These rules will be called FISHCOPFED’s Centrally Sponsored Group Accident Insurance Scheme-Rules.

2.Definition

For the purpose of these rules the following shall unless the contexts otherwise require mean:-

• (A) “Certifying authority” means an officer nominated by the State Government to certify the details of accident and death or injury on account of accident of an insured fisherman member / fisherman for settlement of claim.
• (B) “Executive Committee” means Executive Committee of FISHCOPFED as mentioned in the bye laws of FISHCOPFED.
• (C) “FISHCOPFED” means the National Federation of Fishermen’s Cooperatives Ltd.,7 – Sarita Vihar Institutional Area, New Delhi – 110 076.
• (D) “Fishermen Member” means a duly enrolled fisherman/fisherwoman member of a registered cooperative society/organization of fisheries/fishermen insured under the scheme.
• (E) “Fisherman” who includes a fisherman/fisherwoman by caste or profession, person holding license from competent authority for fishing and a fish farmer, person certified by the competent authority for providing insurance cover under these rules, who is not a member of cooperative society but its insured under the Scheme.
• (F) “Insurance Company” means a subsidiary of the “General Insurance Corporation of India” enrolled as a nominal member of FISHCOPFED.
• (G) “Medical Officer” means a doctor employed in a government dispensary/hospital.
• (H) “Nominee” means a nominee of a fisherman member nominated by him in his membership form/register of his cooperative society. In case of a “Fisherman” nominee means the person nominated by him to receive claim under the Scheme in case of his death.
• (I)“Scheme” means FISHCOPFED’s “Centrally Sponsored Group Accident Insurance Scheme for Active Fishermen”.
• (J)“Society” means a fisheries cooperative society, fishermen’s cooperative society or a fishermen’s Welfare Organization, association or group recognized by the State Government.
• (K) “Sponsoring Agency” means a State Government / Cooperative Society / Federation of Fishermen / Fisheries / Fish farmers or any organization recognized by the State Government or FISHCOPFED for the implementation of the Scheme.

3.Extent of Insurance Cover

A fisherman member / fisherman insured the scheme will get the following insurance cover under the scheme. However, the insurance cover shall be available only if the full premium for such insurance has been received by the insurance company through FISHCOPFED before the date of accident, otherwise no cover will be available.

• (A)If such injury shall within six calendar months of its occurrence be the sole and direct cause of death of the insured the capital sum insured as per the terms of insurance policy, the amount payable under the clause shall be paid to the nominees.
• (B)If such injury shall within six calendar months of its occurrence the sole and direct cause of the total and irrecoverable loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot or of such loss of sight of one eye, the capital sum insured as per the terms of the policy.
• (C)If such injury shall within six calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of one eye or total and irrecoverable loss of use of a hand or a foot, fifty percent of the capital sum insured as per the term of the policy.
• (D)If such injury shall within six calendar months of its occurrence be the sole and direct cause of permanently, totally and absolutely disabling the injured from engaging is being occupied with or giving attention to any employment or occupation of any description whatsoever the capital sum assured as per the terms of the policy.

4.Group Insurance

The Insurance Company will issue a “Group Policy” in favour of FISHCOPFED and sponsoring agency for all the fishermen members / fishermen sponsored for insurance under the scheme during a month and the insurance cover to them shall be available from the date of actual receipt of full premium by the insurance company, for a period of 12 months ending the last day of the twelfth month.

5.Procedure for Insurance

A sponsoring agency may sponsor a group of fishermen members/fishermen for insurance under the scheme by sending the details of the group on the Performa prescribed (Annexure 3 (A)/ (B) as may be applicable) along with insurance premium as per the term of the policy per person to the FISHCOPFED through a bank draft/cross cheque drawn in favour of “National Federation Fishermen’s Cooperatives Ltd. (Insurance Account)” payable at Delhi. A State government may sponsor total fishermen including fisherwomen of the eligible age under the Policy by certifying the number of such persons by remitting the premium as per terms of the policy in the above mentioned manner. The cover will be available from the date of the premium is received by the insurance company after the collection of the proceeds of the draft/cheque by FISHCOPFED. The sponsoring agency must ensure that the person sponsored for insurance must nominate his nominee for payment of the claim.

6.Settlement of Claim

• (I)In case of death of an injured person on account of accidents as defined under Fishermen Accident Policy, the sponsoring agency will submit the claim to FISHCOPFED on form enclosed at Annexure 1 along with certificate on prescribed form (Annexure 2 to these rules which includes prepaid receipt) duly completed and signed by certifying authority within a period not exceeding nine months from the date of the certifying authority within a period not exceeding nine months from the date of the certifying authority will give full details of accident including the date and time of accident and the nature of being performed by the insured person at the time of accident.
• (II)In case of permanent disability or loss of limb the sponsoring agency will submit the claim to FISHCOPFED on form enclosed at Annexure-I to these rules along with certificate on prescribed form (Annexure 2 to these rules which includes prepaid receipt) duly completed and signed by the certifying authority and medical certificate on prescribed form (Annexure 4) from medical officer within a period not exceeding nine months from the date of accident.
• (III)In case of body of an insured is not found due to a natural calamity like tornado, storm etc. and the police confirms that his body is missing, the certifying authority will ascertain all the facts and enclose the police report along with and indemnity bond on such form as is prescribed by the insurance company and approved by the FISHCOPFED duly executed by the nominee and counter signed by the Sponsoring Agency within a reasonable period but not more then nine months from the date of natural calamity (Annexure 5).
• (IV) On receipt of claim FISHCOPFED shall file the claim with the insurance within one month and the insurance company shall settle the claim through the FISHCOPFED within one month from the receipt of the claim through an account payee cheque drawn in favour of the insured member in case disability or loss of limb or nominee in case of death, or in case of missing person.
• (V) On receipt of the claim cheque from the insurance company, FISHCOPFED will send the same to the sponsored agency for onward transmission to the drawee. The sponsoring agency shall be responsible to ensure that the cheque is paid to the nominee of the deceased in case of death/missing person ant to insured member in other cases in the manner approved by the State Government. It shall obtain an acknowledgement of the receipt of the cheque from the drawee and send the same to FISHCOPFED within 15 days of handing over the cheque to the drawee for its record. Payment of claim by the above method to the drawee through the sponsoring agency will absolve the FISHCOPFED and the insurance company of all its financial and legal responsibilities and the FISHCOPFED and the insurance company shall not be made a party to any dispute, whatsoever.

7.Amendments, Addition, Deletions

The Executive Committee of FISHCOPFED is authorized to make such amendments, additions or deletions as it may deem necessary from time to time and FISHCOPFED shall inform the same to the Government of India, State Government concerned, sponsoring agencies and the Insurance Company

8.Interpretation or Omissions

Any matter not covered under these rules shall be subject to the rules existing or amend in future for the Fishermen Accident Insurance Policy.