Heard Sri S.D.Singh, learned Counsel for the petitioner and Sri Prakash Padia, learned Counsel for the opposite parties.
Through the instant writ petition under Article 226 of the Constitution of India, the petitioner challenges the award dated 30.6.2008 passed by the Insurance Ombudsman, Uttar Pradesh & Uttarakhand, Lucknow (opposite party No.1) [hereinafter referrred to as the "Ombudsman" for the sake of brevity], in complaint No. LP-117/21/001/07-08 contained in Annexure 5 to the writ petition, whereby the Ombudsman disposed of the complaint by confirming the orders of the authority of Life Insurance Corporation of India whereby the claim for Double Accident benefit was denied as well as the accrued bonus. However, the liberty was granted by the Ombudsman to the complainant/petitioner to approach the forum directly after the trial was concluded with a certified copy of the judgment of the session's court within two months from the date of judgment and the forum was at liberty to reopen the case, if so warrants.
Factual matrix of the case are that the petitioner's son Sri Neeraj Kumar Agarwal, aged about 26 years, who was engaged in business, took two policies i.e. Policy No. 3116783632 and 312042657, on his own life under plan/term 14/49 from Life Insurance Corporation of India with Double Accident benefit. Unfortunately, her son was murdered on 19.11.2006, as a consequence of which, petitioner being nominee and mother of the deceased claimed the insured amount, to which Life Insurance Corporation of India [hereinafter referred to as "the Insurance Company"] asked the petitioner to furnish the requisite information in the prescribed claim forms. In pursuance thereof, the petitioner submitted her claim in the prescribed claim forms. The In-house Investigating Officer of the Insurance Company investigated the claim and submitted report. On the basis of the said report, the Senior Divisional Manager, Allahabad of the Insurance Company accepted the petitioner's claim for Basic Sum Assured but repudiated/rejected the claim for Double Accident Benefit vide letter dated 28.12.2007 on the grounds that death of the deceased is due to murder after kidnapping and not by an accident and as such, Double Accident Benefit is not payable to her. However, petitioner received the Basic Sum Assured amount, under protest.
Against the letter dated 28.12.2007, petitioner approached the Zonal Manager at Kanpur by preferring a representation. The Zonal Manager also rejected the petitioner's representation and upheld the decision of Senior Divisional Manager, Allahabad. Feeling aggrieved, the petitioner preferred a complaint, bearing No. LP/117/21/001/07-08, before the Ombudsman, who, vide order dated 30.6.2008, after perusing the material on record and submissions made orally before it and relying upon the judgment of Hon'ble Supreme Court in the case of Smt. Rita Devi Versus New India Assurance Co. Ltd.;(2000) ACC 291 SC disposed of the complaint with the following observations and directions :
"In the instant case, the culprits are under trial, hence, it is difficult to say anything conclusively regarding the motive and intent of the persons accused. A lot will depend upon the judgment of the session court in this matter to determine the admissibility of the claim. Under these circumstances, I am disposing off the complaint by confirming the order of respondent company in denying the A.B. However, the complainant by this order is at liberty to approach this forum directly with a certified copy of the judgment of the session's court within two months from the date of judgment. The forum shall be at liberty to reopen the case if so warrants depending on the judgment of the sessions court and pass appropriate orders."
Feeling aggrieved, the petitioner has preferred the instant writ petition inter alia on the grounds that since the murder of the insured was unlooked for or mishap or untoward event which was not expected or designed, as such, the Ombudsman erred in not considering the claim of the petitioner in right perspective.
Sri S.D. Singh, learned Counsel for the petitioner has submitted that from bare perusal of the word 'Accident' under the Accident Benefit Clause of the policies of the insured meant and included all or any reason for death or injury, which is unforeseen and not on account of any natural, probable or foreseen cause, from the point of view of the insured. Thus, the term "Accident" under the Accident Benefit clause of the policies has to be given the widest and must not restricted meaning. He submits that the business rivalry and/or kidnapping of the insured on account of such rivalry or his murder were not and cannot be held to be foreseen or probable causes of death of the insured when his life was insured by the Insurance Company.
Elaborating his submission, Sri Singh submits that intention of the abductors of the insured was irrelevant and extraneous for invoking the Accident Benefit clause under the policies. Thus, the murder of the insured was an accidental happening so far as the insured was concerned and as such, the opposite parties erred in rejecting the claim of the petitioner for Double Accident Benefit.
Refuting the submissions of learned Counsel for the petitioner, Sri Prakash Padia, learned Counsel for the opposite parties did not dispute the facts of the case but submits that on submission of claim in the prescribed proforma, the said claim was investigated and an order was passed to accept the claim for the basic sum assured and repudiated the claim for Double Accidental benefit, vide order dated 28.12.2007 passed in respect of both the policies, the Senior Divisional Manager inter alia on the facts that there is sufficient proof to show that the policy-holder was kidnapped and death was caused due to murder, which is not an accident. The said order dated 28.12.2007 was confirmed by the Zonal Manager of the Corporation in the representation dated 16.2.2008 vide orders dated 18.3.2008. Being dis-satisfied with the aforesaid orders, the petitioner approached the Insurance Ombudsman U.P. and Uttaranchal at Lucknow, which was registered as complaint No.LP-117/21/001/07-08 and vide award 30.6.2008, the Ombudsman disposed of the complaint, which is under challenge in the present writ petition.
Sri Padia, while defending the impugned orders, submits that the findings were recorded after perusing the material on record as well as taking into account the facts which came to knowledge of Ombudsman during the course of personal hearing on 27.6.08 that an FIR was lodged on 11.11.2006 at Police Station Ghoorpur, District Allahabad to the effect that the life assured was abducted by some unknown persons with an intent to kill the life assured. The FIR was lodged by the uncle of life assured, namely, Vijay Kumar Agarawal. It was further stated by the members of family of life assured that there is a business rivalry in the family and as such, certain members of the family had hired the assailants and due to this rivalry, the assailants killed the life assured. It was also brought to the knowledge of the Ombudsman during the course of hearing that against the accused persons, trial is in progress in the Sessions Court and the said fact was also taken into consideration by the Ombudsman in the order impugned.
Sri Padia further submits that the Ombudsman had rightly relied upon the judgment of Smt. Reeta Devi Versus New India Assurance Co. Ltd. Reported in 2000 ACC 291 SC, whereby the Apex Court, while distinguishing between a murder which is not an accident and murder which is an accident, held that if the dominant intention of the Act of felony is to kill any particular person then such killing is not an accidental murder but is a murder simplicitor, while if the cause of murder or act of murder was originally not intended and the same was caused in furtherance of any other felonious act then such murder is an accidental murder and accordingly Ombudsman was of the opinion that as the trial is under progress, it is very difficult to say anything conclusively regarding the motive and intention of the persons accused and lot will depend upon the judgment of the Sessions Court in the matter in question. Thus, after taking all these facts and circumstances, the Ombudsman confirmed the orders passed by the authorities of the Insurance Corporation and a liberty was given to the petitioner to approach the forum directly again, as stated hereinabove.
Having heard learned Counsel for the parties and perusing the records, I am of the view that under the facts and circumstances of the instant case, the only question which requires consideration in this petition is "whether the death caused due to murder of the insured can be held to be ''accidental death' ? "
The material on record reveals that an FIR was lodged on 11.11.2006 at Thana Ghhorpur, Allahabad by the uncle of life insured (Vijay Kumar Agarwal), stating therein that on 11.11.2006, at 6.45 P.M., while the life insured was returning home from Hot Mix Plant situated at National Highway No. 76 with Maruti Van No. UP 70 K-0505 driven by his driver Shekhar and when they reached near Jasra Railway Crossing, 7-8 persons aged about 25 to 32 years, who sat on a Marshal Jeep armed with deadly weapons, abducted the life insured but left his driver. Immediately thereafter, his driver conveyed about the said incident over telephone to the members of family and on that basis, uncle of the life insured lodged the F.I.R. Before the Ombudsman, the insurance company contended that the death of the insured occurred due to murder and, hence, the insurance company was not bound to pay the sum assured.
In order to answer the aforesaid question in an equitable manner, terms of the policy bond, which is under plan/term 14/49, is reproduced as under :
"10-2. Accident Benefit : If at any time when this Policy is in force for the full sum assured, the Life Assured, before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70 whichever is earlier, involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of:-
(a) Disability to the Life Assured : (I) to pay in monthly instalments spread over 10 years an additional sum equal to the Sum Assured under the Policy, if the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid along with the claim, (ii) to waive the payment of future premiums.
The maximum aggregate limit of assurance under all policies on the same life to which benefits (i) and (ii) above apply shall not in any event exceed Rs.10,00,000 if there be more policies than one and if the total assurance exceeds Rs.10,00,000 the benefit shall apply to the first Rs.10,00,000 sum assured in order of date of the Policies issued.
The waiver of premium shall extinguish all options under the policy and also the benefits covered by para (b) of the Clause except as to such assurance, if any as exceeds the maximum aggregate limit of Rs.10,00,000 and which have been kept in force by continued payment of premiums.
10(b) Death of the life assured : To pay an additional sum equal to the Death Benefit under this policy, if the Life Assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 120 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. However, such additional sum payable in respect of this policy, together with any such additional sums payable under other policies on the life of the Life Assured shall not exceed Rs.10,00,000.
The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability of the death of the life assured shall -
i)be caused by intentional self injury, attempted suicide, insanity or immoraly or whilst the life assured in under the influence of intoxicating liquor, drug or narcotic, or
(ii) take place as a result of accident while the Life Assured engaged in aviation or aeronautics in any capacity other than of a fare-paying, part paying or non-paying passenger in any air craft which is authorized by the relevant regulation to carry such passengers and flying between established aerodromes, the Life Assured having at that time no duties on board the aircraft or requiring descent therefrom, or
(iii) be caused by injuries resulting from riots, civil commotion, rebellion, war (whether war be declared or not) invasion, hunting, mountaineering, steeple chasing or racing of any kind; or
iv)result from the life assured committing breach of law, or
v)result from employment of the Life Assured in the armed forces or military service of any country at war (whether war be declared or not) or from being engaged in police duty in any military, naval or police organization."
The policy bond specifically provides that if the life assured sustains any bodily injury resulting solely and directly from the accident caused by outward violent and visible means, which results in the death of the life assured within the period of 120 days of its occurrence, heirs would be entitled to get accidental benefit.
On further perusal of the terms of policy bond, which includes Exclusion Clauses it will be revealed that the Corporation is not liable to pay additional sum in case the death is caused under any of the circumstances mentioned in Clauses (i) to (v) but it does not exclude death due to murder for any reason. Inspite of it, the insurance company has repudiated the Double Accident claim on the ground that the death of the assured was due to murder.
Admittedly, the policy bond did not define the word 'Accident' but qualified that the accident must be accompanied by qualities such outward, violent and visible means. There is no dispute that in a Murder, these three ingredients are existing. As the word 'accident' is not defined in the Terms and Conditions of the policy bond and as such, in the alternative, the Court proceeded with the dictionary meaning.
In England, law on the subject is settled. In Halsbury's Laws of England Vol. 25 Pg.307 Para 569, 4th Edition (2003 reissue), as to the meaning of the word ''accident', it is stated as under :
"569. Meaning of ''accident'. The event insured against may be indicated in the policy solely by reference to the phrase ''injury by accident' or the equivalent phrase ''accidental injury', or it may be indicated as ''injury caused by or resulting from an accident'. The word ''accident', or its adjective ''accidental', is no doubt used with the intention of excluding the operation of natural causes such as old age, congenital or insidious disease or the natural progression of some constitutional physical or mental defect; but the ambit of what is included by the word is not entirely clear. It has been said that what is postulated is the intervention of some cause which is brought into operation by chance so as to be fairly describable as fortuitous. The idea of something haphazard is not necessarily inherent in the word; it covers any unlooked for mishap or an untoward event which is not expected or designed, or any unexpected personal injury resulting from any unlooked for mishap or occurrence. The test of what is unexpected is whether the ordinary reasonable man would not have expected the occurrence, it being relevant that a person with expert knowledge, for example of medicine, would have regarded it as inevitable. The stand point is that of the victim, so that even willful murder may be accidental as far as the victim is concerned."
As per Macmillan English Dictionary for advanced learners, International Edition, the word "Accident" and its related words along with illustrations is as follows:
"ACCIDENT: 1. a crash involving a car, train, plane, or other vehicle; a fatal accident on the autoroute between Paris and Lyons. He was tragically killed in a motorcycle accident. The accident was caused by ice on the road. 1a. a sudden event, usually caused by someone making a mistake that results in damage, injury, or death; Seven men were killed in a serious mining accident yesterday. A riding/climbing/hunting accident. 1b. a mistake that causes minor damage or harm: Don't make such a fuss - it was an accident.
2. Something that happens unexpectedly, without being planned: To be honest, my second pregnancy was an accident. 2a. it is no accident used for saying that something was planned, perhaps for dishonest reasons: It is no accident that every letter we send is delayed.
An accident of birth a situation caused by who your family is rather than by anything you do.
An accident waiting to happen 1. a situation likely to cause an accident: An ageing nuclear reactor is an accident waiting to happen. 2. someone who behaves in a way what is likely to cause trouble By accident by chance, without being planned or intended. Quite by accident, she came up with a brilliantly simple solution. Occasionally we would meet by accident in the corridor."
It will be seen in the word "Accident", the presence of intention, pre-planning or expectations removes a particular happening out of the definition of word Accident. This definition has universal application and the dictionary does not make any distinction based on any particular situation. In legal terms, absence of mens rea is the criteria for calling any incident an Accident.
The word "Murder" has also not been defined in the policy bond and as such, the definition of word "Murder" has also been borrowed as "Murder" is defined in the form of noun as THE CRIME OF KILLING SOMEONE DELIBERATELY and in the form of verb as TO COMMIT THE CRIME OF KILLING SOMEONE DELIBERATELY.
It is this word 'deliberate' that rules out the possibility of an incident being called an Accident. This exactly is the reason that Accident has been made an exception and a defence to a charge of Murder and the Indian Penal Code describes the various kinds of Culpable Homicide amounting to Murder and not amounting to the same as the reading of Sections 299, 300, 301 and 304-A along with Accident as a defense or an exception. Sections 299, 300, 301 and 304-A reads as under :
"299. Culpable homicide:- Whoever causes death by doing an act with the intention of causing death, or with the intention of causing such bodily injury as is likely to cause death, or with the knowledge that he is likely by such act to cause death, commits the offence of culpable homicide.
300. Murder:- Firstly, Except in the cases hereinafter excepted, culpable homicide is murder, if the act by which the death is caused is done with the intention of causing death, or Secondly:- If it is done with the intention of causing such bodily injury as the offender knows to be likely to cause the death of the person to whom the harm is caused, or Thirdly:- If it is done with the intention of causing bodily injury to any person and the bodily injury intended to be inflicted is sufficient in the ordinary course of nature to cause death, or Fourthly:- If the person committing the act knows that it is so imminently dangerous that it must, in all probability, cause death or such bodily injury as is likely to cause death, and commits such act without any excuse for incurring the risk of causing death or such injury as aforesaid.
Exception 1:- When culpable homicide is not murder:- Culpable homicide is not murder if the offender, whilst deprived of the power of self-control by grave and sudden provocation, causes the death of the person who gave the provocation or causes the death of any other person by mistake or accident.
301. Culpable homicide by causing death of person other than person whose death was intended:- If a person, by doing anything which he intends or knows to be likely to cause death, commits culpable homicide by causing the death of any person, whose death he neither intends nor knows himself to be likely to case, the culpable homicide committed by the offender is of the description of which it would have been if he had caused the death of the person whose death he intended or knew himself to be likely to cause.
304-A. Causing death by negligence:- Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both."
The question that under which circumstances the "willful act" of the third party can be held to be 'accidental' ?, is discussed in Halsbury's Laws of England Vol. 25 Pg.311 Para 575, 4th Edition (2003 reissue), as under:
575. Injury caused by a willful act. An injury caused by the willful or even criminal act of a third person, provided the insured is not a party or privy to it, is to be regarded as accidental for the purpose of the policy, since from the insured's point of view it is not expected or designed. Injuries sustained by gamekeeper in a criminal attack upon him by poachers, by a chashier who was murdered by a robber, and by a master at an industrial school who was murdered by the boys, have been held to be accidental. However, if the immediate cause of the injury is the deliberate and willful act of the insured himself, there would seem to be no accident, and no claim will lie under the policy, at any rate if the insured is not mentally disordered at the time of his act.
Mere knowledge of hazard of an occurrence will not take it away from the category of accident in its general sense. Albeit, the law may in a given context define accident to restrict its wider meaning and dilute it to what is called a 'pure accident', but there is no warrant for such restricted meaning in the context of the above clause of the Insurance Policy.
It would not be out of place to mention that Nisbet v. Rayne and Burn, [1910] 2 KBD 689 is a leading case on this subject. A cashier was traveling in a train with a large sum of money intended for payment to his employer's workmen. He was robbed and murdered and the Court of Appeal held the murder was an accident from the point of view of the cashier and, therefore, it was an accident within the meaning of that term in the Workmen's Compensation Act, 1906.
In Smt. Satiya vs. Sub Divisional Officer, 1975 I LLJ 394 (Madhya Pradesh) a chowkidar in the Public Works Department was murdered while on duty. One of the questions that arose was whether his murder could be said to be an accident. Relying upon Nisbet, it was held that the murder was an unlooked for mishap or untoward event which was not expected or designed. The learned Judge held that word "accident" excludes the idea of willful and intentional act but as explained in Nisbet, "the phrase ought to be held to include murder as it was an accidental happening so far as the workman was concerned."
The combined effect of reading the aforesaid sections cannot be better illustrated than mere reproduction of the words of the Supreme Court in the case of Smt. Rita Devi and others Vs New India Assurance Company Limited and Another reported in 2000 (3) Supreme 698, as "the question, therefore, is can a murder be an accident in any given case ? There is no doubt that ''murder', as it is understood, in the common parlance is a felonious act where death is caused with intent and the perpetrators of that act normally have a motive against the victim for such killing. But there are also instances where murder can be by accident on a given set of facts. The difference between a ''murder' which is not an accident and a ''murder' which is an accident, depends on the proximity of the cause of such murder. In our opinion, if the dominant intention of the Act of felony is to kill any particular person then such killing is not an accidental murder but is a murder simplicitor, while if the cause of murder or act of murder was originally not intended and the same was caused in furtherance of any other felonious act then such murder is an accidental murder.
Insofar as legal principle is concerned, it is not the insured's point of view that is the criteria but it is The Rule of Contra Proferentem that is actually the legal principle applicable to insurance contracts.
Rule of Contra Proferentem is generally made applicable to standard form of contracts. Later, this rule was extended to Terms and Conditions of insurance policies. It is strictly a rule of interpretation where, in case of an ambiguity, the construction that is favourable to the insured is adopted. This is purely a rule invoked for interpretation of the terms of contracts. This rule has no application to anything when no particular term of contract is under interpretation. Even this interpretation is confined to cases where there is existence of any ambiguity in any particular term. In the absence of any word being in ambiguity, it cannot be invoked.
As seen from the dictionary meaning and as on exception on defense to a charge of murder and further going by the interpretation of the said term by the Supreme Court in Rita Devi (Supra), hardly any ambiguity exits. The Supreme Court of India in Central Bank of India Vs Hartford Fire Insurance Company reported in AIR 1965 SC 1288 clearly held "it is well known however that the rule (of contra proferentum) has no application where there is no ambiguity in the words in the standard form of contract.
In the case of United India Insurance Company Limited Vs Harchandrai Chandanlal reported in JT 2004 (8) SC 8, the Supreme Court reiterated at para 14 that the terms of contract has to be strictly read and NATURAL meaning be given to it. No outside aid should be sought unless the meaning is ambiguous.
From the aforesaid reasonings, it can safely be inferred that ''even the willful murder' of the assured is accidental as far as insured is concerned and such murder is to be described as ''by chance' or ''fortuitous'.
At this juncture, it would be useful to refer following observations made by the Division Bench of Gujarat High Court in the case of Ambalal Lallubhai Panchal (Ranerwala) v. LIC of India [AIR 1999 Gujarat 280], wherein the question involved was whether a death caused by dog bite can be said to be death caused by an accident so as to make the Life Insurance Corporation of India liable to pay an additional sum equal to sum assured under the extended benefit clause of the Policy, may be referred:
"7. The word "accident" has a very wide significance in its ordinary sense. In the present case, we are not concerned with the philosophical meaning of the expression "accident". The word, though easy to understand when used in any particular context, is found to be difficult to define in a manner that would encompass all its shades of meanings. The expression 'accident' generally means some unexpected event happening without design, even though there may be negligence and it is used, in a popular and ordinary sense of the word, as denoting an unlocked for mishap or an untoward event which is not brought about by intention or design. It is however, unnecessary to attempt any uniform definition of a term which has the utility of answering varied situations.
This term has to be applied in law to any occurrence or result that could not have been foreseen by the agent (because not necessarily involved in his action) or to a result not designed (and therefore, presumably not foreseen) or lastly to anything unexpected. The question as to what will and will not constitute an accident under a given circumstance would depend upon the facts of each particular case and would be a mixed question of law and facts. Accidents can broadly be divided into two categories, viz. where there is some external act, agency or mishap and those where there is no such external act, agency or mishap. In legal contemplation, accident happens without any designed, intentional or voluntary causation such as an occurrence which happens by reason of some violence, casualty or vis. major without any design or consent or voluntary co-operation. An unexpected personal injury resulting from an unlooked-for mishap or occurrence would be an accident. The word "accident" would get its colour from the context in which it is used. The word has fallen for our interpretation in context of the following accident benefit clause in a Life Insurance Policy and in context of the question whether death due to dog bite is an accident within the meaning of this clause, so as to merit payment of additional sum equal to the sum assured under this clause.
10. Accident Benefit : If at any time when this policy is in force for the full sum assured, the Life Assured before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of
a) xxx xxx xxx
b) Death of the Life Assured : To pay an additional sum equal to the Sum Assured under this policy, if the Life Assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward violent and visible means and such injury shall within 90 days of its occurrence solely, directly and independently of all other causes result in the death of the Life Assured. However, such additional sum payable in respect of this policy together with any such additional sums payable under other policies on the life of the Life Assured shall not exceed Rs. 5,00,000/-.
xxx xxx xxx It will be seen that the word "accident" used in this clause is not circumscribed to any narrow meaning. What has been excepted from the liability of the insurer has been specifically mentioned in the said Clauses (i) to (v) of Clause 10(b). All that is required for this clause to operate is that the bodily injury sustained by the Life Assured results solely and directly from the accident caused by "outward violent and visible means", which injury has resulted in the death of the Life Assured within the period as contemplated by the clause."
So far as the reliance placed by the Ombudsman in the case of Rita Devi Vs. New India Assurance Co. Ltd; (2000) 5 SCC 113, is concerned, I am of view that Rita Devi (supra) is not applicable in the facts and circumstances of the case insofar as in the case of Rita Devi (supra), the Apex Court considered and interpreted a phrase providing "death due to accident arising out of the use of motor vehicle". Thereafter, the Court referred to various decisions and arrived at a conclusion that they have no hesitation in coming to a conclusion that the deceased, Dashrath Singh, was employed to drive an auto rickshaw for ferrying passengers on hire. On the fateful day the auto-rickshaw was parked at auto-rickshaw stand and unknown passengers engaged the said auto-rickshaw for their journey and during that journey, it was alleged that the passengers caused murder of Dashrath Singh. The Apex Court held that death in such case was due to accident. The Court further observed that the difference between ''murder which is not an accident' and ''murder which is an accident' depends on the proximity of the cause of such murder. If the cause of murder or act of murder was originally not intended and the same was caused in furtherance of any felonious act then such murder is an accidental murder arising out of the use of motor vehicle and held that the insurance company was liable to reimburse the claimant, whereas in the instant case, in a clause of Insurance policy, which assures accident benefits in respect of the loss caused from any accident by "outward, violent and visible means". There is no warrant to qualify this clause by carving out any exception on the grounds such as carelessness, negligence, avoidability etc. The only exceptions that apply are those which have been specifically enumerated and for all other eventualities, which can be described as accident by its general and non-technical sense, the liability to pay the accident benefit arises when the accident is caused by "outward, violent and visible means". This qualification is meant to provide for ascertainability of the event.
Considering the matter in all pros and cons, I am of the view that reasoning given by the Ombudsman cannot be justified by any standard. LIC policy excludes death due to limited causes mentioned in Exclusion Clause under para 10(b) and, therefore, it is totally irrelevant to find out the background of the deceased. Further, even in case where there is a criminal background of the assured, it would be difficult to hold that his murder was not accidental unless he has taken up the quarrel and that the immediate cause of injury was deliberate and willful act of the insured himself.
For the reasons aforesaid, the decision for repudiating the claim vide letter dated 28.12.2007 by the Senior Divisional Manager, Life Insurance Corporation, with regard to Double Accident Claim benefit and the decision of the Zonal Manager upholding the order passed by the Senior Divisional Manager as well as the award dated 30.6.2008, which confirms the above orders in denying the accrued bonus and the findings recorded therein, are hereby quashed. The Insurance Company shall disburse the amount accrued towards the Double Accident Claim benefit including bonus and also pay an interest at the rate of 8% per annum on the said amount from the date the same has fallen due under Policy Nos. 3116783632 and 312042657, within a period of three months from the date of receipt a certified copy of this order.
I pain to note that petitioner's son died due to untoward incident and she is running from pillar to post since 2008 for her legitimate claim/right but the Insurance Company, on one pretext or other, is dragging the petitioner from one litigation to other litigation, therefore, it is appropriate and just to impose cost upon the Life Insurance Corporation of India.
The writ petition is allowed with costs, which is quantified to Rs.25,000/-. The Life Insurance Corporation of India shall pay the cost of Rs.25,000/- within a month from today before the Registry of this Court. On receipt of the said cost, Registry is directed to pay Rs.15,000/- to the petitioner and balance of the amount i.e. Rs.10,000/- shall be remitted to the account of Mediation and Conciliation Centre of this Court forthwith.
Order Date : 25.4.2012 Ajit/-