On January 8, the Bombay high court said the Insurance Regulation and Development Authority (IRDA) can go ahead with the process of finalising regulations for settling insurance claims and for the role of third party administrators (TPAs) and powers of ombudsmen. The division bench of chief justice Mohit Shah and justice AV Mohta was hearing a public interest litigation (PIL) filed by social worker Gaurang Damani about the hardships faced by mediclaim policyholders.

It is primarily because of Damani’s efforts that rules are being drafted to regulate the health insurance industry in India. “Seven crore people in the country have health and medical insurance policies and approximately Rs 13,000 crore is paid as premium annually. It is appalling that such a huge industry has flourished without regulations and policies to govern the sector,” Damani says.

This unassuming, 40-year-old Mumbai-born and -bred Gujarati has activism in his nerves and sinews. Like one of the roads in Mumbai which he got concretised, as he puts it, “after 13 letters and one PIL”, Damani says he puts one key to solve every issue – perseverance.    

An electronics engineer from Mumbai University, Damani started his career with Tata Unisys Limited, which sent him to the US in 1994. After working there for three years, he realised the potential of the dotcom boom and floated his company to cash on in it. His gut was right — the next five years were a rollercoaster ride for his fortunes. Being at the right place at the right time helped Damani earn enough to support him for many years to come — maybe for a lifetime, if on diet.     

Clinking coffers seldom breed noble ideas. In Damani’s case, however, they did. He sensed that the bedazzled NRI community in the US was plagued by an inferiority complex and thought of doing something for them. In 2000, while still in the US, he started a website on governance, called diehardindian.com, for the NRI community and their achievements as reported in the world press. The response was humongous: the site still gets 10-12 lakh views every year.
Buoyed by the initial success, Damani left for India to do something for the people here. 

Back in Mumbai, he volunteered with the NGOs, CRY and ‘Sunday Friends’ and later, in 2003, started an NGO called ‘Karmayogi Pratishthan’, which provides education and in some cases school fees to the needy children of the city’s Dharavi slums. “I knew education was very important for children and started working on local issues,” he says.

Wife Jayshree volunteers with Sion Hospital as a coordinator for skin donation, where a dead person’s skin from lower back is grafted on burn victims.

Picking up the pieces in Mumbai

While Damani realised many well-intentioned people were doing good work, people rarely got involved with issues related to the Brihanmumbai Municipal Corporation (BMC) and the city’s traffic police. This is where he saw a huge opportunity. Starting with the local ward office, he began persistently to follow up issues with the civic body, mainly getting roads paved and potholes patched up.    

“They ignore you initially. When they see how persistent you are, work gets done. And you get the hang of how work gets done, since they don’t tell you,” he says. “It took me a few years to find out where papers go from the local ward office and who the officer concerned is. Although the ward office remains the same, different agencies had to be chased.”

Though it came late, Damani had his share of success as well. Due to his efforts, many roads in Sion area, like roads number 24 and 25 (each nearly a kilometre long), were asphalted; Adenwala Road was concretised, Paubhaji Cross Road no. 10 and Plank Road were tiled, while Balchandra Road and Gali no. 32 will be asphalted soon.

Helping many residents enroll as voters where people could find their names registered as voters electronically, Damani and his friends also pointed out many faults in the voters’ list, helping the election commission bring in necessary changes.

Now general secretary of the district (south central Mumbai) BJP unit (Damani joined the party’s IT cell in 2002), he has so far refrained from using his party letterhead for civic issues — he is conscious of the fact that if the local corporator is from the Congress, there is a greater chance of work being stalled.
Ask him if his party helped him in his social causes, and he says a firm “no”.

In the 2007 BMC elections, after his party denied him a ticket, Damani fought as an independent from Sion, his area of residence, but lost by 240 votes to the Congress candidate despite winning the highest number of votes as an independent in entire Mumbai city. After much deliberation, he rejoined the saffron party considering the fact that he believed in its ideology and the position offered to him was good.

An ardent supporter of Arvind Kejriwal, Damani says good people joining politics is the only way out if you want to bring about a change in society. Maybe in his own case, the tireless activist in him stands between him and the party.

Damani’s tryst with PILs goes back to 2005 when he filed a PIL on the menace of towing vans that was being run by the havildar-ruled mafia. Of 130 towing trucks in Mumbai city, seven were operating in Matunga area alone; they would pick up cars randomly on flimsy grounds citing ridiculous rules that were neither part of nor approved by the Motor Vehicle Act. The havildars had printed fake booklets of these “rules” and would come out with these booklets when arguments with car owners started.

Damani filed a PIL against the menace.

“When the (then) chief justice of the Bombay high court, Swatanter Kumar, asked for tenders and/or contracts, there were none,” he says. “They admitted in writing that many havildars owned trucks. I provided photographic instances to prove that towed cars had not obstructed traffic movements and the 15-metre corner parking rule, though non-existent as per rulebook, had not being violated.”

The case moved fast and closed in six months. Against seven trucks operating between Sion and Dadar area earlier, there are now three, with a total of 75 towing trucks in the entire city.

In 2007, Damani challenged illegal extension of terms of Maharashtra DGP PS Pasricha and Mumbai police commissioner DN Jadhav by state home minister RR Patil, and also sought implementation of police reforms. As a face-saving exercise, both officials resigned.

In case of police reforms, though he got a favourable order reforms are yet to be implemented.

In 2010, Damani filed a PIL against the western and central railways for improving toilets.

Now he is fighting against the parking of 55 garbage trucks of the entire residential area in front of his own house — a contemptuous move by the BMC after he fought parking of these 55 trucks for the last 30 years in the precincts of the residential area. After the court ordered shifting of these trucks, the civic body decided to shift the garbage trucks near Damani’s house instead of open land near Wadala station which is devoid of slums.

“It’s all in the game. Tomorrow will be another day,” says Damani as he gets ready to leave for his next appointment with a senior citizen in the area.

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HOW DAMANI TOOK ON TPAs

It is primarily because of Gaurang Damani’s efforts that rules are being drafted to regulate the health insurance industry in India. Damani produced evidence in the Bombay high court as to how third party administrators (TPAs) took cheques from insurance companies and posted them to customers only after two or three months.

After fighting it out for nearly six months, Damani has now succeeded in getting an order stating that though TPAs can do administrative and processing work, they cannot settle claims — it is the job of insurance companies to settle claims.

“This has been put in place by IRDA in its revised draft,” he says.

“More than 70-80 percent of our suggestions have been accepted,” Damani says. But his fight is far from over. Now he is fighting for issues such as insurance companies giving incentives to TPAs for reducing claims. This is done by randomly rejecting claims or assuming that out of 100 complaints only one will go to consumer court.

“While most demands are being met, some like incentive clause are not finding favour with judges,” Damani says. The 40-year-old electronics engineer also succeeded in getting a court order that gives permission for the electronic transfer of documents to the doctor’s office so that the doctor does not have to go to an insurance company for settling claims.

Damani is at present fighting for the processing of cashless insurance, though he feels it may not work out. The PIL filed in January 2011 secured a favourable order in December 2011. While the first six months IRDA did not bother to respond, the ministry came to court in March 2011. Besides IRDA is represented by heavyweight Ernst and Associates while Damani fights his own cases.

(This story first appeared in the February 16-28, 2003 issue of the print magazine)