Case Study -11 - Ombudsman directed National Ins to pay 8.4 lac with 12% interest

National Insurance Vs JAYA HARIKRISHNAN

JAYA HARIKRISHNAN'S world fell apart on 11 August 1999. That was the day her husband, an employee in Apollo Tyres, Gurgaon, drowned in the Ganga at Garhmukteshwar, near Delhi, while on a pilgrimage. His body was never recovered: in December that year, the municipal authorities issued a death certificate, after the police confirmed a case of death due to drowning.

Grief wasn't all that the young widow had to contend with: in one of life's bitter moments, she found herself grappling with red tape. Harikrishnan had taken an insurance policy with LIC (Life Insurance Corporation) and was also covered under a group accident insurance policy, taken by Apollo Tyres, with National Insurance Company (then a subsidiary of General Insurance Corporation). While LIC settled the claim promptly and Apollo Tyres processed Harikrishnan's terminal dues speedily, National Insurance kept the claim on hold for 15 months.

The insurer first said it was waiting for the 'verification' of the death certificate. Even after it received the report, it sat on the claim, on the ground that Harikrishnan had been insured for an extremely large amount–Rs 8.4 lakh, or 60 times his basic salary.

In despair, Jaya Harikrishnan turned to the insurance ombudsman for help, on 22 September 2000: that's the office established by the Insurance Regulatory and Development Authority to arbitrate insurance-related disputes quickly and at low cost. The invocation of this authority worked in Jaya Harikrishnan's favour. In a little over a month, after going through the claims and counter-claims, the ombudsman directed National Insurance to pay the Rs 8.4 lakh along with 12 per cent penal interest with effect from 1 January 2000. In his order, the ombudsman said there were "no extenuating circumstances" to explain the delay in the settlement of a "crystal-clear" claim.