Exercise - I

The Complainant Mr. Anand gives an application against Respondent Meta Life
Solution to pay back an expenditure incurred by him as per the insurance
scheme. The Complainant holds the policy bearing No. 44022/4014/1100 and
membership bearing ID No. COM/EME/JUN/14/3205. He and his wife have
regularly paid the premium quantum for the last 4 years. They obtain medical
treatment from the hospital upon intimation to Met Life Solution. They took
treatment from the total bill amount of Rs.80,000/- paid to the respective
hospital by the complainant. As per the insurance scheme respondent is liable
to pay wherever the amount is paid by the claimant. The complainant gave all
the relevant documents to Met Life Solution on 02/04/2014. It is further case
that on 10/02/2014 the respondent replied against on 16/04/2014 and on
25/05/2014 all the originals consisting of 42 pages were given to the
respondent. In spite of the submission of records, the respondent didn’t pay the
treatment cost as per the scheme. On repeated visits to the respondent’s office,
the complaint didn’t get any benefit from the policy.
The case is before the conciliation board decides the matter.

1. Opening statement of the Conciliator

Welcome parties to your Conciliation Session.
My name is….. today in this session I’m playing the role of Conciliator
and I will try my best to give you both an amicable settlement.
As a Conciliator, my role is to hear both parties and give the best solution
to both of you.
Can parties give a short introduction about themselves
Party A- Met Life Solution and Party B- Mr. Anand, Thank you both
parties for the introduction.
 First of all, I would like to describe the Conciliator ground rules:
Conciliator is voluntary, I hope all the parties present here are voluntary
basis and not to be forced into this mediation session.
Conciliation is an alternative dispute resolution process whereby the
parties to a dispute use a conciliator, who meets with the parties both
separately and together in an attempt to resolve their differences.

2. Statement by the First Party (Mr. Anand)

i. Good Morning, Conciliator ……….. as you know, I filed this
complaint as I had taken the policy of Meta Life Solution bearing
policy No.44022/4014/1100 and membership bearing ID No.
COM/EME/JUN/14/3205.
ii. We are paying the premium amount for the last 4 years regularly and
we had taken the medical treatment from Narayana Hrudayalaya and
Vasan Eye Care Hospital for the amount Rs- 80000/- which must be
payable by the Meta Life Solution insurance company, but after
submitting all the relevant documents on 02/04/2014 no proper
response was taken till today and both of us are repeatedly visiting the
office of the insurance company but no insurance Amount has been
given till now.
iii. As a common man I don’t want to approach court so that’s why I want
to settle this dispute with the help of a Conciliator. That’s why we both
come voluntarily for the conciliation process to resolve this issue.

3. Statement by the Second Party (Met Life Insurance)

i. Good morning, Mr. Conciliator as per the issue/ concern raised by Mr.
Anand in his complaint we regret to inform you that the treatment
taken by Mr. Anand from the Narayana Hrudayalaya and Vasan eye
 care hospital of amount Rs. 80,000/- will not cover under the
Insurance taken by Mr. Anand.
ii. Though the Insurance company is Verifying the document produced
by Mr. Anand, our company is not bound to pay the amount as Mr.
Anand has violated the term and conditions which is mentioned under
the Insurance Policy Company.
iii. To resolve this dispute company wantsa Conciliation process, we
don’t want to go for litigation matters because we have a reputed
Company and our time is precious.

4. Statement of Conciliator to Second Party

i. As I heard from both parties, I would like to mention here that the
main motive is to conciliate the matter in a peaceful manner, the main
concern is /the Insurance company wants to return the money.
ii. I would like to suggest to the second party that Mr. Anand has
purchased an insurance policy and as you said that his amount is not
covered by your policy.
iii. When Mr. Anand purchased the policy from you, so there should be a
relationship exist between both parties, and this relationship is called a
Fiduciary relationship.
iv. Here as an Insurance company, you need to fulfill the reasonable
demand of your client.
v. In my opinion you both should agree on a specific point that this will
also create a friendly relationship for both of you.
vi. As a conciliator, I made an offer/option to you that as per
convenience, the Insurance company should do the appropriate steps
or give some other policy that will benefit Mr. Anand.
5. Statement of the Second party to the Conciliator
i. Well, I am only the representative of the company and am not able to
promise the same but if the company decides to pay, I will try to repay
the loan amount as soon as possible.
ii. And Conciliator you made some other option i.e., that the company
needs to provide some other facility that will benefit to Mr. Anand in
the future, on this point the insurance company will look after.
iii. Thank you for your consideration, sure the company will look after
your option.

6. Observation by the Conciliator

i. According to my observation of the above said Facts and
circumstances the Insurance company should pay the amountto Mr.
Anand or to provide some facility which can be availed by Mr. Anand
in future.
ii. As Mr. Anand had taken the insurance and always pay the installment
on time but at the time of need he was suffering sothis is the duty of
the company to provide or to take reasonable care of the claimant’s
claim.

7. Settlement Agreement
The parties hereto agree that this lawsuit and all related claims
and controversies between them are hereby settled in accordance
with the following terms:
1. The parties acknowledge that bona fide disputes and
controversies exist between them, and they desire to
compromise and settle all claims and causes of action of any
kind whatsoever which the parties may have arising out of the
transaction or occurrence which is the subject of this
 litigation. It is further understood and agreed that this is a
compromise of a disputed claim, and nothing contained
herein shall be construed as an admission of liability.
2. That both the parties agrees to settle down the dispute and the
claim of Mr. Anand is correct and genuine and it is hereby
directed to the Meta Life Solution insurance company to pay
the full amount with interest of 8% p.a. from the date of
12/04/2014.
3. If any party feels aggrieved from the above direction they can
appeal to the higher authority.

_________________________________                                                         Date: 
Signature of first Party

_________________________________                                                         Date: 
Signature of Second Party

_________________________________                                                          Date:
Signature of Mediator