Tuesday, October 30, 2012
inappropriate influence of insurers, and the exchange staff’s decision not to negotiate with insurers to get the best value for customers. Through negotiation, MA’s exchange has been able to keep the rate of premium increases to half what it is outside their exchange. However prices in Utah’s exchange, which does not negotiate with insurers as CT’s exchange is planning, are actually higher than prices outside the exchange. CT’s exchange is being set up by the state, with millions in federal grants, to help consumers get decent, affordable coverage and is expected to purchase on behalf of one in ten state residents. As of Jan. 1, 2014, everyone in CT will be required to have coverage. Residents who qualify for federal affordability subsidies will have to buy their insurance through the exchange. Check back at the CT Health Policy Project’s site soon for a brief on the benefits for CT consumers, promoting value and affordability, through negotiation on CT’s exchange.
Posted by Anggun Orizah at 6:15 AM
Friday, October 26, 2012
INTRODUCTION This project has been an eye opener for me. It is extremely relevant to the modern times and as the future of India we should understand that it is the common mass that runs the country. Consumer protection rights are an important issue in modern days. The law can be effectively used to stop any abuse of the common people especially illiterate masses who do not understand the rules and regulations which is to be followed while buying particular item. It is law, the controller of the entire society which can stop this abuse from taking place. It can place effective standards guiding a product's genuinity and the proper verification of its price. No extra taxes should be issued according to the seller's wish. I have proceeded by referring to the books written by Avtar Singh, Venkat Rao and others. It has been a wonderful and educational delight in going about this topic and making a project which is of greatest importance in the present day scenario. DEFINITION OF CONSUMER The words "consumer", "consumed", "consumption" is all cognate, and when one is defined, the contents of the definition go into all of them wherever they occur in the same act. Section 2 of the act wherein 'consumer' is defined. According to him, the definition of the consumer will not take a client who engaged the advocate for professional services. Consumer means any person who- - Buys any goods for a consideration which has been paid or promised or partly paid and partly promised or under any system or deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly promised or under any system of deferred payment when such use is made with the approval of the person, but does not include a person who obtains such goods for resale or for any commercial purpose - Hires or avails of any services for a consideration which has been paid or promised or partly paid or partly promised or under any system of deferred payment and includes any beneficiary of such services other than the person who hires or avails of the services for the consideration paid or promised or partly paid or partly promised or under any system of deferred payment when such services are availed of with the approval of the first mentioned person but does not include a person who avails of such services for any commercial support In Black's Law Dictionary it is to mean: One who consumes. Individuals who purchase, use, maintain or dispose of products and services. A member of that broad class of people who are influenced by pricing policies, financing practices, quality of goods and services, credit reporting debt collection and other trade practices for which the state and federal consumer laws are enacted. OBJECTVES OF THE ACT The act is dedicated, as its preamble shows, to provide for better protection of rights of consumers and for that purpose to make provisions for the establishment of consumer councils and other authorities for settlement of consumer disputes and for other connected matters. In the statement of objects, reasons it is said that and the act seeks to provide speedy and simple redressal to consumer disputes. Quasi judicial body machinery has been set up at the district, state and central levels. These quasi judicial bodies have to observe the principle of natural justice and have been empowered to give relief to a specific nature and to award, wherever appropriate, compensation to consumers. Penalties for non compliance of orders given by quasi judicial bodies have also been provided. The object and purpose of rendering the act is to render simple, inexpensive and speedy remedy to consumers with complaints against defective goods and deficient services and for that quasi judicial machinery has been sought to be set up at the district, state and national levels. These quasi judicial bodies are required to apply the principle of natural justice and have been empowered to give relief of specific nature and appoint wherever necessary, compensation to consumers. INSURANCE An operational definition of insurance is that it is - the benefit provided by a particular kind of indemnity contract, called an insurance policy; - that is issued by one of several kinds of legal entities (stock company, mutual company, reciprocal, or Lloyd's syndicate, for example), any of which may be called an insurer; - in which the insurer promises to pay on behalf of or to indemnify another party, called a policyholder or insured; - That protects the insured against loss caused by those perils subject to the indemnity in exchange for consideration known as an insurance premium. The influence of insurance on the law of torts has been significant, both on theoretical level and on practice. Insurance has undermined one of the two main functions of awarding of damages, and it has in cast doubt on the value judgements made by the courts in determining which particular test of liability is appropriate in the given circumstances. Regardless of whether in the particular circumstances the appropriate principle of liability is intention is malice, fault or strict liability, the purpose of common law damages remains the same. The primary purpose of an award of damages is to compensate the victim for his loss, with view to restoring him as near as possible to the position he would have been in but for the tort of the wrongdoer. But damages have another: by making the wrongdoer responsible for meeting an award of damages, the courts are trying to deter others from committing similar tortuous wrongs. Insurance vitiates the secondary purpose of damages, at the same time incidentally ensuring that the primary purpose is more often achieved. It can scarcely be realistically asserted that insured defendants are deterred by the prospect of losing no-claims bonus or by increasing of premium on renewal of their policies. Once it is conceded that insurance renders compensation for the sole purpose of damages but then the tort action itself becomes vulnerable to attack, for there are many ways-some perhaps fairer and administratively cheaper than tort- of compensating a victim for a loss he has suffered. Prima facie, where a person suffers loss of recognized kind as the result of another's act, then the latter should have to make good that loss. But for valid reasons, the courts have held that, in certain circumstances, the actor will have to compensate his victim only if he is at fault. The victim's right to compensation is, therefore curtailed in an attempt to be fair to both the parties. The courts have made a policy decision that, in the circumstances, it is right to reward a defendant who has been careful by protecting him from liability for the consequences of his actions and that, as a corollary the plaintiff must forego his compensation. The policy decision is made on the supposition that the wrongdoer would himself have to pay for the damages but for this protection; it by no means follows that the same decision would be made if there were no risk of the wrongdoer having to provide the compensation. It is difficult to judge the victim's right to compensation should be curtailed when that curtailment is not justified by a corresponding benefit to the wrongdoer. The requirement of fault ceases to play its role as the leveler between the victim's legitimate expectations and the wrongdoer's legitimate expectations, and becomes simply a hurdle to the victim's progress to compensation. If it is accepted that no one can insure against liability for harm caused by intentionally to another , then similar arguments can be made by the inappropriateness of the victim's having, in certain circumstances to prove an intention to do him wrong or harm, when it is irrelevant to the wrongdoer whether he had such an intention or not. Again the victim's right to compensation is being curtailed without any corresponding benefit to the wrongdoer. However, insurance has influenced the law of tort on a much more practical level as well. While the fact of insurance is not of itself a reason for imposing liability , there can be no doubt that it does add "a little extra tensile strength" to the chain which a wrongdoer to his responsibilities. As well it has given new horizon to damages ; it is true that traditionally it was considered to inform the court that a defendant was insured , but "those days are long past" and now it is frequently openly recognized that the defendant would be insured. The policy of insurance constitutes a contract of insurance between Life Insurance Corporation or a subsidiary of General Insurance Company of India, as the case may be, such services such has been undertaken to render under the contract of insurance. However as a rule, occasion to render services arise only when insured surrenders his policy, or the policy matures for payment or the insured dies or any other contingency which gives rise to render service occurs. Breach of contract of insurance may give rise to a cause of action to file a civil suit, but such breach of contract may itself constitute deficiency in service, so as to give a cause of action to file a complaint under the consumer protection act for one such more relieves awardable hereunder. Section 13(4) of the act vests in a redressal agency powers of the Civil Court, while trying a suit in respect of such matters as examination of witnesses on oath and production of documents. Declining to exercise jurisdiction in a case before it only because it involves examination and cross examination of facts, witnesses and production and consideration of documents would amount to abdication of its jurisdiction. Such discretion can be exercised only when the gives rise to several issues and necessities taking of voluminous oral and documentary evidence, or otherwise involve complex questions of fact and law which cannot be decided in time bound proceedings under the consumer protection act. MOTOR VEHICLE INSURANCE Where the sale of a vehicle is complete, the title therein passes to the purchaser notwithstanding that his name has not been recorded in the R.C.Book. Such owner is entitled to get his vehicle insured and also to maintain a claim on the basis of such insurance. The earlier owner, who has lost insurable insurance on the sold vehicle, cannot advance a claim on the basis of policy of the said vehicle, earlier taken by him, on the ground that he is still the recorded owner of the said vehicle. Section 157 of the motor vehicles act is only in respect of third party risks and provides that the certificate of insurance described therein shall be deemed to have been transferred in favour of the person to whom the motor vehicle is being transferred. It does not apply to other risks, if any, covered by the policy. If the transferee wants to avail the benefits of other risks covered by it, he has to enter into an agreement thereof with the investor. FRAUD BY INSURER If it is established that the discharge voucher was obtained by fraud, misrepresentation, undue influence or coercive bargaining or compelled by circumstances, the authority of the consumer forum may be justified in granting relief. Mere execution of the discharge voucher would not deprive the consumer of his claim in deficiency of service. DELAY IN SETTLEMENT OF CLAIM In Sarveshwar Rao v. National Insurance Company Ltd. , it was held that the delay of two or more years in settling the insurance claim would result in inadequacy in the quality, nature and manner of the service which the insurance company has undertaken to render, and amounts to deficiency in service. In Delkon India Pvt. Ltd. V. The Oriental Insurance Company Ltd. . The National Commission has held that it was a deficiency of service to have delayed the claim by two years on the ground that the final police report was not coming. INTERPRETATION OF TERMS In Skandia Insurance Company v. Kokilaben Chandravadan , the honorable Supreme Court ruled that the exclusion terms of the insurance must be read with so as to serve the main purpose of the policy, which is to indemnify the damages caused to the vehicle. CONDUCT OF THE INSURER In Oriental Insurance Co. Ltd. V. Mayur Restaurant and bar , the conduct of the insurer was under question. The commission held that deficiency of the service was established on the part of the opposite party on two counts i)delay in settlement of claims and ii) unreasonable and un maintainable reasons for repudiating the claim of the complainant, and the compensation with the interest and cost was awarded. SUICIDE BY THE ASSURED In Life Insurance Corporation v Dharma Vir Anand, the national commission refused to hold the insurance commission liable as the insured committed suicide before the expiry of three years from the date of the policy. BREACH OF TERMS In B.V.Nagarjuna v Oriental Insurance Company Ltd., the terms of insurance contract permitted the insured vehicle to carry six passengers at a time but the driver allowed two more persons to get in. It was held that merely adding two more persons without the knowledge of the driver did not amount to indemnification by the insurance company. NOMINEE'S RIGHTS In Jagdish Prakash Dagar v. Life Insurance Corporation , it was held that a nominee under a policy of life insurance will be a consumer within the meaning of section 2(1) (d) of the Consumer Protection Act. The commission held that the nominee could legislatively maintain an action against deficiency raised in service by the arbitrary decision of the insurer. REPUDIATION Repudiation is defined as the renunciation of a contract (which holds a repudiator liable to be sued for breach of contract, and entitles the repudiatee on accepting the repudiation to treat the contract as at an end This concept of repudiation is needed in the concept of insurance. The concept of repudiation will be dealt hereto a number of times and to provide beneficiary evidence, the definition has been given. Unilateral repudiation of its liability, under the contact of by the life insurance corporation or an insurance company does not, by itself oust the jurisdiction of a redressal agency, to go into the sustainability of such repudiation, on facts and in law and to decide and to adjudicate if, in the facts of the case, it amounts to deficiency in service or unfair trade practice, and if so, to award to the aggrieved person, such relief or reliefs under Section 14(1) of the said Act as he or she is entitled to. The fact that before such repudiation it obtained a report from a surveyor or surveyors also does not oust the jurisdiction of a redressal agents to into the merits of such repudiation, for otherwise in each case the corporation or such company, and deprived the aggrieved person of the cheap and expeditious remedy under the consumer protection act. Where, however the corporation or the company conducts thorough investigations into the facts which have given rise to claim and other associated facts, and repudiates the claims in good faith after exercise with due care and proper application of mind, the redressal agency should decline to go into the merits of such repudiation and leave the aggrieved person to resort to the regular remedy of a suit in a civil court. The law does not require the life insurance corporation or an insurance company to accept every claim good or bad, true or false, but it does require the corporation or the company to make a thorough investigation into such claim and to take decisions on it, in good faith, after exercise of due care and proper application of mind and where it does so it renders the service required by it and cannot be charged with deficiencies in service, even if, in the ultimate analysis, such decisions is wrong on the facts and in law and the redressal agency would be disinclined to substitute its own judgement in the place of the judgement of the corporation or insurance company. The question as to whether repudiation of its liability does or does not amount to deficiency in service would depend upon the facts of each case. Where a cheque sent towards a premium is dishonoured by the drawee bank and consequently the policy is cancelled or it lapses or the injured dies before the proposal is accepted and contract of insurance results, no claim can be founded in such a policy, which was cancelled or has since lapsed, or a contract of insurance, which did not materialize at all. Repudiation of such claim can never amount to deficiency in service. Insurance agent is not entitled to collect premium on behalf of the corporation. Where an insured issues a bearer cheque towards premium and hands it over the insurance agent who encashes it, but does not deposit the premium with the corporation event till the expiry of the grace period and consequently the policy lapses and meanwhile the insured also dies, his nominee has to blame himself or herself for the indiscretion of the insured and cannot blame or fault the corporation. BASIC PRINCIPLES OF INSURANCE There are some basic principles concerning the topic of Consumer Protection Law and Insurance. - Settlement of insurance claim is service, default or negligence therein is deficiency of that service In the case of Shri Umedilal Agarwal v. United India Assurance Co. Ltd, the National Commission observed as under: "We find no merit in the contention put forward by the insurance company that a complaint relating to the failure on the part of the insurer to the settle the claim of the insured within a reasonable time and the prayer for the grant of compensation in respect of such delay will not within the jurisdiction of the redressal forums constituted under the consumer protection act. The provision of facilities in connection with insurance has been specifically included within the scope of the expression "service" by the definition of the said word contained in section 2(i) (o) of the act. Our attention was invited by Mr. Malhotra, learned counsel for the insurance company to the decision of the Queen's Bench in national transit co. ltd. V. customs and central excise commissioners . The observations contained in the said judgement relating to the scope of the expression insurance occurring in the schedule of the enactment referred to therein are of no assistance to all of us in this case because the context in which that expression is used in the English enactment considered in that case is completely different. Having regard to the philosophy of the consumer protection act and its avowed object of providing cheap and speedy redressal to customers affected by the failure on the part of persons providing service for a consideration, we do not find it possible to hold that the settlement of insurance claims will not be covered by the expression insurance occurring in section 2(1)(d).Whenever there is a fault of negligence that will constitute a deficiency in the service on the part of the insurance company and it will perfectly open to the concerned aggrieved customer to approach the Redressal Forums under the act seeking appropriate relief." - L.I.C. Agent has no authority in collecting the premium The supreme court held that under regulation 8(4) of life insurance corporation of India (agents) regulation, 1972 which had acquired the status of life insurance corporation agents rules with effect from January 31, 1981, which were also published in the gazette, LIC agents were specifically prohibited from collecting premium on behalf of LIC and that in view thereof an inference of implied authority cannot also be raised. - Rejection of claim as false after full investigation The national commission held as follows: " from the facts disclosed by the record and particularly averments contained in the consumer affidavit filed by the first respondent it is seen that the insurance company had fully investigated into the claims put forward by the complainant that his claim was rejected. Thus it is not a case where the insurance company did not take a prompt and immediate option for deciding the claims against the insurance company. Having regards to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a civil court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out the commission for local inspections etc. and have an elaborate trial of the case." - Unilateral reduction in the insurance amount. The national commission held that the insurance company is not entitled to make a unilateral reduction of Rs. 4, 29,771 from Rs. 30, 12,549 at which its own surveyor assessed the loss. - Mere repudiation does not render the complaint not maintainable. The national commission overruled the objection of the insurance company that merely because the insurer had totally repudiated its liability in respect of the claim, no proceedings could validly be initiated by the insured under the consumer protection act. - Mere unilateral repudiation does not oust the jurisdiction. The national commission held that merely because the insurer has repudiated the insurance claim under the policy unilaterally, it is difficult to hold that the various redressal forums constituted under the consumer protection act, 1986 will have no jurisdiction to deal with the matter that if such a contention of the insurance company can get a report from the surveyors, repudiate the claim and oust the jurisdiction of the redressal forums, that the redressal forums are, therefore, bound to see whether or not the repudiation was made in good faith on valid and justifiable grounds that if the surveyor or surveyors choose to submit the wrong report and the insurance company repudiates the claims without applying its mind then the repudiation cannot be said to be justified that the report of the surveyor will show that the investigations have been proper, fair and thorough and that it has to be remembered that the surveyors bread comes from the employer. - Mere unilateral repudiation no ground to oust jurisdiction. The national commission repelled the objection and observed as under: "Ordinarily a remedy is available to a consumer in Civil Court but mere repudiation of claim arising out of policy of insurance under section 45 of the insurance act, 1938, cannot take away the jurisdiction of the redressal forum constituted under the act. The avowed object of the act is to provide cheap, speedy and efficacious remedy to the consumers and it is with this object that section 3 of the act lies down as follows: 3. Act not in derogation of the provisions of any other law: - the provisions of this act shall be in addition to and not in derogation of the provisions of any other law for the time being in force." The national commission overruled the objection in the view of repudiation of contract of insurance by the corporation; the redressal agencies under the act cannot entertain the claim of the insured and reiterated the law laid down by it in the Divisional Manager, Life insurance Corporation of India, Andhra Pradesh v. Shri Bhavnam Srinivas Reddy. - Removal of insured goods on attachment no theft. It was ruled in the stated case that attachment of certain items of insured Machinery and goods by the bailiff of a civil court, though later found to be illegal and consequent removal did not amount to theft and or house breaking by force so as to entitle the insured to prefer a claim under the policy. - When repudiation amounts to deficiency and when it does not? The national has held: In M/s Rajdeep Leasing and Finance and others v. New India Assurance Company Limited and others - That rejection of the claim by the insurance company after examining and considering the two separate survey reports from qualified surveyors and three legal opinions from different oriental counsels could not be said to constitute a deficiency in service so as to give a rise in the cause of action for a complaint under the consumer protection act. In Oriental Insurance Co. Ltd. V Modern Industries Ltd. , the national commission has held that where the cover note inter alia mentions that the risk is subject to the usual terms and conditions of the standard policy, it is equally the responsibility of the complainant to call for these terms and conditions even if they are not sent by the insurance company, as alleged, to understand the extent of risk covered under the policy and associated aspects. In Life Insurance Corporation of India v. Dr. Sampooran Singh The complainant had taken out an insurance policy of 40,000 rupees in 1982, for the purpose of payment of estate duty on his only residential house in chandigarh in the event of his death and paid 5 premia, but with the abolition of estate duty on one residential house owner in 1985, the policy became inoperative due to the act of the state and not due to any deficiency on the part of the corporation any dispute between the parties as to the amount payable there under cannot be construed as deficiency in service on part of the corporation. In LIC of India v M/s Kanchan Murlidhar Akkalwar The complainant applied to the opposite party for housing loan, and on the advice of the latter, she took two LIC policies, one for Rs. 90000 and the other for Rs. 20000 entered into an agreement for the purchase of the house with the house with the owner on the advice of the opposite party obtained a fire policy for Rs. 2 lakhs. The opposite party advised the complainant to obtain a release deed from the zilla parishad co operative society in respect of the she proposed to purchase with a certificate that the said plot is not mortgaged therein. The complainant got a certificate from the Maharashtra government that the vendor had re paid the housing loan and interest thereon due to Zilla Parishad Krishi Karmachari Sehakari Gribe Narman Sanstha and that there was nothing outstanding from him towards loan amount or interest. Still the opposite party did not release the loan. On these facts the national commission by its majority judgement observed that: "We have carefully gone through the records and heard the counsel. Clause 1 (c) of the loan offer letter clearly states that the advance of the loan is subject to the property being free from encumbrances to the satisfaction of the insurance company and a good and marketable title. At the same time it appears that the respondent-complainant had to go through a number of steps, although necessary, having financial implications and causing mental and physical stress to her and at the end of all of which she was told that no dues certificate given by the maharashtra government in respect of the prospective seller of the property in question, was not "release of mortgage" certificate that was obtained. The respondent complainant perhaps also had in her mind the case of Mr. Vaishempayam who got the loan under similar circumstances. Thus the evasion petition is disposed of as above." CONCLUSION This project topic is increasingly beneficial in the modern times with the consumer protection rights being redressed with due care. It is being advertised in the mass media in our country. The slogan which our consumer is using is: "JAGO GRAHAK JAGO". The time has come to realize the ideal market situation in which the buyers are not persuaded or coerced falsely into buying items which are of no use to them at all. Besides the relationship between buyer and seller should not be damaged at any cost. The relationship between the buyer and seller is said to be a fiduciary relationship and the trust between them should remain intact. A time has come in which the customer should get his proper position in the market conditions. He has to have proper knowledge about what is going on in the market and the concerned prices and the supply and the different other practices referred to. Insurance is a very sensitive issue in the modern times. People are being hoodwinked into signing up in companies which are turning out to be frauds in the true sense of the term. This project has been an eye opener to me and I have come to realize the importance of the consumer protection act and insurance.
Posted by Anggun Orizah at 6:30 PM
Wednesday, October 17, 2012
Staff of the CT Health Insurance Exchange have “opted to utilize an ‘any qualified plan’ approach” for determining which plans can be offered in the exchange. Proposed qualifications are minimal and generally only what is required by the Affordable Care Act. This decision is counter to the CT exchange’s own research. According to the market consultants, “One of the most attractive aspects of the Exchange is that the big insurance companies compete for their business. The feature evoked references to Lending Tree’s slogan ‘When banks compete you win.’” Utah’s health insurance exchange has pursued an “any qualified plan” approach, similar to CT’s staff proposal, and has attracted little enrollment with no evidence of cost control. Massachusetts’s Connector, on the other hand, operates with an active purchasing approach – negotiating with insurers to get the best price and quality for consumers. Annual premium increases for plans in Massachusetts’s exchange have been half the increase of plans outside the exchange. Starting in 2014, every CT resident will be required to secure health coverage. Over 150,000 state residents will have to buy it in the exchange to get federal affordability subsidies. According to the staff memo, the decision not to negotiate on behalf of consumers has been made and they are only taking comment on how to implement that policy. The memo was delivered Monday to the Qualified Health Plan Committee that no longer includes a consumer representative due to the unfortunate loss of Jennifer Jaff.
Posted by Anggun Orizah at 3:52 AM
Tuesday, October 9, 2012
Once again, CT health care thoughtleaders give our state a C+ on health reform. From the beginning of the CT Health Thoughtleaders Survey in February, CT has varied between C and C+. CT has always received a B for effort. In good news, grades for the CT Health Insurance Exchange improved since June with fewer D’s and some A’s in this survey. Unfortunately, grades for Engaging Consumers in Policymaking and Data-based Policymaking have fallen. The former was the most common recommendation from thoughtleaders to improve progress toward reform. The overwhelming response was to engage consumers in policymaking – increase consumer voices, greater public engagement in the process, and engage advocates. Other suggestions included smarter policymaking (data, best practices), improve communications and transparency, convene stakeholders to build trust, and guard against conflicting financial and special interests. New questions in this survey found that almost all thoughtleaders are somewhat or very engaged in the process of reform, however all but four cite barriers to engagement. Understanding how critical stakeholder engagement will be to success, policymakers should work to improve effective, meaningful access to the process. A disturbing number of respondents have not been asked, or have tried but found few ways to participate. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.
Posted by Anggun Orizah at 4:37 AM