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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
A.P. Sahi, President
Steel Authority of India – Complainant
versus
National Insurance Company Ltd. – Opp. Party
Consumer Case No.616 of 2015
Decided on 16.5.2024
For the Complainant:Mr. Yashraj Singh Deora, Mr. Abhishek Singh and Mr. Priyesh Mohan Srivastava, Advocates
For the Opp. Party:Mr. Yogesh Malhotra, Advocate
IMPORTANT POINTS
(1) Oral Arguments cannot be accepted without there being any evidence led to the contrary.
(2) Tender – Medical facilities – Insurance Company cannot unilaterally reduce OPD reimbursement rates.
Headnote:
Tender – Deficiency in service – Extending medical benefits to all retired employees – Unilaterally reducing rate of OPD reimbursements – Refund of amount unjustifiably and unauthorizedly withheld by Insurance Company – Sole purpose of scheme is to comfort retired employees and reimburse them to a certain extent while availing medical facilities which is neither any profit not for benefit of complainant – Insurance company could not have altered rates of OPD facilities for the extended period of 3 months which had been agreed upon to be on same terms and conditions as disclosed in acceptance of contract – Insurance company was unjustified in reducing rate which amounts to clear deficiency in service by imposition of reduced rate for OPD reimbursement unfairly – There is no error in calculations and argument that claimants are put to strict proof of each and every entry made in the charts appended along with complaint is made in desperation without any document to contradict claims which could be placed by Insurance company itself – OPD claims were wrongly reviewed by Insurance company on their own unilaterally imposing revised rates of Rs. 2,000/- and Rs. 1,000/- respectively – Let sum of Rs. 2.68 Crores unjustifiably and unauthorizedly withheld by Insurance Company be released together with 9% interest thereon w.e.f. 1.4.2015.(Paras 26, 27, 28, 29, 31 and 32)
Result: Complaint allowed.
ORDER
The complainant in order to extend medical benefits in general to all its retired employees under a Mediclaim Scheme 2014 invited bids, for which Request For Quotation (RFQ) was floated. The terms and conditions while inviting the bids were unambiguously framed giving the period of coverage from 01.01.2014 to 31.12.2014, followed by a right to the complainant to extend the same for a further period of 3 months upto 31.03.2015 on the same terms and conditions. This request was published on 14.11.2013 and the ultimate bid of the opposite party/National Insurance Co. Ltd. was accepted about which there is no dispute. The relevant Clause of the RFQ on the basis whereof the contract was finalized and accepted is extracted hereunder:
“The contract period of the intended scheme viz. the SAIL Mediclaim Scheme-2014 will be one year. The scheme shall come into effect from 01.01.2014 (0000 Hrs IST) and remain valid upto 31.12.2014 (2400 Hrs. IST). SAIL, however, reserves the right to extend the contract for a further period of 3-months up to 31.03.2015 (2400 Hrs. IST) on the same terms and conditions within the contract period.”
2. The terms and conditions under Clause-5 give a look out period to a bidder for a clarification of the RFQ. The same is extracted hereunder:
“5.0 Clarification of RFQ: A prospective Bidder requiring any clarification of the RFQ may notify SAIL in writing or by fax / email at SAIL’s mailing address indicated in the RFQ. SAIL will respond in writing or by fax / email to any request for clarification of the RFQ which it receives not later than five (5) days prior to the deadline for the submission of bids prescribed by SAIL.”
3. A bidder intending to deviate from any of the terms was required to specify the same, if any, under Clause-12 which is extracted hereunder:—
“12.0 Statement of Deviations:
12.1 Bids are solicited in conformity with the terms and conditions, without any deviations. However, if any Bidder is unable to accept any particular term or condition as incorporated in the RFQ, or proposes any deviation therefrom, the Bidder shall enclose alongwith his offer, a Statement of Deviations as per Annexure VIII, clearly spelling out the deviations proposed, which will be evaluated in accordance with provisions of RFQ Acceptance/Rejection of the deviations, if any, proposed by the Bidder(s), shall be at the sole discretion of SAIL.
12.2 The Bidder shall submit his Bid confirming his acceptance to all the terms and conditions of this Tender Documents, except for the deviations specifically proposed by him in his Bid. All the pages of this Bidding Document, duly signed by the Bidder, should be submitted alongwith the Bid, as a token of acceptance of SAIL’s terms and conditions.”
4. Clause-18 authorises the bidder for modification and withdrawal, if any, but before the deadline fixed for submission of bids.
5. Since there was no request for any clarification or modification by the opposite party/Insurance Company, the letter of acceptance was executed and finalized in terms of Clause-23.
6. The premium payment terms in Clause-33 provide for 100% premium to be paid on equated monthly basis and the last premium/instalment was to be adjusted on the basis of final number of members expected for the year 2014.
7. Clause-39 specifically provides the contract period which is extracted hereunder:
“39.0 Contract Period: The contract period of the intended scheme viz. the SAIL Mediclaim Scheme 2014 will be one year. The scheme shall come into effect from 01.01.2014 (0000 Hrs. IST) and remain valid upto 31.12.2014 (2400 Hrs. IST). SAIL, however, reserves the right to extend the contract for a further period of 3- months upto 31.03.2015 (2400 Hrs. IST) on the same terms and conditions & premium, within the contract period.”
8. The policy coverage provides for under Clause-40(b) that is relevant for the present controversy. The same is extracted hereunder:
“40.0 Policy Coverage
b. The policy covers reimbursement of Ho
