IN THE HIGH COURT OF KERALA
K. Vinod Chandran, J.
Valsala Devi - Appellants
Vs.
Divisional Manager, Kottayam and Ors. - Respondent
W.P. (C) No. 16473 of 2008
Decided On: 22.06.2015
Life Insurance Corporation Act 1956 - Accident Claim - Payment of insurance - medical condition - Held, accident caused by an 'outward, violent and visible means'. It cannot at all be said that, only an accident caused by a third party would be covered under the said clause. Whether it be induced by a third party or by reason of a mere slip or as in the present case, an accident, a fall would be an accident coming within the coverage of the policy; if it is fatal - 'outward, violent and visible cause' is the head injury which injury alone was the cause of the death. The fall and the injury to the head, which occasioned death, is the outward cause, as distinguished from an internal cause like a hemorrhage or hypoglycemia.
K. Vinod Chandran, J.
1. The issue arising in the above writ petition, filed impugning the award of the Ombudsman, is whether the petitioner is entitled to the additional benefit of 'death by accident' as covered in Ext. P1 policy. The policy is said to be one which indemnifies the death and death by accident, the latter entitling double benefit to the beneficiary. With respect to death by accident, the nominee is entitled to Rs. 5 lakhs as indemnity for the death caused and an additional Rs. 5 lakhs as indemnity if such death is caused by an accident. The petitioner, the nominee of the policy holder-who died by reason of a fall from a height, was granted the death benefit, but was declined the accident benefit for reason of the death having not been caused by an "outward, violent and visible means". This is the exact words used in Clause 10(b) of Ext. P1 which refers to the entitlement of 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 120 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured".
2. The learned Counsel for the petitioner would rely on AIR 1999 Guj. 280 1999 KHC 496 : 1999 (2) KLT SN 531999 KHC 496 : 1999 (2) KLT SN 53 Ambalal Lallubhai Panchal (Ranerwala) v. L.I.C. of India and 2003 (3) KLT 316 (Patna) 2003 KHC 1117 United India Insurance C. Ltd. v. State of Bihar to contend that, the repudiation made on the ground of the accident itself having been caused by Diabetes Mellitus and Hypertension cannot be sustained. The learned Counsel would also take me through the 4th edition of Halsbury's Laws of England, 4th edition, 2013 (Vol. 25) in which the concept of injuries resulting from accident by violent, external and visible means has been dilated upon on the strength of judicial precedents.
3. The learned Standing Counsel appearing for the respondent Insurance Company however, would urge that, a strict interpretation is necessary in the case of the policies governing the indemnification of death and accident, as has been consistently held by the Hon'ble Supreme Court in Life Insurance Corporation of India and Another v. Dharam Vir Anand 1999 KHC 464 : 1998 (7) SCC 348 : 1999 (2) KLT SN 21, Amravati District Central Cooperative Bank Limited v. United India Fire and General Insurance Company Limited 2010 KHC 4249 : 2010 (5) SCC 294 : 2010 (3) SCALE 715 and Export Credit Guarantee Corporation of India Limited v. Garg Sons International 2013 KHC 4040 : 2013 (1) KHC SN 16 : 2013 (1) SCALE 410 : 2013 (2) KLT SN 168 : 2014 (1) SCC 686 : 2013 (178) Comp Cas 341 : 2013 (116) Cut LT 395 : 2013 (123) AIC 268 : 2013 (97) ALR 195.
4. The learned Counsel for the insurer relies on these decisions, to persuade this Court to construe the provisions in the policy strictly; not tinged with liberalism or laced with equity. The decisions of the National Consumer Disputes Redressal Commission, Life Insurance Corporation of India and Another v. N. Shanker Reddy is placed not as a precedent but for the compelling reasoning, in an identical situation.
5. The background facts are that, the policy holder had been employed in Saudi Arabia and the death was caused in that foreign State, while he was in employment. Ext. P2 is the medical report issued by the Ministry of Health, Kingdom of Saudi Arabia, which diagnosed the death as having been caused by "severe injury in the head after falling down from a high place which caused severe damage to the brain". The 'death notification' issued by the hospital is also produced at Ext. P3 in which the cause as indicated herein above is reiterated. The Insurance Company however relies on the 'morbid condition' noticed in Ext. P3-Diabetes Mellitus and Hypertension-to contend that this was the cause of death. The ground of repudiation was that, the f
Ambalal Lallubhai Panchal (Ranerwala) v. L.I.C. of India
Life Insurance Corporation of India and Another v. Dharam Vir Anand
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