TEAM CODE: 20

PART -II
ROLE PLAY

PARTIES INVOLVED:

1. Mrs Annamma Johny, W/O C.P.Johny residing at Charuvilathekkethil Udayam House,

Puthenchantha Muri,Vallikunnam Village in Alappuzha District– The Complainant
2. Ms. Drishiya Mohan (Divisional Head), C/O Great Benefit Insurance Company, St Thomas
Junction, Alappuzha – The Respondent

CONCILIATOR: Adv. Rithu Varma

 PROBLEM

Annamma Johny is a 71-year-old woman, residing in Vallikunnam village, Alappuzha District. On

06.03.2019, she was riding a Hero Honda bike along the Chennampalli-Thengamom Public Road
from South to North at about 10:40 AM. On reaching a place called Cherupuncha, anotherbike, driven
by one Sibin Jospeh, which came from the opposite direction hit her bike. It was a Bajaj bike
registered under the name of one Mr. Joseph Samuel, who was riding behind. Due to the forceful hit,
the bike and Annamma fell onto the road. She was rushed to the Holy Cross Hospital, Adoor where
she was treated for the multiple injuries sustained. Her injuries include c/o pain in the right gluteal
region and coccygeal region and also multiple injuries all over the body. An F.I.R was registered at
the Adoor police station as registered crime number 663/2019.Both Shibin Joseph and Joseph Samuel
are residing at Adoor.
She was a healthy person before the accident but as a result of this accident, have been permanently
disabled. She has already spent a huge amount of money for treatment and continues to do so even
now. Her hospital expenses and the vehicle repair have all come to an estimated amount of Rs 3, 00,
00/-. The case between the parties is pending before the Motor Accidents Tribunal in Adoor but she
is in immediate need for financial assistance for which Annamma approached her insurance company,
The Great Benefit Foundation in Alappuzha. Heroriginal motor insurance is a comprehensive motor
insurance and covers all financial losses dueto damages caused by accidents or malicious acts and so
on. The insurance company failed to accept her request on various ground for which they have not
been clear.

Due to her inability to afford all her expenses, she approached the Sub Court, Alappuzha for ansuit
against her insurance company. The Court entrusted the mediation cell to arrive in to an outof court
settlement in this matter. Convene the same.

FACTS IN ISSUE

1. Whether Annamma is entitled to the motor insurance?

2. Whether the reasons stated for the rejection of application of insurance is reasonable?
 ROLE PLAY SCRIPT

CONCILIATOR: Adv. Rithu Varma

PARTIES:
1. Mrs. Annamma Johny – Aggrieved Party [AP1]
2. Mrs Drishiya Mohan, Divisional Head,
Great Benefit Insurance Company -Defending Party [DP1]

INTRODUCTORY SESSION
(Two Scenes)

SCENE I

[All Negotiators and the Conciliator join into common web media platform and exchange greetings
and pleasantries within the group. The Conciliator requests all attendees to be seated; he formally
greets all of them.]
(Conciliator kicks off the meeting with a formal introduction of herself detailing her credentials. she
then for the purpose of records requests each member to formally introduce themselves).

CONCILIATOR: Good Morning All. I am . Rithu Varma, a practicing lawyer and appointed
conciliator for this case. I have been practicing as a conciliator for the last 6 years. As your conciliator
I am here to resolve the disputes between both the parties and to reach an amicable settlement for the
same. You can feel free to address your respective grievances and issues and based on your reasonable
interest, as a conciliator I promise to act in an independent, confidential, and impartial manner and
also will be binding by the principles of objectivity, fairness and justice while reaching a proper
settlement for resolving the disputes between you. First of all, I should clarify that I have no
connection with this case. I will do everything in my power to assure that the process remains
confidential. Our goal here is to reach an agreement. So before we begin to discuss and resolve the
issue at hand, both of you can introduce yourself and your respective involvement and interest in the
matter.
 SCENE II

[The participants start to introduce themselves, starting with Mrs. Annamma.]

Mrs Annamma (AP1): Good Morning. I am Annamma, a 71 year old who is being harassedby them.
[Mrs Annamma seems to be angry and Mr. Abraham has next turn.]

Mrs Drishiya (DPI): I am the divisional head of the Alapuzha Division of Great Benefit. [She
acknowledges.]

PRESENTING SESSION
(Five scenes)

SCENE III

CONCILIATOR: Well, as both of you have introduced yourself let’s move to the issue athand. But
before that there are certain things that you have to keep in mind during the proceedings. As you
already know I will be leading the mediation sessions. You have to understand that both will be getting
their respective chances to present your scenarios suchthat refrain from all possible interferences.
Both of you have to keep the decorum and let’sconduct this session civilly and peacefully.

[Mrs Drishiya getting ready for her oral submissions]

Mrs Drishiya (DPI): Maam , we are reputed insurance company in Kerala. We have been providing
all kinds of insurance and helping our clients like our own family. Our repute is such that our clients
trust us. Most of our clientele are middle class families keeping aside money for a rainy day. Though
most insurance we provide are with specific consideration, we meet a long list of clients who approach
us at the least inconvenience looking to receive the amount even if none of the condition of the
insurance are met. In Mrs. Annamma’s case, she met with the accident almost two years ago, but it
was only six months ago that she approached us for her comprehensive vehicle insurance. We could
only reject her applicationbecause her insurance stipulated a period of one year after an accident to
approach us.
Further she also failed to submit an independent medical examination which we had madeclear to her
on cases such as this….

[Mrs.Annamma in her desperate to make her move to speak]

Mrs.Annamma (AP1): It is true that I approached them only six months ago, but I was bedridden
for so long and I was not in a state to make any such request beforehand. But these people are holding
money and they should be able to make it available to me when I need. Iam denied my earnings in
time of a emergency.
Mrs Drishiya (DPI): we are an insurance company who faces many cases like this. We cannot make
her an exception if she has not abided by any of the conditions. Further it has come to our
understanding that she is also suing the owners and insurance company of the other party in accident
to receive compensation. I do not see how she needs amount from ustoo.

[Pointing both the parties and communicates]

CONCILIATOR: Alright. What we need here is a reasonable settlement protecting theinterest of

both of you.

[Mrs. Annamma showing some inconvenient gestures and attitude.]

Mrs.Annamma (AP1): I can only reach a settlement where I can get my money from thesepeople
who cheated me.

Mrs Drishiya (DPI): We cannot just give her money when she has not abided by ourprocess.

[Mrs.Annamma becomes a little emotional.]

Mrs.Annamma (AP1): But it’s my money and I need it more than any time before now.

Mrs Drishiya (DPI): But ma’am, like we have already said, we cannot give you the amountas such
without proper procedure.
 SCENE-IV

Mrs.Annamma (AP1): You never told me about any of this procedure when I was taking the
insurance. This is just their excuse to deny my claim, the claim which is mine.

[Mr. Abraham shakesherhead and showshercomplete disagreement with Mrs.Annammaand strives

forward withherarguments.]

Mrs Drishiya (DPI): We have said about all this conditions in the documents that we shared with
you at the time of the plan. We did make it clear that you need to go through thatdocumentation.

Mrs.Annamma (AP1): I can’t believe that you are saying that you have told me. The documents
were a bunch of papers with big words which made little sense to me. You didnot take the time to
even make it clear for me or even explain to me its contents. You justbriefly told me my plan covered
a all kind of needs I have regarding my vehicle.

Mrs Drishiya (DPI): Your husband told us that he understand the entire thing and said hewill explain
everything to you. It is not our fault if he did not do so. You should maybe askhim why he never
explained.
[CONCILIATOR intervenes in between trying to hold the topic from deviating.]

CONCILIATOR: Let’s stop talking about other people. You are both mature persons. Solet’s be
reasonable and make a settlement based on your relative interests.

SCENE-V

Mrs Drishiya (DPI): We rejected her claim for genuine reasons only. She did not seek forinsurance
within twelve months of the accident.

Mrs.Annamma (AP1): It is true but that time I was not in state and I expected compensation from
the persons who hit me. Since that is lagging, I am in dire need ofmoney.
Mrs Drishiya (DPI): I cannot blindly twist rules for her. If she needs the amount now thereis another
set of process involved and we told her about it.

Mrs.Annamma (AP1): And I told you I have submitted all documents regarding the accident
including the photograph.

Mrs Drishiya (DPI): Ma,am, we have already told you that we need a separate medicalexamination.
Also like we said, your disability is not covered in your Bike insurance package. It is not included in
the add-on and therefore we are not obligated.

SCENE- VI

CONCILIATOR: Our main issue is regarding the amount that Mrs. Annamma can claim orreceive
right?

Mrs. Annamma(AP1): That is true. I asked for an amount of 3,00,000/- lakhs for all mylosses as a
result of the accident.

CONCILIATOR: And Mr Abraham, your company is rejecting claim because the periodhas elapsed
and also it is a wrong claim? Is that correct?

Mrs Drishiya (DPI): Yes, for the accident she should claim the amount within a year afterthe accident
and she did so only after a period of 1 year and 5 months have elapsed. Even ifwe can let that go, she
is asking for a claim not including in her insurance add on. And thenthere is the issue where Mrs.
Annamma is not listening to us when we say that she needs tosubmit a few more documents.

CONCILIATOR: Oh, I see. And Mrs Annamma what do you have to say?

Mrs. Annamma (AP1): This issue can only be settled if I get back my money. I dideverything they
asked me to, yet they are not giving me anything.
[*The unwillingness of Abraham with Annamma’s settlement terms were visible fromherbody
language.]

Mrs Drishiya (DPI): We sincerely told you what you need to do to get the amount. And wemade it
specifically clear on how much you have the claim to.

Mrs. Annamma (AP1): I now feel like I deserve to get damages for the mental pain, agonythat I
suffered as a result of you are doing to me. I am a very old women and I have the rightto the amount
that I seek.

Mrs Drishiya (DPI): Ma’am I am making it clear that you did not come to us within thestipulated
period and even so your claim is rejected because it’s not a part of your actual plan. We do not cover
disability. You have not seeked that in your plan.

CONCILIATOR: I like to say that an Insurance company can reject the claim on the said grounds
but Mrs. Annamma, the company will give the same on a new application with thecorrect add-on.
This is my understanding. Is that right?

Mrs Drishiya (DPI): That is exactly what I am saying.

Mrs Annamma (AP1): But they never told me any of this. They just blindly rejected my claim
without stating any reason. And they made me go after then for so long.

(Sobbing) [Mrs Annamma also gets a little bit emotional.]

Mrs Annamma (API): I am so sorry. But I am tired. I am not yet fully recovered from the accident.
I cannot do anything without the help of someone. For a person like me that is very difficult, and
these people kept making me run here and there in my situation. If only they told me any of this
sooner.

Mrs Drishiya (DPI): But ma’am, we did tell you this and even send you a letter for thesame.
 SCENE-VII

[CONCILIATOR suddenly felt that there is a slight possibility resolving the conflict and he
madeherstatement without much time.]

CONCILIATOR: What I understand is that this entire thing is a misunderstanding betweenthe two
parties. Mrs.Annamma, why don’t you give the application again? This time don’t seek insurance for
your disability rather only on what is included in your plan?

[Mrs Annamma became speechless for a moment as she got. confused.]

Mrs Drishiya (DPI): Maam , that is I exactly what we have been saying.

Mrs Annamma (AP1): Then will I be able to get any kind of amount?

Mrs Drishiya (DPI): Yes, ma’am. Like we already said, you need to only give us another application
for the same and we will give you an amount of lakhs, excluding the 1 lakh you claimed for your
disability because that does not come within your insurance plan. But sincethe period expired consider
this a loan that you need to repay on settlement of your case.

Mrs Annamma (AP1): Oh.

CONCILIATOR: I know there are some mistakes from the part of both of you but we have an option
to resolve this conflict now and let us try to achieve that.
 CONSENSUS SESSION
(Two Scenes)

SCENE VIII

CONCILIATOR: See OUR GOAL is a resolution that would be arrived at only by building
consensus. One thing I noticed is that both of you really want to resolve this conflict without
approaching the court. So can’t you make some adjustments in the matter.

Mrs Drishiya (DP1): I am actually ready to make a compromise here as I understand her situation
and I would like to make resolution easier. If only she had made it an point to listento me sooner.

Mrs Annamma (API): What do you expect from me now?

Mrs Drishiya (DP1): I just want afresh application without the disability claim. And you will have
to return whatever amount we give you soon enough.

SCENE IX

CONCILIATOR: Annamma, you should have tried to understand what the company wastelling you
before jumping into the case.

Mrs. Annamma (AP1): Okay, but they just said a lot of things to do and I had no idea whatto do.
And all the while they did not try to give me the money that belongs to me rightfully.

CONCILIATOR: Yes, that is why Abraham, considering her old age, your company shouldhave
tried to resolve this amicably. You should have tried to make her understand your rejection and
grounds. Being a senior citizen you could have minimized all this stress for her.

Mrs Drishiya (DPI): You need to understand that we would reject claims which are not based on
what is agreed in your insurance plan. Therefore you need to first understand everything about your
plan. We will first tell everything that you need including the amountyou can claim.
Mrs. Annamma (AP1): I will then do as you say but I need this process to move forward. Ineed the
same for my treatment. You cannot kick me around like a ball this time.

CONCILIATOR: Well, I believe the issues are sorted out.

SETTLEMENT /CONCLUSION SESSION

(One Scene)
SCENE X

[Conciliator is seen showingherinterest to close in on the consensus]

CONCILIATOR: I appreciate all of you. It appears that we are happy moon, a position to arrive at
a consensus on the key issue that we discussed today. As we know discussions are always better than
arguments, we proved it once again. Thanks to all. I would like to read thesettlement arrived at today
for further proceedings.

[SETTLEMENT UNDER SECTION 30 OF THE ARBITRATION AND CONCILIATION ACT,

1996]

Date:
 DECISIONS

At this juncture both the parties have agreed on the following conditions for sorting out the difference
between the two. The conditions arrived at this session will be entered in writing to deal with any
future issues regarding the same. The common points flagged may be summarised as follows.
(Recording the settlement in the form of an arbitral award on agreedterms under Sec.30 (2) of the
Arbitration and Conciliation Act, 1996)

1. Annamma has agreed to apply for the insurance in the correct terms again.
2. Abraham, on behalf of the Great Benefit has agreed to accept the application even if the
period to seek it has elapsed considering the special circumstances.
3. Annamma can seek an amount upto 2 Lakhs from the insurance company.
4. The company is reserved the right to reject the application again if it does not adhere tothe
terms for claiming the amount

Agreed and signed with date by:

AP1- DP1-

IP-