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UTTARAKHAND HIGH COURT
BEFORE : RAJIV SHARMA, J.
Smt. PUSHPA AGRAWAL ....Petitioner
Versus
INSURANCE OMBUDSMAN U.P. AND UTTARANCHAL AND OTHER ....Respondents
(Civil Misc. Writ Petition No. 50352 of 2008, decided on 25th April, 2012)
Counsel :
S.D. Singh and Diptiman Singh for the Petitioner; Prakash Padia for the Respondents.
The absence of mens rea is the criteria for calling any incident an accident, and the Rule of Contra Proferentem is applicable to insurance contracts.
Headnote:
Accident - Insurance Claim - 10-2, 10(b) - The court discussed the interpretation of the term 'accident' under the Accident Benefit Clause of the insurance policies and its application to the case. It highlighted the legal provisions and their interpretations, emphasizing that the absence of mens rea is the criteria for calling any incident an accident. The court also applied the Rule of Contra Proferentem and referred to relevant case laws to support its decision.
Fact of the Case:
The petitioner challenged the denial of Double Accident Benefit claim by the Insurance Ombudsman after the insured's murder. The petitioner's son had taken two insurance policies with Double Accident benefit, and the claim was denied by the Insurance Company on the grounds that the death was due to murder and not an accident.
Finding of the Court:
The court analyzed the terms of the insurance policy and the circumstances of the insured's death. It concluded that the murder of the insured was accidental from the insured's point of view and that the insurance company was liable to pay the Double Accident Claim benefit and accrued bonus. The court also imposed a cost on the Insurance Company for delaying the legitimate claim.
Issues: The main issue was whether the death caused due to murder of the insured can be held to be 'accidental death'.
Ratio Decidendi: The court applied the Rule of Contra Proferentem and interpreted the term 'accident' under the insurance policy. It emphasized the absence of mens rea as the criteria for calling any incident an accident and referred to relevant case laws to support its decision.
Final Decision: The court quashed the decision to deny the Double Accident Claim benefit, ordered the Insurance Company to disburse the amount accrued towards the claim and pay interest, and imposed a cost of Rs. 25,000 on the Insurance Company.
JUDGMENT
Hon’ble Rajiv Sharma, J.—Heard Sri S.D.Singh, learned Counsel for the petitioner and Sri Prakash Padia, learned Counsel for the opposite parties.
2. 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.
3. 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.
4. 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 v. 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 re-open the case if so warrants depending on the judgment of the sessions Court and pass appropriate orders.”
5. 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 w
