the MIHS scheme is extended to retired employees as good will gesture and the Company does not take any liability whatsoever on account of it.  The company is only facilitating these categories of eligible employees to take their policy from Insurance Company.  We do not have any objection to facilitate you to continue your Mediclaim policy as good will gesture on payment basis, provides you withdraw the case against the Company.  The renewal will be for only, the sum assured for the Mediclaim policy, applicable to your category.  You cannot contend that the coverage for major diseases should be Rs12.5 lakh etc. The present coverage for major diseases is only Rs3.5 lakh.  If the same is acceptable, you may send your request for coverage with the Demand Draft for the premium amount.

 

It is also made clear that, you are free to take Mediclaim policy of your choice from any insurance company and there is no compulsion of any kind from us.”

 

The NCDRC said, in this identical matter, it also relied upon the decision of the Supreme Court in the Civil Appeal No 2296/2000, Biman Krishna Bose Vs. United India Assurance Co. Ltd and Ors. (2001)6 SSC 477 in which the Court directed the respondent company for renewal of appellant’s mediclaim policy for the expired period, and pay the premium; the respondent company would renew the said mediclaim policy forthwith.

 

While partially allowing the petition, the apex forum directed RGI and Alankit to settle Yoganarsimha’s claim of Rs3.5 lakh and Federal Mogul to renew his policy after taking Rs14,000 for the expired period and renew further from time to time till he needs it. NCDRC also asked Federal Mogul to pay Rs20,000 for mental agony and Rs10,000 towards cost to Yoganarsimha.

User

COMMENTS

Arun

3 years ago

Good article, Extensive research input.

Sensex, Nifty struggle to hold gains: Monday closing report

Nifty will continue to make attempts to cross 6,100

Last Friday, we had mentioned that as long as the NSE Nifty stays above 6,030, it may move higher. After a volatile session Monday, where the index traded on both the side of Friday’s closing, Indian stock markets closed a little lower. From here we may see the Nifty making continuing attempts to cross 6,100.

 

The BSE 30-share Sensex opened at 20,429 and moved between 20,312 and 20,435 before closing lower at 20,334 (down 42 points or 0.21%). The Nifty opened at 6,073 and witnessed moved down to 6,046 from 6,083 before closing at 6,053 (down 10 points or 0.16%). The NSE recorded a lower volume of 48.23 crore shares.

 

Among the other indices on the NSE, the top five gainers were Realty (1.30%); Pharma (0.77%); Energy (0.49%); Auto (0.46%) and PSE (0.11%) while the top five losers were Finance (0.85%); Service (0.84%); Consumption (0.67%); MNC (0.65%) and Infra (0.63%).

 

Of the 50 stocks on the Nifty, 23 ended in the green. The top five gainers were DLF (2.86%); Dr Reddy (1.90%); Sun Pharma (1.58%); HCL Technologies (1.42%) and LT (1.37%). The top five losers were Jaiprakash Associates (3.23%); HDFC (2.48%); Hindustan Unilever (2.42%); TCS (2.42%) and Bharti Airtel (2.39%).

 

Of the 1,472 companies on the NSE, 660 closed in the positive, 722 closed in the negative while 90 closed flat.

 

The Indian economy is expected to continue to expand at a pace of less than 5% in the year ending 31 March 2014, according to a government forecast released after trading hours on 7 February 2014. In the latest official forecast for the fiscal year ending next month, the Ministry of Statistics & Programme Implementation projected a 4.9% expansion for 2013-14. The weak growth projection underscores the severity of the slowdown in the south Asian economy which grew close to 9% as recently as in the year ended 31 March 2011. The statistics ministry's estimates show that the manufacturing output is expected to contract 0.2% during the current fiscal year while mining output is expected to fall 1.9%. However, farm output growth is expected to be much better this year on the back of higher-than-usual rainfall. The ministry estimates a 4.6% expansion in farm output, compared with the 1.4% increase in the last fiscal year. Output of services, which contribute about 60% to India's GDP, is expected to grow 6.9% this year, almost the same as the 7% expansion last fiscal year.

 

Business activity across emerging markets expanded in January at the slowest pace in four months, dragged down by sluggish services sectors in the BRIC quartet of big developing countries, a survey showed on Monday.

 

HSBC's composite emerging markets index of manufacturing and services purchasing managers' surveys slipped for the second month running to 51.4 in January. It stayed under the 2013 average of 51.7 and well below the score of 64.1 posted last January.

 

US indices closed in the positive on Friday.

 

Payrolls rose less than projected in January and the jobless rate unexpectedly dropped to the lowest level in more than five years. The 113,000 gain in hiring fell short of the estimates and followed a 75,000 increase the prior month, Labor Department data showed in Washington. Unemployment declined to 6.6%, the least since October 2008, from 6.7% in December.

 

Asian indices had mixed performance. Shanghai Composite  was the top gainer which rose 2.03% while Jakarta Composite was the top loser which fell 0.36%.

 

China's central bank signaled volatility in money-market interest rates will persist and borrowing costs will rise, underscoring the risk of defaults that could weigh on confidence and drag down growth.

 

Japan's current-account deficit widened to a record level in December on soaring imports, adding to Prime Minister Shinzo Abe's challenges to recovery the economy. The 638.6 billion yen ($6.2 billion) shortfall surpassed November's gap of 592.8 billion yen, the finance ministry said today.

 

European stocks were trading marginally higher while US Futures were trading lower.

User

Rail Budget: Will FDI in railways become reality?

Ensuing interim railway budget may be populist, as elections are around the corner. However, there is dire need for the Railways to raise its own resources. Will Mallikarjun Kharge deliver what is most needed for the railways?

India has the fourth largest rail network in the world, but the work, its performance and developments have not been very satisfactory. Railways carry some 25 million passengers a day, and despite the fare being cheap, we still do have a large percentage of ticketless travel (there are no figures available here) and the freight carried is substantial. Indian railways have an estimated $19 billion in annual revenue.

 

Railway Minister Mallikarjun Kharge is scheduled to present interim rail budget (Vote-on-account, the presentation of statement of revenue and expenditure for the entire year, with a Parliament nod for expenditure in the next four months) on 12th February.

 

By very nature of its size and the volume of traffic, though a few developments have taken place in the related industries, such as production of rails, locomotives, coaches and wagons, and a number of allied products, India cannot boast of top class signalling equipments, engines and coaches being produced in the country itself. Imports continue and there is tremendous scope for industrial development and infrastructural needs that can be additionally met by inducing foreign investors to come into the country.

 

In fact, the DIPP (Department of Industrial Policy and Promotion) have come out with a plan that proposes a 100% FDI in Railways. After preparation and circulation of a note for the Cabinet, and taking into account certain conditions laid by Railways, there are reasonable prospects for this to become a reality soon.

 

It appears, when the proposal is finally approved, it may permit foreign investors to fully own new services in suburban areas, lay high speed tracks and connections to ports, mines and power installations. However, the existing passenger and freight network operations may not be open to foreign investors. Also, Railways would gladly accept such investments in areas of construction and maintenance of projects, but not in running operations, as they would like to control these themselves.

 

DIPP plan would eventually attract an estimated $5 billion of investments in Railways and giants like General Electric Co and Bombardier are keen to take advantage, when this opportunity is given. It appears that this proposal has been vetted by Railways, Ministry of Industry as well as Finance Ministry.

 

In just making a passing reference, we may note that, in 66 years India has added 13,000 Kms of new railway lines, while, according to Ernst & Young, China added 14,000 Kms just between 2006 and 2011! On the top of that, the China Railway Construction Corporation has plans to invest a staggering $104.2 billion in fixed assets during 2014. Set against this, as mentioned earlier, our revenue in the Railways chugged along to reach a measly $19 billion.

 

But Railways can no longer act as a cheap public transport system for aam aadmi alone. They need to improve the quality of service by making facilities for the passengers, ensure well maintained passenger coaches and railway stations, and provide security and safety besides eliminating accidents, which, in the recent past, have become a regular occurrence. They need to make Railways a profitable proposition by increasing the passenger fare, ensure no ticketless travel and decrease the freight rates, so that heavy cargo movement that clogs the roads can be taken over by them. This will also save foreign exchange on imported fuel.

 

FDIs in railways may also be encouraged to build dedicated corridors for movement of freight, such as coal and iron ore from mining centres to areas of consumption and to points of export exit. So far, the Railways did not have any competition and so the aam aadmi had to take what was given to him. By encouraging direct FDIs in railways, it is hoped the spirit of competition would create better, safer and reliable service.

 

(AK Ramdas has worked with the Engineering Export Promotion Council of the ministry of commerce. He was also associated with various committees of the Council. His international career took him to places like Beirut, Kuwait and Dubai at a time when these were small trading outposts; and later to the US.)

User

COMMENTS

Dr Anantha K Ramdas

3 years ago

Mr Vinay Joshi:

After reading your comment, I double checked to find that in the list of 10 of the world's largest railway networks, the actual ranking are as follows:

USA 224,792 Kms
Russia 87,157
China 86,000
India 63,974

Mine reporting was also based on newspaper published data.

Thanks for your continuing interest in these articles.

REPLY

Vinay Joshi

In Reply to Dr Anantha K Ramdas 3 years ago

Hello,

I do not dispute your statement. Appreciate your info to me.

Regards,

Vinay Joshi

3 years ago

BY THE WAY IR IS FIFTH LARGEST [not 4th as stated]. The other four, US, Russia, Canada & PRC.

I had read this in ET, but the present passenger & freight system will be out of the ambit of such FDI.

What is contemplated is for only 'last mile connectivity', to the ports, mining areas etc.

As of now Bombay-Delhi freight corridor only on paper. Int'l funding sanctioned for the said project.

Mono rail, metro & Delhi metro aspects to be replicated on the anvil which are not owned by IR.

Today in CR/WR/KR we are already having Siemens rakes, Delhi metro coaches were supplied by Bombardier [Canada] factory in Gujarat. [possibly NaMo is unaware or else he would have bombarded with it.]Hence this lobbying is an aspect.

To some extent IR operating ratio has improved but if we put this to Lalu, he will vociferously ask where is the 20KCr he had shown on paper? Business schools 'CASE STUDY'!?

IR has to downsize by 40-50%, it should not be the fiefdom of the govt; as we have seen Bansal.

But the technical capabilities & stds of RSDO, or suburban rail rout mgmt is applaudable.

Regards,

Vinay Joshi

3 years ago

BY THE WAY IR IS FIFTH LARGEST [not 4th as stated]. The other four, US, Russia, Canada & PRC.

I had read this in ET, but the present passenger & freight system will be out of the ambit of such FDI.

What is contemplated is for only 'last mile connectivity', to the ports, mining areas etc.

As of now Bombay-Delhi freight corridor only on paper. Int'l funding sanctioned for the said project.

Mono rail, metro & Delhi metro aspects to be replicated on the anvil which are not owned by IR.

Today in CR/WR/KR we are already having Siemens rakes, Delhi metro coaches were supplied by Bombardier [Canada] factory in Gujarat. [possibly NaMo is unaware or else he would have bombarded with it.]Hence this lobbying is an aspect.

To some extent IR operating ratio has improved but if we put this to Lalu, he will vociferously ask where is the 20KCr he had shown on paper? Business schools 'CASE STUDY'!?

IR has to downsize by 40-50%, it should not be the fiefdom of the govt; as we have seen Bansal.

But the technical capabilities & stds of RSDO, or suburban rail rout mgmt is applaudable.

Regards,

We are listening!

Solve the equation and enter in the Captcha field.
  Loading...
Close

To continue


Please
Sign Up or Sign In
with

Email
Close

To continue


Please
Sign Up or Sign In
with

Email

BUY NOW

The Scam
24 Year Of The Scam: The Perennial Bestseller, reads like a Thriller!
Moneylife Magazine
Fiercely independent and pro-consumer information on personal finance
Stockletters in 3 Flavours
Outstanding research that beats mutual funds year after year
MAS: Complete Online Financial Advisory
(Includes Moneylife Magazine and Lion Stockletter)