This query is related to one of my friends. His father was employed in a Central PSU. The Company had entered into an arrangement with a national Insurer Company to provide Group Insurance on payment of a premium of Rs. 525/-. The PSU management decided to deduct the amount in 3 installments of Rs. 176/- each. Whether this was agreed upon by the Insurance Co. or not is not known. One installment was deducted, and his father met with an accident and expired. The matter relates to 1999-2000. The Insurance Co. has denied to pay the group insurance amount on the ground that the full premium has not been paid. PSU management has declined to take responsibility on the plea that group insurance was provided by the Insurance Co.
My friend filed a complaint with the local Consumer forum but lost due to a lack of legal assistance. Now he wants to know whether something can be done in this matter at this point or not. If yes, what documents will be needed and where to go for justice?
From India, New+Delhi
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164My friend filed a complaint with the local Consumer forum but lost due to a lack of legal assistance. Now he wants to know whether something can be done in this matter at this point or not. If yes, what documents will be needed and where to go for justice?
From India, New+Delhi
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Dear Arun, I would suggest you to approach the Insurance Ombudsman appointment by the IRDA. I hope you will get justice from there. regards, Kamal
From India, Pune
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From India, Pune
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I think the PSU might not have deposited the premiums to the insurance company. The PSU is liable to pay the compensation. The case has to be filed against the employer. Better consult a good lawyer.
Pon
From India, Lucknow
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Pon
From India, Lucknow
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Dear Sir,
The accident is whether on duty or a private accident. If it is an on-duty accident, the PSU has to pay compensation; it is their bounden duty. In case it is an outside private accident, the Motor Vehicles Act or personal accident policy will take care of the compensation. Whatever the case may be, please take further action by consulting a senior Advocate.
D. Gurumurthy
From India, Hyderabad
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The accident is whether on duty or a private accident. If it is an on-duty accident, the PSU has to pay compensation; it is their bounden duty. In case it is an outside private accident, the Motor Vehicles Act or personal accident policy will take care of the compensation. Whatever the case may be, please take further action by consulting a senior Advocate.
D. Gurumurthy
From India, Hyderabad
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Dear All,
Thank you for the concern. However, my query remains unanswered. It is clarified that the death occurred while the employee was away on official duty. The bus in which he was traveling got drowned. The only claim that has not been settled is that of group insurance. Mr. K. Prasoon has advised me to approach the IRDA Ombudsman. However, in the case of corporate group insurance schemes, individual employees are unaware of the terms and conditions of the agreement. What can they provide besides a copy of the payment slip, which certifies the deduction of the premium against the group insurance head? I kindly request only valid legal opinions so that I can assist the grieving family.
AK Jain
From India, New+Delhi
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Thank you for the concern. However, my query remains unanswered. It is clarified that the death occurred while the employee was away on official duty. The bus in which he was traveling got drowned. The only claim that has not been settled is that of group insurance. Mr. K. Prasoon has advised me to approach the IRDA Ombudsman. However, in the case of corporate group insurance schemes, individual employees are unaware of the terms and conditions of the agreement. What can they provide besides a copy of the payment slip, which certifies the deduction of the premium against the group insurance head? I kindly request only valid legal opinions so that I can assist the grieving family.
AK Jain
From India, New+Delhi
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Dear Mr. Jain,
I suggest you file a claim under the Employees' Compensation Act against the PSU since this is an accidental death that occurred during employment. If there is insurance, the employer can plead and involve the insurer in the process. Both the employer and insurer will present their positions. Please ensure that proper legal advice is sought, as any delays in this case need to be adequately explained.
Thanks,
V K Gupta
From India, Panipat
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I suggest you file a claim under the Employees' Compensation Act against the PSU since this is an accidental death that occurred during employment. If there is insurance, the employer can plead and involve the insurer in the process. Both the employer and insurer will present their positions. Please ensure that proper legal advice is sought, as any delays in this case need to be adequately explained.
Thanks,
V K Gupta
From India, Panipat
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Dear Arun Jain,
Please make sure that the insurance company has issued the policy or not. Whether the policy was issued, go through the terms and conditions of the policy. If the insurance company or the PSU should pay the amount to the deceased.
Regards,
L. Kishore Kumar
From India, Hyderabad
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Please make sure that the insurance company has issued the policy or not. Whether the policy was issued, go through the terms and conditions of the policy. If the insurance company or the PSU should pay the amount to the deceased.
Regards,
L. Kishore Kumar
From India, Hyderabad
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Dear Arun,
I had the impression that you have all policy details. Without policy details, you can't approach the Insurance Ombudsman. Employees have every right to know about the insurance policy if it is part of the employment contract or if the premium amount is being deducted from the employee's salary. Since the concerned person was working with the PSU, I believe the PSU will share the policy details if asked. Usually, PSUs don't play hide and seek games with employees. Still, if the PSU is not ready to share the details, you can obtain such information through the RTI Act.
As you have mentioned that your friend filed a complaint with the Consumer forum, on what basis did he file the complaint? If there are no details of the policy with the complainant, the Forum can't entertain such complaints. Also, the Forum can't entertain issues between the Employer and the Employee. I would advise you to please get the full details from your friend and then seek advice.
Regards,
Kamal
From India, Pune
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I had the impression that you have all policy details. Without policy details, you can't approach the Insurance Ombudsman. Employees have every right to know about the insurance policy if it is part of the employment contract or if the premium amount is being deducted from the employee's salary. Since the concerned person was working with the PSU, I believe the PSU will share the policy details if asked. Usually, PSUs don't play hide and seek games with employees. Still, if the PSU is not ready to share the details, you can obtain such information through the RTI Act.
As you have mentioned that your friend filed a complaint with the Consumer forum, on what basis did he file the complaint? If there are no details of the policy with the complainant, the Forum can't entertain such complaints. Also, the Forum can't entertain issues between the Employer and the Employee. I would advise you to please get the full details from your friend and then seek advice.
Regards,
Kamal
From India, Pune
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Thanks all,
I appreciate your concerns. As advised by Mr. Kamal, an RTI application has already been filed to obtain as many details as possible. Regarding death compensation under the Employees Compensation Act, the compensation has been paid under the Motor Vehicle Act. This Group Insurance scheme serves as a form of accidental insurance in addition to compensation under the Act. I am also attempting to seek legal advice once the RTI application is responded to with the relevant documents. However, being in a remote location, obtaining legal advice poses a challenge. One would need to travel at least 300 kilometers to access legal assistance from a High Court-level Advocate.
Suggestions from all experts/professionals are welcome.
AK Jain
From India, New+Delhi
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I appreciate your concerns. As advised by Mr. Kamal, an RTI application has already been filed to obtain as many details as possible. Regarding death compensation under the Employees Compensation Act, the compensation has been paid under the Motor Vehicle Act. This Group Insurance scheme serves as a form of accidental insurance in addition to compensation under the Act. I am also attempting to seek legal advice once the RTI application is responded to with the relevant documents. However, being in a remote location, obtaining legal advice poses a challenge. One would need to travel at least 300 kilometers to access legal assistance from a High Court-level Advocate.
Suggestions from all experts/professionals are welcome.
AK Jain
From India, New+Delhi
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Greetings AK Jain,
Generally, it is advisable to approach different levels before approaching the highest authority. In your case, you have to approach the zonal level office of the insurance company, and they have a grievance redressal authority who will help you in sorting out the issue. If you are still not satisfied, the insurance ombudsman will sort out the matter, and thereafter, the consumer forums will take up the matter to sort out the issue. If these fail, you can approach the judicial system to sort out the matter.
As your father was working in a PSU, you can approach the authorities there to seek a copy of the policy for your perusal.
Regards
From India, Madras
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Generally, it is advisable to approach different levels before approaching the highest authority. In your case, you have to approach the zonal level office of the insurance company, and they have a grievance redressal authority who will help you in sorting out the issue. If you are still not satisfied, the insurance ombudsman will sort out the matter, and thereafter, the consumer forums will take up the matter to sort out the issue. If these fail, you can approach the judicial system to sort out the matter.
As your father was working in a PSU, you can approach the authorities there to seek a copy of the policy for your perusal.
Regards
From India, Madras
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