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Caring for the Needy in Difficult Times: Ethical Dilemma Novartis, leading global pharmaceutical brand, pro- duces a number of health-related products and has core businesses in pharmaceuticals, vaccines, consumer health, generics, eye care, and animal health. Headquartered in Basel, Switzerland, Novartis employs nearly 115,000 people in over 140 countries worldwide to help save lives and improve the quality of life. The group is present in India as Novartis India Limited and listed on the Mumbai Stock Exchange. It has three wholly-owned subsidiaries-Novar- tis Healthcare Private Limited, Sandoz Private Limited, and Chiron Behring Vaccines Private Limited The prod uct list of the company also includes Lucentis which is a prescription medicine for the cure of age-related macular degeneration (AMD) Macular degeneration affects aged people and results in loss of vision. Lucentis cures patients with diabetes who are losing their sight from diabetic mac- ular edema or wet AMD. The medicine helps to prevent new blood vessels from growing and helps the eye to heal itself to some extent. Novartis India has a tie up with Ori- ental Insurance Company to provide insurance cover to pa-tients suffering from AMD as the cost of treatment is very high. Oriental Insurance a leading public sector undertaking that provides insurance for life, mediclaim etc. Rasula Begum Chaudhary, a resident of Kolkata, was suffering from neovascular wet AMD and visual disorder, and required Lucentis treatment. She purchased Orien tal Insurance's mediclaim reimbursement policy through Novartis for one year with effect from September 25 , 2008 to September 24, 2009 to cover her medical expenses. She purchased four doses of Lucentis R from Novartis and sought reimbursement from the insurer against her medi cal reimbursement policy. Oriental Insurance reimbursed the cost of medicine for the first three doses but declined to pay for the fourth one amounting to 71,412 because the patient had failed to go for monthly follow-up with the doctor. Rasula Begum was taken aback by this development and took up the matter with Novartis, but the company declined her request to intervene even though the policy was purchased through them. She expected care during the difficult times and continuously followed up with both the companies but failed to get the declined amount. Finally when there were no options left, she filed a case against Novartis and Oriental Insurance in Consumer Disputes Redressal Forum stating that it was a case of gross neg ligence, unfair trade practice, and deficient service and demanded compensation for causing her unnecessary mental agony and harassment. On September 28, 2012, the court directed Novartis India and Oriental Insurance to reimburse a sum of 71,412 to Rasula Begum for the cost of fourth dose of the medicine with cost at 9% per an num from the date of repudiation till the date of realization along with a further direction to pay compensation of 65,000 for the harassment and mental agony caused. The companies were also ordered to pay the litigation cost amounting to 10,000 . As per the provisions laid down un der Consumer Protection Act, 1986, the court also directed both the companies to pay 72,00,000 to Rasula Begum as punitive damages for carrying out unfair trade practices. However Norias didn't agree with this verdict and chalieved he order in the upper court. Once again in the court Oriental Insurance maintained its earlier stand for rejecting Rasila Begum's compensation for the fourth dose. As per the company, she had failed to follow-up with the doctor which is a pre-condition for the release of reimbursement for the fourth dose; hence, the company was not at fault and there was no deficiency in service on their part. In its defense Novartis, stated that it has no role in claim settlement but admitted having tie-up with the insurer. After hearing both the parties, on July 25,2013 , the upper court also ruled in favor of Rasula Begum as she managed to produce a valid and relevant doctor's certificare related to the fourth dose of Lucentis Hence, the insurance company's plea was rejected and the Consumer Disputes Redressal Forum's decision was upheld. Questions 1. Explain the summary of case study. 2. What are the ethical issues involved in this case? 2. Why did Rasula Begum meet with problems while settling her mediclaim? 3. Is it justified, on the part of Oriental Insurance, to deny the medical reimbursement to Rasula Begum