IMPORTANT POINT
The interpretation of exclusion clauses in insurance policies must be strict, and insurers bear the burden of proving that claims fall within such exclusions, particularly when ambiguities exist.

JUDGMENT :

GOPINATH P., J.

1. A short but interesting question arises for consideration in this case. The Writ Petitioner is the wife of late Sunil Kumar P.P who was murdered on 06.05.2009 by one Mathew Antony (‘the accused’). By Ext.P4 judgment of the Additional Sessions Court (Adhoc)-II, Kalpetta, Wayanad district, aforesaid Mathew Antony was convicted for the offence under Section 302 of the Indian Penal Code for the murder of late Sunil Kumar. At the time of his death, the late Sunil Kumar was holding three life insurance policies bearing Nos.792075377, 793732239 and 791166804 with the Life Insurance Corporation (hereinafter referred to as ‘the LIC’). These policies were, admittedly, in force at the time of the death of Sunil Kumar. In addition to other benefits, all the above three policies had identical terms [Clause 10.2] providing what is called ‘accident benefit’. It is not disputed before me that the terms providing for such a benefit were identical in all the three policies issued to the late Sunil Kumar. However, the LIC denied the claim for ‘accident benefit’ in terms of the aforesaid policies, upon the ground that the claim for accident benefit could not be granted on account of the exclusion clause forming part of Clause 10.2(b) of each of the policies issued to the late husband of the petitioner which to the extent relevant reads thus:

“The Corporation shall not be liable to pay the additional sum referred to in (a) or (b) above, if the disability or the death of the Life Assured shall:

(i) Be caused by intentional self-injury, attempted suicide, insanity or immorality or whilst the Life Assured is under the influence of intoxicating liquor, drug or narcotic......”

[Note: This clause is referred to as the exclusion clause hereafter]

It is the case of the LIC that the motive behind the murder of late Sunil Kumar by the aforesaid Mathew Antony was that late Sunil Kumar was allegedly having an illicit relationship with the wife of the aforesaid Mathew Antony and therefore, the claim for accident benefit cannot be considered in terms of the exclusion clause, as it was an immoral act that led to the death of Sunil Kumar.”

2. The claim for accident benefit was repudiated by Ext.P5 communication, which reads as follows:

“Re: Policy No. 791166804, 792075377 & 793732239

- Sunil Kumar PP (decd)

- Claim for Accident Benefit

With reference to your claim for the accident benefit under the policies on the life of your deceased husband, we may inform you that your claim was considered by us and it has not been found possible to us to admit the claim.

As you might have noted, it is clearly stated in the judgment by the Court of the Additional Sessions Judge Kalpetta, that the death of the assured was an intentional murder, as he had been involved in immoral activities. Your kind attention is invited to the exclusion clause of Double Accident Benefit as per policy condition 10(2)(b)(i) (copy of policy bond attached) which states that “The Corporation shall not be liable to pay the additional sum assured if the death of the life assured shall be caused by intentional self injury attempted suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic.

However, if you disagree with our decision, you may send in your written representation stating therein the specific grounds on which reconsideration is needed to the higher authority whose address is as given below, within three months positively after receipt of this letter.

The Zonal Manager, LIC of India,

Southern Zonal Office, LIC Building,

Anna Salai, Chennai- 600002.”

Being aggrieved by the repudiation of the claim through Ext.P5, the petitioner preferred a representation to the Zonal Manager. However, the Zonal Manager through, Ext.P6 communication upheld the repudiation of the claim for accident benefit prompting the petitioner to approach the Insurance Ombudsman, constituted in terms of the Redressal of Public Grievances Rules, 1