If you are part of a group insurance scheme provided by your employer, make sure that the premium is being paid regularly and on time.
Check from your salary account whether the premium is being deducted without fail, and make sure that the policy is always kept alive, without any break. There have been many instances of employees being denied the benefit of the insurance policy, only because the employer forgot to pay the premium.
In fact, in a number of such cases, the policy-holders or the beneficiaries have had to seek the help of the consumer courts to get what was due to them. In DESU vs Basanti Devi (CA No 6113 of 1995, decided in 1999) and Chairman, LIC vs Rajiv Kumar Bhaskar (CA NO 6028 of 2002, decided in 2005), the insurer repudiated the claim of the beneficiaries of the 'Salary Savings Scheme' on the ground that the employer had failed to pay the premium deducted from the salary of the employee.
In both these cases, the Supreme Court asked the insurance company to pay the insured amount. It held that the employer was acting as the agent of the insurance company in collecting the premium from the employee and remitting it to the account of the insurer. Since the employer, as the agent, had failed to pay the premium, the insurance company, as the principal, had to take responsibility.
In Central Coalfields vs Bandana Mishra (RP NO 702 of 2005), where the employer had taken a group insurance scheme on behalf of all the employees and signed a MOU with Oriental Insurance, the National Consumer Disputes Redressal Commission held that the Coalfields liable for not paying the premium on time and directed it to pay the widow, the full insured amount along with interest.
More recently, the parents of a student (following his death in a road accident) had to wage a long legal battle to get the insurance amount promised under a student insurance policy, only because the college had not remitted in time, the premium collected from the student.
The National Commission directed the insurance company to pay the insured amount (National Insurance vs DAV (PG) College (RP NO 2095 of 2009, decided on January 10, 2012).
Archana Jain: I became a member of the Delhi Government Employee Health Scheme in 2006, when I joined a Delhi government hospital as a doctor. The contribution was being deducted from my salary. Last December, I was taken aback when my application for reimbursement of a medical bill was rejected on the ground that my contribution had been stopped from March 2009. My letters questioning the discontinuation without any intimation to me is not being answered. I now hear that this has happened on account of an error in the computer software and probably I am not the only sufferer. What can I do? Answer: As a first step, I would suggest that you file an application under the Right to Information Act, seeking details on how or why your contribution was stopped without your consent and your membership discontinued.
Armed with this information, demand that your medical bill be reimbursed and your membership of DGEHS restored without any break. If it is not done, I would suggest that you file a complaint before the consumer court.
I also notice that the Delhi government website on the DGEHS Scheme says that "Membership of the scheme is compulsory for all Delhi government employees". If that is so, how can your membership be discontinued as long as you are an employee of the Delhi government? That is also a point in your favour.