State District level Committee Implementation of RSBY for Construction Workers


Government of Andhra have issued orders in the reference 1st read above approving implementation of RSBY (Rastriya Swasthya Bima Yojana) for brick kiln workers on a pilot basis in Rangareddy District. M/s Reliance General Insurance Company Limited has been selected as insurer on due process of rendering for implementation of RSBY (Rastriya Swasthya Bima Yojana).   Accordingly a Memorandum of Understanding entered with the Insurance Company vide MoU G.O.Ms.No. 52 Dated: 30.10.2013

Ministry of  Labour &  Employment, Government of India has requested to designate Nodal officers / coordinators for the grievance Redressal system in the State and District level for efficient and transparent settlement of issue between different stakeholders in RSBY (Rastriya Swasthya Bima Yojana) and to monitor the disposal of complaints and grievances in effective and time bound manner.  Grievances under RSBY (Rastriya Swasthya Bima Yojana) broadly relate to issue concerned with enrolment, hospital empanelment,  de-empanelment, delay in claims settlement or payment of premium to the insurance company.

Grievance is a documented manifestation of dissatisfaction of a beneficiary or stake holders.  Such dissatisfaction, if left unaddressed and unresolved, could spoil the image of the scheme.  It is therefore desirable that a robust Grievance Redressal  Mechanism  shall  be  in  place  within  the  framework  of  the  RSBY (Rastriya Swasthya Bima Yojana) guidelines.

In  the  circumstances stated by the Commissioner  of  Labour  and considering the reports, Govternment hereby constitute the Grievance Redressal Committees with the following members  at State and District level to attend to the grievances of various stakeholders at different levels as indicated in the guidelines vide reference

DISTRICT GRIEVANCE REDRESSAL COMMITTEE (DGRC)

1. Joint Collector & Additional District Magistrate of the concerned District  

–  Chairman

2. Deputy Commissioner of Labour of the concerned District  

–  Convenor

3. District Medical Health Officer of the concerned District     Member
4. Representative of the Insurance company –   Member

The Deputy Commissioner of Labour, Rangareddy who is the District Key Manager  and  also  coordinating  the  RSBY  (Rastriya  Swasthya  Bima  Yojana) activity is designated as District Nodal Officer / Coordinator for the DGRC.  He will be responsible for the timely disposal of the complaint by convening the meeting.

STATE LEVEL GRIEVANCE REDRESSAL COMMITTEES:

1.  Principal Secretary to Govt., LET&F Dept.                               – Chairman

2.  Secretary, APB&OCWW Board                                               – Convener

3.  State Representative of the Insurance Company- Member

4.  Directors IMS                                                                            – Member

6.       The Secretary, Andhra Pradesh Building & Other Construction Workers Welfare Board is designated as State Nodal Officer for the SGRC. He will be responsible for the timely disposal of the complaint by convening the meeting. Guidelines for robust Grievance Redressal Mechanism annexed to this G.O.

GUIDELINES

Annexure to G.O.Ms.No. 52 , LET &F (Lab.IV) Department, Dated: 30.10.2013.

A. Grievance of a Beneficiary: If a beneficiary has a grievance on issues relating to enrolment or hospitalization against the Insurance Company, hospital or their representatives, beneficiary will approach DGRC. The DGRC should take a decision within 30 days of receiving the complaint.

If either of the parties is not satisfied with the decision, they can Appeal to the SGRC within 30 days of the decision of the DGRC. The SGRC shall decide the appeal within 30 days of receiving the Appeal.  The decision of the SGRC on such issues will be final.

Grievance against DKM or other District Authorities: If the beneficiary has a grievance against District Key Manager or an agency of the State Government; it can approach the SGRC for resolution.  The SGRC shall decide the matter within 30 days of the receipt of the grievance.

In  case  of  dissatisfaction with  the  decision of the SGRC, the affected party can file an appeal before NGRC within 30 days of the decision of the SGRC and NGRC will decide the appeal within thirty days of the receipt of appeal after seeking a report from the other party. The decision of NGRC shall be final.

B. Grievance of a Hospital

If a hospital has any grievance with respect to Beneficiary, Insurance Company or their representatives, the Hospital will approach the DGRC. The DGRC should be able to reach a decision within 30 days of receiving the complaint.

If either of the parties is not satisfied with the decision, they can go to the SGRC within 30 days of the decision of the DGRC, which shall take a decision within 30 days of receipt of Appeal.   The decision of the Committee shall be final.

C.  Grievance of Insurance Company:

1. Grievance against FKO– If an insurance company has any grievance with respect to Beneficiary, or Field Key officer, it will approach the DGRC. The DGRC should take a decision within 30 days of receiving the complaint.

If either of the parties is not parties is not satisfied with the decision, they can Appeal to the SGRC within 30 days of the decision of the DGRC. The SGRC shall decide the appeal within 15 days of receiving the Appeal.  The decision of the SGRC on such issues will be final.

2. Grievance against DKM or other District Authorities– If

Insurance Company has a grievance against District key

manager or an agency of the State Government, it can approach the SGRC for resolution.  The SGRC shall decide the matter within 30 days of the receipt of the grievance.

In case of dissatisfaction with the decision of the SGRC, the affected party can file an appeal before NGRC within 30 days of the decision of the SGRC and NGRC will decide the appeal within thirty days of the receipt of Appeal after seeking a report from the other party.   The decision of NGRC shall be final.

D. Grievance against State Nodal Agency / State Government: Any stakeholder aggrieved with the action or the decision of the State Nodal Agency / State Government can address his grievance to the NGRC which shall take a decision on the issue within 30 days of the receipt of the grievance.  An appeal against this decision within 30 days of the decision of the NGRC can be filed before Director General (Labour Welfare), Ministry of Labour & Employment,  Government  of  India  who  shall  take  a  decision within  30  days  of  the  receipt  of  the  Appeal.  The  decision  of Director General (Labour Welfare) shall be final.

There would be a fixed date once a month for addressing these grievances in their respective committees (DGRC/SGRC/ NGRC). This would enable all grievances to be heard / settled within the set time frame of 30 days.

Leave a comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.