IMPORTANT POINT
Terms of insurance contract cannot be interpreted in narrow sense.

Kanwal Inder, Member—Vide this appeal, the appellant is challenging the order of the District Consumer Forum dated 22.7.2009 whereby it has been directed to pay Rs.5,00,000 towards insurance amount Rs.1,00,000 towards compensation and Rs.10,000 towards cost of litigation to the respondent Nos. 1 to 3 (complainants of the original case).

2. The respondents have filed reply. We have heard learned counsel for the parties and have perused the record.

3. As per record the respondent Nos. 1 to 3 filed complaint against appellant and the respondent No.4 Bank on the ground that they are widow, son and daughter of late Shri Ramji Lal who was holder of HDFC Bank credit card No.4346771001782037 on which he was having Life Insurance Policy issued by the appellant which was accident claim-cum-accidental death policy. The sum assured was Rs.5,00,000. The policy was taken with card in June, 2003. Shri Ramji Lal suffered accidental death on 21-22

December, 2003 midnight due to Haemorrhagic Shock due to injury by missile fired from the arm. He was the only bread earner to the family who left behind wife, two minor children and one ailing mother staying at her ancestral village. The claim was filed on 22.1.2004 along with documents. Further documents required were also submitted on 9.9.2004. Thereafter several letters were written. The appellant sent repudiation latter dated 18.1.2006 stating that as per the provisions of the policy the cover is granted for death by accident on air/rail/road and not otherwise, while the deceased was shot by some miscreant consequence upon which he died.

4. The respondent Nos. 1 to 3 challenged this ground of repudiation and referring to definition of accident in dictionaries, stating that purpose of insurance is to provide assistance to the person insured and his family in case of mis-happening and it is public policy for the betterment of public, but the insurance companies are trying to make profit due to ambiguous phraseology of terms and conditions.

5. In reply the appellant justified the repudiation stating that it is in accordance with the terms and conditions of the policy. This personal accident policy covers only case of air/ rail/ road accident, and death of the alleged card holder cannot be regarded as covered in the policy. In the present case, the accident was not so caused in the circumstances within scope of insurance. Its liability for any claim is to be linked into the provisions of the policy. Meaning of word in dictionary comes for consideration only when insurance documents provides no assistance to determine the scope of insurance. There is no deficiency on its part, and therefore there cannot be any mental agony, pain or discomfort. Preliminary objections have been raised that the respondent Nos. 1 to 3 are not consumers, there is no privity of contact between them and the appellant, the deceased cannot claim position of an insured unless the policy holder, the respondent No.4 confirms that on date of occurrence the deceased was such a card holder and that such a card was current and valid on that date.

6. There is no dispute between the parties regarding the fact that the subject-matter is to be determined with reference to the terms of this policy. The relevant provisions of the policy are re-produced below:

“Section 1. Personal Accident Cover— If, at any time, during the currency of his policy, the insured shall sustain any bodily injury, resulting in death, solely and directly from Air/Rail/ Road accident caused by external, violent and visible means, then the company shall pay to the legal personal representatives the sum or sums hereinafter set forth in the schedule. Air/Rail/Road accident will be subject to MV Act and Railway Act provisions and for Multiple Cards held by the Card Holder, the amount payable will be maximum sum insured set in the schedule or anyone card under the Policy.

If such injury shall within 12 calendar months of its occurrence by the sole and direct cause to