An insurer cannot reject a valid claim based on procedural delays; the rights of the insured must be upheld in cases of serious injury, reflecting the principles of equity and justice.

JUDGMENT :

Ziyad Rahman A.A., J.

This writ petition is submitted by a company engaged in the business of general insurance, challenging the award passed by the Lok Adalat for Public Utility Services, Kozhikode in O.P.No.95/2024. Ext.P6 is the said award, which was passed on the original petition submitted by the 1st respondent herein, being aggrieved by the non-consideration of his claim based on an Accident Care individual insurance policy, which was valid for the period from 06.07.2020 to 05.07.2021. The cause of action for submitting the claim was that, the 1st respondent, who was a toddy tapper, sustained serious injuries on 28.05.2021, when he fell down while tapping toddy from a coconut tree. He sustained injuries on his spinal cord, ribs, head and shoulder, and underwent treatment at Malabar Medical College, Government Medical College, Kozhikode etc., and consequently he became permanently disabled. The extent of permanent disablement is certified to be 75% by the Medical Board.

2. According to the 1st respondent, the claim was not entertained by the petitioner, based on the policy issued by them, and it was in those circumstances Ext.P3 complaint was submitted before the Permanent Lok Adalat for Public Utility Services. The petitioner appeared before the Adalat and Ext.P5 counter statement was filed, disputing the claim raised by the petitioner. According to the petitioner, no claim was ever raised before the petitioner, highlighting the injuries sustained. As per the terms and conditions of the policy, the claim based on the injuries sustained during the period of the policy, has to be made within a period of 60 days from the date of injuries and, since the same has not been complied with, the claim cannot entertained.

3. However, the Permanent Lok Adalat, after appreciating the evidence adduced by the parties and the documents produced, passed Ext.P6 order, allowing the claim and directing the petitioner insurance company to pay Rs.7,50,000/- to the applicant as insurance benefit and Rs.10,000/- as cost of the proceedings. This order is under challenge in this writ petition.

4. I have heard Sri. R.S.Kalkura, the learned counsel appearing for the petitioner, who argued at length, highlighting the discrepancies and illegalities in the findings entered into the Permanent Lok Adalat while passing Ext.P6. The main contention raised by the learned counsel for the petitioner is that, in Ext.P6 award itself, a finding has been practically entered into regarding the non submission of the claim before the petitioner, but yet, the Adalat proceeded to allow the Original Petition and granted compensation.

5. It is pointed out by the learned counsel for the petitioner that, as far as a claim based on an insurance policy is concerned, it is the bounden duty of the insured to raise a claim before the insurance company first, and it is for the insurance company to process the said claim and to take a decision to grant the amount. The quantification of the amount is also to be made by the insurer. In this case, instead of adopting the said process, the Permanent Lok Adalat proceeded to determine the claim even in the absence of any claim and hence it is to be interfered with, contends the learned counsel for the petitioner.

6. However, on going through the observations made by the Adalat, which led to the ultimate decision of allowing the claim, it can be seen that, the Adalat acted upon the principles that, merely because of the fact that there occurred some delay in raising a claim, the petitioner cannot be exonerated from the liability to satisfy the obligations arising from the terms and conditions of the policy. The Permanent Lok Ad