PENDENCY OF COMPLAINTS AT INSURANCE OMBUDSMAN [IO],AHMEDABAD & SUGGESTIONS

J P SHAH,

202 Velamani Residency,

9A Vrindavan Park Soc,

VADODARA GUJARAT 390008

Email ID: jpshah50@yahoo.co.in

Cell: 9924106490

___________________________________________________________________

   SENIOR CITIZEN WITH FATAL LIVER DISEASE   DATE:  15-08-2019                                                          

                                                                                                           

To,

Chairman,

Executive Council of Insurers,                                                  By email

3rd Floor, Jeevan Seva Annexe,

S. V. Road, Santacruz [west]  Mumbai 400054

email ID: inscoun@ecoi.co.in

Dear Sir,

PENDENCY OF COMPLAINTS AT INSURANCE OMBUDSMAN [IO],AHMEDABAD & SUGGESTIONS

Greeting on INDEPENDENCE DAY.

I understand per your RTI reply dated 22-07-2019 that nearly 2600 complaints are pending with Insurance Ombudsman Ahmedabad [IOA for brevity] due to vacancy of post of IOA since 21-07-2014, though there is visiting IO for few days in a month/fortnight.

2. Reckoning that IOA decides 5-7 complaints per day on an average and works for 20 days a month [excluding Sundays/Saturdays/Holidays/Leave etc], it will take nearly two years to clear the backlog. In addition there will be equal number of new complaints in these two years. Thus pendency will continue to be around 2500 equal to 2 year period against mandated 90 days as per IO rules.

3. Many of complainants may be senior citizens and this killing pendency is putting them in financial and mental tension at the fag end of their lives. Some will unfortunately not get decision/award during their life time. Thus the very purpose of IO scheme of speedy and cost-effective disposal of complaints against insurance companies is mercilessly butchered, more so for senior citizen insureds in Gujarat. Most complaints will get time barred for complaints under CPA 1986/2019 [if decision is not satisfactory] putting further loss to insureds for no fault on their part and undue gain to insurance companies.

4. Such pendency also undermines Central and State Govt’s Insurance Covers to masses under welfare measures initiated by Hon’ble Prime Minister.

5. This being pitiable condition of IOA, while I am sure ECOI and IRDAI are capable to resolve it in the interest of insureds, I humbly suggest that even after posting permanent IOA latest by Aug 2019-end, the visiting IO should continue for few days in a week/fortnight at Ahmedabad till pendency is reduced to 180 days if not mandated 90 days as per IO Rules.

6. Alternatively, I suggest that complaints of senior citizens should be separately listed for priority hearing and disposal by IOA and 1 or 2 days in a week/fortnight should be exclusively reserved for hearing and disposal of complaints of insureds who are senior citizens at the time of filing. The life time of senior citizens is fast running out.

7. Please take suitable action urgently specially for AIO.

8. To make IO Scheme more user friendly and effective, I also suggest:

a] appeal mechanism like Banking Ombudsman,

b] on line filing of complaints and video or audio hearing on mobile like CIC/some SICs [Digital initiative of Central Govt and ease of living]. CPA will fully go online shortly as per new CPA 2019 BILL.

c] Provision of Internal Ombudsman [as prevailing in banks under RBI directives] for all Insurance Companies. This is successful in Banking Sector.

d] Circuit benches at various places other than State capitals.

e] President or Chairman of two leading NGOs working in consumer protection be included in Council of ECOI, as there is no representation of insureds at present in the Council.

I hope you will respect principle of “Ease of Living” as pronounced in today’s independence speech by hon’ble Prime Minister. This was also quoted by hon’ble Finance Minister in her budget speech of 2019.

Thanking you,

Yours faithfully,

J P SHAH

Copies by email to:

1. Insurance Regulatory and Development Authority of India

 Gachibowli,  Hyderabad – 500032        

e-mail: irda@irda.gov.in –with a request to kindly intervene in the interest of insureds, specially senior citizens

2. Secretary, Dept of Consumer Affairs, Ministry of Consumer Affairs, food and public distribution, GoI, New Delhi Email: secy-ca@nic.in

--Consumers of Insurance Cos are adversely affected.

3.  Secretary, Dept of Financial Services, Ministry of Finance, GoI, New Delhi  Email: secy-fs@nic.in  -Please expedite solution.

4.  Secretary,  Dept of Social Justice and Empowerment, Ministry of Social Justice and empowerment, GOI, New Delhi  email: secywel@nic.in               Please intervene as senior citizens  are affected adversely

5. Consumer Education and Research Centre, Thaltej, Ahmedabad-380054

EMAIL: cerc@cercindia.org

FRAUDS AT BANK ATMs

15-04-2019

Please refer following link in connection with cash withdrawal at ATM without debit card:

https://economictimes.indiatimes.com/wealth/save/heres-how-you-can-withdraw-cash-without-using-credit-or-debit-card-at-these-3-banks-atms/articleshow/68811216.cms?from=mdr


This was suggested to RBI on 19-04-2015 by me and after long follow up RBI forwarded to NPCI and after my chasing RBI/NPCI to implement or show reasons why it cannot be implemented, it has been NOW implemented for three banks [may be on trial and to gain experience before all banks are made to follow], with minor changes to my suggestion. This system will stop ATM frauds by cloning of card and skimming PIN number. A OTP received on phone will ensure full safety of customers money.

I reproduce first letter dated 19-04-2015 addressed to RBI:

Date: 19-04-2015             by email and posted on website of RBI

To,

Chief General Manager
Consumer Education and Protection Department
Reserve Bank of India
1st Floor, Amar Building, Sir P.M. Road,

Mumbai-400 001

Email: helpdoc@rbi.org.in

Respected Sir,

Subject: Suggestion for Safety of ATM Transactions

For on line payment by debit/credit cards customers get One Time Password [OTP] on registered mobiles before making payment. I suggest that same system be adopted for ATM cash withdrawals. Customers should send particular SMS message [say “ATM”] from registered mobile to a particular number given by bank. In few minutes customer should get SMS informing him of OTP, which should be valid for 15 minutes. Cash should be dispensed only when OTP is keyed in ATM, in addition to PIN. This will stop ATM frauds by cloning of cards and skimming of PINs.

I handled similar fraud case of my friend and it took one year for SBI to refund the amount, after prolonged correspondence from Branch up to Chairperson, 7 RTI applications and three first appeals. Hence this suggestion.

Yours faithfully,

J P Shah.

VACANT POSTS OF INSURANCE OMBUDSMAEN

EMAIL

To,  Secretary General, ECoI,

inscoun@ecoi.co.in

consumerfeedback@@irda.gov.in

VACANT POSTS OF INSURANCE OMBUDSMEN

08-03-2019

Above posts are vacant at Ahmedabad, Bhubaneshwar, New Delhi, Kolkatta, Lucknow, Gautam Buddh Nagar,  Patna and Pune totaling to eight posts as per your website. This causes delay and insured/claimant may lose claim amount if claim becomes time barred at Consumer Forum due to delay if the decision of Ombudsman is against him. I humbly request to kindly fill-in vacant posts of Insurance Ombudsman to ensure “achhe din”

INTERNAL OMBUDSMAN [IO] SCHEME- SUGGESTION

Date: 06-09-2018

To,

Chief General Manager,

Reserve Bank of India,

Consumer Education and Protection Dept

Sir P M Road, Mumbai 400001

Email: helpdoc@rbi.org.in

Dear Sir,

INTERNAL OMBUDSMAN [IO] SCHEME- SUGGESTION

Under extant above scheme, the complainant has no access to IO. Bank is supposed to invariably forward rejected/partly rejected complaints to IO. The complainant is not even informed of reference to IO, unless he resorts to RTI Act. This provision of scheme facilitates Bank’s lower level officer not to refer complaints to IO.

In one of the complaints of my relative against PSB, the matter does not appear to have been referred to IO, till receipt of RTI application seeking interalia information on reference to IO.

If complainant is not informed of reference to IO or pending with IO, customer may proceed to BO/Consumer Forum, which will frustrate one of the aims of above scheme.

My humble suggestions to make aforesaid scheme effective and really customer-centric are as under:

1. Public should be informed of IO [name, designation, postal address and email ID] through bank’s website/passbook or monthly statement of account/notice board at branches.

2. Whenever GM/PNO refers complaint to IO, copy of covering letter should be marked to complainant.

3. IO should provide opportunity for hearing [by mobile/phone] or written submission of complainant. My relative had received mobile call from IO when he was deciding the complaint.

4. Condition that customer can approach BO only after complaint is decided by IO, be deleted. This is anti-consumer and restrictive.

5. Time limit be fixed for reference to IO by bank and for IO to decide, or else complaint may be time-barred at BO level/consumer forum.

6. Decision of IO should necessarily be signed by IO.

7.  At present Bank’s executive acts as IO.  Retired General Manager/Executive Director of other Bank or retired Judicial Officer may be considered as IO to avoid conflict of interest. Such IO be paid per complaint decided by him.

In the present form, the scheme will not be of any effect nor enjoy confidence of public. It will be just one more layer in grievance handling mechanism and cosmetic.

Please consider suggestions positively.

Yours faithfully,

J P Shah

DENTAL SURGERY IN DENTAL CLINIC AS DAY CARE PATIENT- INSURANCE COVER UNDER IBA GROUP POLICY FOR RETIREES

DENTAL SURGERY IN DENTAL CLINIC AS DAY CARE PATIENT- INSURANCE COVER UNDER IBA GROUP POLICY FOR RETIREES

                                      Guidance Note

            Large number of bank retirees are having doubt if dental surgery/treatment performed / taken in a private dental clinic [not hospital] under day care is covered by IBA Group Insurance Policy or not. In most of cases such claims are denied by TPA/Insurance Co as treatment is not taken in a hospital. My humble opinion is that such claims are payable even if treatment/surgery is taken/performed in a private dental clinic, subject to following conditions, based on clauses 2.9, 2.10 and 3.3 of insurance policy:

01. Treatment /surgery should be administered/performed by a qualified and registered doctor [say BDS/MDS etc]

02 Clinic should be registered with local municipal authorities, wherever it is legally required to register.

03. It could be a department of a registered hospital rather than stand alone facility/unit.

04. It should have qualified nurses.

05. In-charge of Unit should be qualified in dentistry [say BDS/MDS].

06. Unit should have fully equipped operation theatre of its own where surgical procedure is carried out.

07. Unit should maintain daily record of patients which should be made accessible to Insurance Co staff.

08. Medical treatment and surgical procedures are covered.

09. Treatment/procedure should be done with local or general anesthesia.

10. Treatment/procedure should be done in a dental clinic or day care centre. Dental clinics are treated as day care centre in my opinion.

11. Treatment/procedure may require less than 24 hours due to technological advancements in medical treatment of diseases. Hence visits for treatment/procedure for few hours per day on various different days should be covered.

12. But for technological advancements, the treatment/procedure/surgery would have required hospitalization of more than a day.

13. Treatment taken as OPD patient will not generally be covered.

14. List of treatment/procedure at clause No. 7 of insurance policy covers dental surgery.

15. It is advisable to obtain attached certificate along with Form-B of claim form, self attested photocopy of treating doctor’s final degree certificate and municipal registration license of day care centre/clinic, whenever dental treatment is taken in a private dental clinic as day care patient.

[Compiled for guidance of bank retirees by J P Shah, RTI & Consumer Activist]

Blog: www.jps50.blogspot.in                                                                    12022018

                       

Format of certificate…………….

   

                                                             CERTIFICATE

                                    This is to certify that following patient has undergone dental treatment/surgical procedure in this clinic /day care centre for his dental disease:

Name of patient:                                                              Gender & Age of patient:

Address of patient:                                                           Patient No:

Particulars of disease:

Details of treatment /procedure:

Period of treatment / procedure:

Dates of visits to dental clinic/centre             Arrival Time                Period [in hours]

a.

b.

c.

Total amount charged as per details in bill: Rs.__________

Treatment / procedure was administered/performed by a doctor qualified in dentistry, assisted by qualified nurses, under local anesthesia. He was day care patient for this day care centre/clinic and NOT out door patient.  This centre/clinic is registered with municipal authorities.

Rubber stamp:                                                                        SIGNATURE OF TREATING DOCTOR

                                                                                    Name:

Date:                                                                           Qualifications:

Countersign:                                                                Registration No:                     

In-charge Doctor of day care centre / clinic [if not treating doctor]