Pon1965
Construction
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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 at deduct the amount in 3 installments of Rs.176/- each. Whether this was agreed 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 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 local Consumer forum, but lost due to 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?
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
I think the PSU might not have deposited the premia 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

Dear Sir,
The Accident is while on duty or private accident. If it is while on duty
accident, the PSU has to pay compensation. it is their bounden duty.
In case it is outside private accident, as Motor vehicles Act or personal accident policy take care of the compensation.
Whatever it may be please take further action by consulting a senior Advocate.
D.Gurumurthy

Dear All,
Thanks for the concern. But my query is unanswered yet. However 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 which has not been settled is of group insurance. Mr. K Prasoon has advised to approach IRDA Ombudsman. But Sir, in case of corporate group insurance schemes, individual employee knows nothing about the terms and conditions of agreement. What can he produce except the copy of payment slip which certifies the deduction of premium against group insurance head. I request only for valid legal opinions please, so that I may be able to help the grieved family.
AK Jain

Dear Mr. Jain,
I suggest you to file claim under Employees Compensation Act against the PSU since this is accidental death out of and in the course of employment. If there is insurance, employer can plead and make party there.Both, employer and Insurer will plead their stands. Please take care that proper legal advice is obtained as in this case delay is to be properly explained.
Thanks
V K Gupta

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

Dear Arun,
I had the impression that you have all policy details. Without policy details you cant approach Insurance Ombudsman.
The employees has every right to know about the insurance policy if it is a part of the employment contract or if the premium amount is being deducted from employees salary.
Since the concerned person was working with the PSU, i believe PSU will share the policy details if asked for. Usually PSUs don't play hide and seek game with employees.Still if the PSU is not ready to share the details, you can get such details through RTI Act.
As you have mentioned that your friend had filed a complaint with Consumer forum. On what basis he had filed the complaint? If there is no detail of the policy with the complainant Form can't entertain such complaints and also Form cant entertain the issue between the Employer & the Employee.
I would advise you to please get the full details from your friend and then seek advise.
regards,
Kamal

Thanks all,
I appreciate your concerns. As advised by Mr. Kamal, RTI application has already been filed as advised by me to get as much details as could. As regards death compensation under Employees Compensation Act, the compensation has been paid under Motor Vehicle Act. This Group Insurance scheme is a kind of accidental insurance which is in addition to compensation under Act. I am also trying to seek legal advise after RTI application is replied with relevant documents. But being a remote place, getting legal advise is a tough call at this place. He will have to travel at least 300 KMs to get some legal assistance from an Advocate of High Court level.
Suggestions from all experts/professionals is welcome.
AK Jain

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


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