The court established that claims under insurance for accidental death cannot be denied without substantial evidence of negligence or illegal actions by the insured.

JUDGMENT

Dated this the 10th day of November, 2022 The petitioner’s husband Nasumudeen, died on

19.09.2019, due to an accidental fall, while traveling in the Mangalapuram - Trivandrum Express Train. The deceased was working as a Civil Police OfÏcer in the Railways and was on duty when the unfortunate incident occurred. Thereafter, the petitioner submitted an application claiming the insurance amount due under the Group Personal Accident Insurance Scheme . The claim was rejected under Ext.P11, stating the reason that accidents relating to trains will not be considered for insurance under the Scheme. In support of the rejection, reference was made to certain Government Orders. Aggrieved by Ext.P11, petitioner preferred Ext.P12 appeal, which also was rejected under Ext.P13. This time the reason stated was that the accident and untimely death of petitioner’s husband had occurred due to his negligence and as per the extant Government Orders, no claim is payable for train accidents and accidents resulting from some illegal activity of the injured/deceased.

2. Learned Counsel for the petitioner submitted that the relevant clause in the Government Order relied on has no application. In this regard, reference is made to Clause 6 of Ext.P5 and Clause iv of Ext.P6.

3. Learned Government Pleader submitted that the Government Orders referred to in Ext.P9 provides for rejection of claims under the circumstances mentioned in Exts.P11 and P13.

4. Having heard the learned Counsel on either side and having gone through the Government Orders, I find substantial merit in the challenge raised in this writ petition. It is pertinent to note that proviso to Clause 6 of Ext.P5 is to the following effect;

‘Provided that no compensation shall be paid for death or disablement as described above, arising out of internal injury, suicide, attempt of suicide, death or disablement due to accident under the influence of intoxicating liquor or drugs and death or disablement while breaching law with criminal intent’.

Even the respondents do not have a case that the death had occurred under any of the circumstances mentioned in the proviso. Ext.P6 Government Order is to the effect that ‘Claims with respect to accidents occurring due to the illegal action of the injured/deceased, including unauthorised entry into the properties of K.S.E.B., Railways etc., will not be sanctioned.’ Pertinently, the respondents do not have a case that the petitioner had transgressed into the Railway property or had indulged in any illegal activity. On the other hand, it is the admitted case that the petitioner, a Railway Constable, was traveling as part of his duty. As such, I find the grounds on which the petitioner’s claim is rejected to be totally unsustainable.

The writ petition is hence allowed and respondents 1 and 2 are directed to process the petitioner’s claim and do the needful for paying the insurance amount within an outer limit of three months of receipt of a copy of this judgment.