BRIEF NOTE OF ARGUMENT CC-354-2022

A written brief note of argument by the complainant in colloquial language.

Most Respectfully Showeth:

1. The Insurance Company (Insurer) selling Health Insurance Policies has listed its Terms & Conditions thus they are the subject matter expert.
2. Every representative of the Insurance Company is officially expected to follow the Terms and Conditions prior to making a promise to the insuree.
3. The promise in writing on 17 Nov 2020 has been made to deliberately mis-sell the policy and exploit the insuree by not disbursing the promised amount once the sale is completed.
4. The Insurer lied to Insurance Ombudsman. Insurance Ombudsman Complaint Number — KOL-H-018–2122–0878 and Insurance Ombudsman Award Number — IO/KOL/A/HI/0036/2022–2023.
5. A copy of the verdict of the Insurance Ombudsman has been submitted to the Consumer Dispute Redressal Commission. Request you to check page 3, Contention of the Respondent, Complaint No 1 Repudiation of Health Checkup Claim, Point (vi).
6. Lying to a Central Government Statutory Body Insurance Ombudsman on Records is likely a Perjury/Forgery Criminal Offence.
7. The Government of India promotes Insurees to approach the Insurance Ombudsman before visiting Consumer Dispute Redressal Commission.
8. This is an appreciable strategy for managing the volume and pendency of cases by addressing as many cases as it could at the level of the Insurance Ombudsman.
9. I believe it is the moral obligation of the Consumer Dispute Redressal Commission to take into account Insurer perjury/forgery offenses wrt the Insurance Ombudsman which is burdening the Consumer Dispute Redressal Forum.
10. A complaint has been made by the Insuree to the Insurance Regulatory and Development Authority of India against the Insurance Ombudsman for not taking any action against the Insurer. IRDAI complaint number is 08–22–008408.
11. IRDA hasn’t taken any action, instead circles back to the Grievance Redressal Office of Insurer.
12. The Insurer doesn’t hold the authority to take action against the Insurance Ombudsman. The matter is circling to-n-fro on purpose to tire the complainant (Insuree) & sweep it under the rug.
13. IRDA’s ignorance in taking action against the Insurance Ombudsman and the Insurance Ombudsman’s ignorance in taking action against the Insurer has advanced those cases to the Consumer Dispute Redressal Forum piling to the volume of cases, pendency of cases and adding to the woes of Insuree.
14. The case is important because it is trying to uncover a systemic cavity exploited by Insurers (might be lobbying as well) against a large base of Insuree.
15. The cavity is related to exploitation by the planned statistical implementation as stated in the paper submitted, “Subject — Request to reconsider demanding 5000 Crore INR instead of the earlier amount of 50000 INR from HDFC ERGO as a relief on behalf of District Consumer Forum.” (Link)
16. The Insuree is not in a position to quantitatively investigate the stated statistical averment.
17. However, the qualitative observations can’t be outright denied either.
18. The Consumer Dispute Redressal Forum is requested to get the averment investigated by a competent authority like The Ministry of Statistics and Programme Implementation of the Government of India in the best interest of the insurees base across the insurance sector exploited for thrifty amounts.
19. If the Consumer Dispute Redressal Forum finds itself incapable in its Quasi-Judicial jurisdiction to order an investigation, I’d request to escalate the matter to the appropriate appellate.
20. The motive of the complainant (Insuree) is to eliminate such statistically planned thrifty but large volume of exploitations once and for all through this exemplary lawsuit such that the Insuree can rescue himself and a large base of Insurees across the insurance sector from being the prey in similar exploitive traps in the future, drawing away a fragment of the burden of thrifty amount lawsuits from the shoulder of the legal system (Consumer Dispute Redressal Commission and Civil Court) in our populated country India. Economic Times Article, Govt asks IRDA & insurance cos to address six major concerns to reduce pendency of consumer cases. Read more at: https://economictimes.indiatimes.com/industry/banking/finance/insure/govt-asks-irda-insurance-cos-to-address-six-major-concerns-to-reduce-pendency-of-consumer-cases/articleshow/97733096.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
21. Though the Insurance Ombudsman, IRDA, Consumer Court, Appellate, and District Courts are positioned under different ministries in the government of India yet the complainants’ expectation and sole objective from these Regulatory, Quasi-Judicial, and Judicial bodies are to receive justice within the stipulated time. So these departments shouldn’t be made a tool of tossing, tiring, and discouraging the complaint to sweep matters under the rug. One regulatory or legal entity’s failure should be seen as the failure of the legal system. The legal system should therefore collectively take appropriate corrective actions to restore the faith of the People of India in the legal system.
22. I’d request the Consumer Dispute Redressal Forum to take action in such a manner that it restores the sanctity of the Insurance Ombudsman and IRDA by escalating the issue with the respective Ministries in the Government of India to create collective consensus on such deliberate misdeeds resulting in harassment to the insuree across the insurance sector.
23. Failing to take such an action and instead reimbursing a 20% award of 2000 disputed amount that is 20000~50000 INR by the Consumer Dispute Redressal Forum won’t bring any systemic level change and thus the Insurer may once again deliberately put me and other insurees in a similar situation to continue exploitation by applied statistics.
24. The hassle to visit the Consumer Dispute Redressal Commission and the follow-up over the last 8 months wasn’t just for the meager 20000~50000 INR award but to bring a systemic change in the state of Insuree in the Insurance Sector.

The first in the series is, How effective is complaining to the Insurance Ombudsman and the Insurance Regulatory and Development Authority of India (IRDAI)? (Link)

Previous in the series is, Collection of Key Email Conversations with HDFC ERGO regarding Yearly Health Checkup Claim Repudiation. (Link)

Next in the series is, Suspected Discrimination with Plaintiff and undue favor to HDFC ERGO by Delay in Justice of CC/354/2022 CDRC Barasat. (Link)

A detailed copy of the litigation for public review

HDFC ERGO Health Insurance full body health checkup Claim Number RR-FC21–12734614. HDFC ERGO Optima Restore Health Insurance Policy number 2805203553540501. Insurance Ombudsman Complaint Number — KOL-H-018–2122–0878 and Insurance Ombudsman Award Number — IO/KOL/A/HI/0036/2022–2023. IRDAI complain no 08–22–008408. GRO HDFC ERGO Ref 57153289. Consumer Court eDaakhil reference number A22080005770 and case number CC/354/2022.