Panchayat:Repo18/vol2-page0716

716 GOVERNAMENT ORDERS


(iii) Mahazar from Police Department.

(iv) Death Certificate

(v) Postmortem report

(vi) Form No. (Nomination form)

(i) On receipt of the certificates referred to in sub-para (d) or sub-para (e), the Officer mentioned in para 5 shall verify the same and then prefer a claim to the Director of Insurance, Thiruvananthapuram for benefits there with the attested copies of the above said certificates along with proof regarding remittance of premium in favour of the member to Kerala State Insurance Department along with Form No.l. If a member having no family dies in an accident without nominating any person and if a dispute in respect of his succession is pending before a Court of law, or if a dispute among the nominees of a deceased member regarding their eligibility to be his nominees of the proportion in which the benefits were apportioned among the nominees by the deceased member pending before a court of law, officer mentioned in Para 5 with a request to deposit the entire benefits received on behalf of the deceased member or as the case may be or part thereof, on which there is dispute, in the respective Court where the dispute is pending.


(g) The Director of Insurance shall, after making such enquiries as it deems fit, sanction the compensation in cases where no dispute is pending, in accordance with the scale referred to in paragraph 6 and pay by way of Demand Draft(s), through the officer mentioned in para5, to the member/nominee(s) the amount that each is entitled to under intimation to Government. Compensation amount in respect of cases where disputes are pending before Court shall be deposited in respective Court. The Kerala State Insurance Department shall withdraw and release the amount deposited in Courts only after the final settlement of the dispute pending before the Court in accordance with the decision of the Court.

(h) The Officer mentioned in para 5 shall, as soon as the Demand Drafts are received, send it to the member/nominee(s) concerned under intimation to the Director of Insurance.

(i) When there is no nomination, the Officer mentioned in para 5 shall prefer a claim before the Director of Insurance after determining the eligibility of the surviving members of the family as mentioned in paragraph 9 (iv) to receive the amount. Kerala State Insurance Department and Officer mentioned in para 5 shall follow the procedures prescribed in sub paras (g) and (h), for payment of compensation to such members of the family.

(j) In the absence of any Surviving eligible member of the family as defined in paragraph 2(c) the amount shall be paid to the eligible legal heirs in equal shares on production of a succession Certificate from Court of Law. There a sons for delay in determining the eligible legal heirs shall be reported by the Officer mentioned in para 5 to the Director of Insurance while preferring the claim.

12. Procedure in case of rejection of claim

(a) If the member who suffers the accidental disable mentor his/her nominees or dependents in case of accidental death are of opinion that the compensation claim rejected by the Kerala State Insurance Department is not in accordance with the terms and conditions for issuing the policy, he/she or they may make a complaint to the Principal Secretary, Finance Department, Government of Kerala within sixty days of the rejection of the Compensation claim by the Department.

(b) The complaint under sub-section (a) shall be accompanied by

i Copy of the report of Kerala State Insurance Department rejecting the claim

ii. A clear and brief statement of reasons for reconsideration of the claim.

iii. Copies of Certificate mentioned at Section 11 of the scheme and further documents to substantiate the Complaint.

(c) The Complaint and the enclosures therewith shall be submitted in duplicate.

(d) AS Soon as the Complaint is received and in any case not later than ninety days from the date of rejecting the claim by the Kerala State insurance Department, the Principal Secretary (Finance) shall forward a Copy of the same to the Director of Insurance, Thiruvananthapuram with the enclosures thereto and direct the Director of Insurance to authorize a representative to appear before Government to have a discussion to settle the matter in the presence of the member concerned or his nominees or dependents or authorized agents.