When mediation efforts fail, CERS files a complaint as the first litigant supporting the consumer right through the legal process.


ONGC, PF dept pulled up for denying widow pension for 16 years

Inderjeet Sandhu, who worked as a cleaner for ONGC, died on 16 April 1991 while in service. His widow Nishan Kaur sent the completed application form for family pension and all required documents to the Dehradun office of ONGC. In return she received the paltry amount of Rs. 5,000 as one-time settlement for life insurance! Despite several attempts over 16 years she did not get the pension amount. Finally, she contacted CERS which filed a case before the District Forum, Ahmedabad.

The Forum ruled against both the opponents, ONGC and the PF authorities, who were passing the buck to each other. It found negligence and deficiency in service on their part. It ordered in 2008 that family pension be paid to Nishan with effect from 1 May 1991. ONGC appealed to the Gujarat State Commission. The Commission rejected its objections that the complainant was not a consumer and the complaint was time barred.

In its order dated 9 May 2014, it said that payment of pension was the responsibility of the PF department. ONGC was negligent for not forwarding the relevant documents to the PF office. The PF authorities had to pay the pension within 30 days of the receipt of the order and the opposing parties had to pay compensation of Rs. 5,000 each.


New India Assurance rapped for wrongly citing exclusion clause

Narendra P. Bhatt took a mediclaim policy for his whole family on 21 May 2001 from New India Assurance Co. Ltd. Strangely, without any evidence of his wife Chandraprabha having had a surgery for varicose veins, an exclusion clause was introduced in 2002 for that ailment. In 2008-09, he increased the sum assured to Rs. 1 lakh for himself and his wife. On 11 November 2010, Chandraprabha developed a problem in her lower limbs and had to be hospitalised. She was operated on for varicose veins and discharged the next day. The total medical expenses came to Rs. 56,915.

When the TPA (E-meditek Services Ltd.) and later the insurer rejected his claim it came as a shock to Narendra. He contacted CERS and a complaint was filed before the District Forum, Ahmedabad. He contended that even if varicose veins were initially excluded from coverage, the exclusion clauses ceased to exist two years from the policy’s inception as per 2007 rules. The insurance company argued that the complaint was filed one year after repudiation of the claim. It also argued that Chandraprabha had had the pre-existing condition of varicose veins.

The Forum pulled up the insurance company for wrongly citing the exclusion clause and ordered it to pay the complainant the claim amount with 9% interest. It also told the insurer to pay Rs. 3,000 as compensation for mental agony and Rs. 1,500 towards costs.

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