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2009 Supreme(Online)(KER) 22809
HIGH COURT OF KERALA
M.N.KRISHNAN, J
THE ORIENTAL INSURANCE COMPANY LIMITED – Appellant
Versus
GEORGEKUTTY AND OTHERS – Respondent
MACA/450/2009
ADV. SRI.MATHEWS JACOB, SENIOR ADVOCATE SRI.P.JACOB MATHEW
Liability of an insurance company under an Act only policy is contingent on the clear presentation of policy conditions governing personal accident coverage.
Headnote:
Liability - Insurance - Act Only Policy - Personal Accident Coverage - Tribunal's Decision
Fact of the Case:
An appeal was made against the Claims Tribunal's decision regarding the liability of an insurance company for injuries sustained by a pillion rider in a two-wheeler accident. The policy in question was an Act only policy with additional premiums for personal accident coverage.
Finding of the Court:
The court ruled that the absence of policy conditions prevented a definitive conclusion on the insurance company's liability, and thus set aside the award relating to liability, remitting the case back to the Tribunal for further examination of policy documentation.
Issues: Whether the insurance company is liable for the personal accident coverage under the Act only policy considering additional premiums were collected.
Ratio Decidendi: The court emphasized the necessity for clear policy conditions governing personal accident coverage, indicating that the mere collection of additional premiums does not necessarily establish liability without supportive documentation.
Final Decision: The award regarding the insurance company's liability is set aside and remitted for further consideration.
J U D G M E N T
This is an appeal preferred against the award of the Claims Tribunal, Kottayam in OP(MV)No.648/2005 The short point that arises for determination in the appeal is regarding the liability of the insurance company. The person who sustained injuries was a pillion rider in a two wheeler. The policy is an Act only policy. But it is seen that premium of Rs.50/= is collected for personal accident coverage and extra P.A Rs.70/=. The Tribunal took the view that since extra premium is collected for personal accident coverage, the insurance company is bound to pay the amount. Unfortunately, the conditions governing coverage on payment of premium for P.A. are not produced before the court. Normally personal accident coverages are governed by endorsements like IT 64, IT 70 etc. The normal conditions in those endorsements are that there must be either death or permanent disability, in some cases amounting to total disablement and in some cases relating to privation of eye or bone etc. So on the basis of the conditions, the personal accident coverage is to be looked into. Extra premium most probably is collected for unlimited coverage covering persons under personal accident coverage. Nothing is produced before the Tribunal but it appears to be an almost settled position and therefore, I do not want to deprive the insurance company from contending for the position regarding its non-liability.
Therefore the award under challenge is set aside so far as it relates to the inter se liability between the insurance company and the owner is concerned and the matter is remitted back to the Tribunal for a fresh consideration and direction is given to the insurance company to produce the policy conditions and explain what is personal accident coverage relating to the policy. For that purpose, additional documents can be produced and evidence can be adduced after entering appearance. It is directed to take out summons to the owner and the claimant for a proper disposal of the case. The insurance company is directed to appear before the court below on 27.1.2010.
Disposed of accordingly.
M.N. KRISHNAN, JUDGE cl
