NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
(From the
order dated 21.5.07 in Appeal No.2675/03 of the State Commission, U.P.)
BEFORE :
HON’BLE MR. JUSTICE M.B. SHAH,
PRESIDENT
HON’BLE MRS. RAJYALAKSHMI RAO,
MEMBER
For
the Petitioner : Mr.Manoj R. Sinha, Advocate
For
the Respondent : Mr.Mohinder Singh and Ms.Diksha
Khanna,
Advocates
21.05.2008
The
State Commission held that death of the insured was due to murder and,
therefore, the heirs of the insured were not entitled to any benefit under the
policy. Hence, allowed the Appeal and
dismissed the complaint. On being
aggrieved and dissatisfied by judgement and order dated 21.5.2007 passed in
Appeal No.2675/03 by State Consumer Disputes Redressal Commission, U.P., the
original complainant has filed this Revision Petition.
It
is evident from the FIR dated 17.7.1996 that the insured went to the shop of
one, Jagdish, for purchasing bidi. Upon
being refused, some altercation between the insured and the shopkeeper took
place. On the next day, the brother of
the shopkeeper shot the insured at his forehead with his country made revolver,
which resulted in the death of the insured.
Before the State Commission, the insurance company contended that the
death of the insured occurred due to murder and, hence, the insurance company
was not bound to pay the sum assured.
Hence, the only question which requires consideration
in this Revision Petition is – whether the death caused due to murder of the
insured can be held to be ‘accidental death’?
In our
view, it is absurd to contend that, a ‘murder’ of an insured would not be
treated as an accidental death in view of the terms of the policy. The relevant terms of the said Money Back
Policy is as under :
“10(b) Death of
the life assured : To pay an additional sum equal to the Death Benefit 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 180 days of its occurrence solely, directly
and independently of all other causes result in the death of the life
assured. However, such additional
sum payable in respect of all the policies taken under this plan and under Bima
Kiran Plan (Table No.111) on the same life to which this benefit will apply
shall not exceed Rs.5,00,000/-.
The Corporation shall not be liable to pay the additional sum referred
in (a) or (b) above, if the disability of the death of the life assured shall –
i)
be caused by
intentional self injury, attempted suicide, insanity
or immortality or whilst the life assured in under the influence of
intoxicating liquor, drug or narcotic or……………………
iv) result from the life assured committing breach of law,
or………………………..
The main
part of the policy specifically provides that if the life assured sustains any
bodily injury resulting solely and directly from the accident caused by outward
violent and visible means, which results in the death of the life assured,
heirs would be entitled to get accidental benefit. It is apparent that in case of murder, bodily
injury is caused by outward violent and visible means which results in the
death.
Further
Exclusion Clauses would not be applicable in such cases.
In case of
murder of assured, Clause (i) which provides that if the death is caused by
intentional self injury, attempted suicide or insanity etc. would not be
applicable. Secondly, Exclusion clause (iv) would also not be applicable because it has not resulted
from any breach of law committed by the life assured. The policy does not exclude death due to
murder for any reason. In that set of
circumstances, exclusion clause which deprives the complainant from accidental
benefit would not be applicable in the present case.
Further,
it is to be stated that the insurance company has not repudiated the claim on
the ground that the death of the assured was due to murder, but solely on the
ground that before taking the insurance policy, the insured, who was a Grade-IV
employee in Nav Bharat College in Ghaziabad, suppressed the fact that he had
taken some leave on medical ground. The
so-called leave on medical ground has no connection with the murder of the
assured.
Further,
in
“569. Meaning of ‘accident’. The event insured against may be indicated in the policy solely by reference to the phrase ‘injury by accident’ or the equivalent phrase ‘accidental injury’, or it may be indicated as ‘injury caused by or resulting from an accident’. The word ‘accident’, or its adjective ‘accidental’, is no doubt used with the intention of excluding the operation of natural causes such as old age, congenital or insidious disease or the natural progression of some constitutional physical or mental defect; but the ambit of what is included by the word is not entirely clear. It has been said that what is postulated is the intervention of some cause which is brought into operation by chance so as to be fairly describable as fortuitous. The idea of something haphazard is not necessarily inherent in the word; it covers any unlooked for mishap or an untoward event which is not expected or designed, or any unexpected personal injury resulting from any unlooked for mishap or occurrence. The test of what is unexpected is whether the ordinary reasonable man would not have expected the occurrence, it being relevant that a person with expert knowledge, for example of medicine, would have regarded it as inevitable. The stand point is that of the victim, so that even willful murder may be accidental as far as the victim is concerned.”
From the above quotation, it is clear that ‘even the willful murder’ of the assured is accidental as far as insured is concerned and such murder is to be described as ‘by chance’ or ‘fortuitous’.
Now, the question is, under which circumstances the ‘willful act’ of the third party can be held to be ‘accidental’?
This is
discussed in Halsbury’s Laws of
“575. Injury caused by a willful act. An injury caused by the willful or even criminal act of a third person, provided the insured is not a party or privy to it, is to be regarded as accidental for the purpose of the policy, since from the insured’s point of view it is not expected or designed. Injuries sustained by gamekeeper in a criminal attack upon him by poachers, by a chashier who was murdered by a robber, and by a master at an industrial school who was murdered by the boys, have been held to be accidental. However, if the immediate cause of the injury is the deliberate and willful act of the insured himself, there would seem to be no accident, and no claim will lie under the policy, at any rate if the insured is not mentally disordered at the time of his act.”
In the present case :
.(i). As per
the postmortem report, the insured was shot dead by the assailant who appeared
from nowhere;
.(ii). the insured is not party to the ‘murder’, i.e. he did not
give rise to provocation. After appearing before a Panchayat, he was going
somewhere, when this attack was made at him. Hence, he is not a party or privy
to the event of murder.
.(iii). the immediate cause of injury (bullet injury) is not the
result of the deliberate or willful act of the insured.
.(iv). this event is an unlooked for mishap or an untoward event
which was not expected or designed by the insured nor the insured had expected
the occurrence.
Hence, it is to be held that death of the
insured was accidental.
However, learned counsel appearing
on behalf of the LIC relied upon the decision rendered by the two-Member Bench
of this Commission in the case of Prithvi
Raj Bhandari Vs. Life Insurance Corporation of India & Ors. –
III(2006)CPJ 213, wherein reliance was placed upon the judgement rendered by
the Apex Court in the case of Rita
Devi Vs. New India Assurance Co. Ltd. – 2000 ACJ 801 = (2000) 5 SCC
113.
Firstly,
it is to be stated that in the case of Rita Devi (supra), the
The Court referred to the decision
in the case of Nisbet Vs. Rayne and
Burn – (1910) 1 KB 689, where a cashier, while traveling in a railway
to a colliery with a large sum of money for the payment of his employer’s
workmen, was robbed and murdered. The
Court of Appeal held that murder was an accident from the standpoint of the
person who suffered from it and that it arose ‘out of’ an employment which
involved more than the ordinary risk and consequently the widow was entitled to
compensation under the Workmens Compensation Act.
Despite the aforesaid two
judgements, in the case of Prithvi Raj
Bhandari (supra), the
Commission observed that ‘the important point which required notice was whether
murder was an accident would depend upon proximity of cause of such murder’ and
held on facts that the complainant has suppressed the fact that various
complaints against the deceased were filed under various Sections of the IPC,
and concluded that there was no doubt that this was a murder by design and
intent rather than a case of accidental murder.
In our view, the said reasoning
cannot be justified by any standard. LIC
policy excludes death due to limited causes mentioned in Exclusion clauses
under para 10(b) and, therefore, it is totally irrelevant to find out the
background of the deceased. Further,
even in case where there is a criminal background of the assured, it would be
difficult to hold that his murder was not accidental unless he has taken up the
quarrel and that the immediate cause of injury was deliberate and willful act
of the insured himself.
Hence, this Revision Petition is
allowed. Impugned order passed by the
State Commission is set aside. Order
passed by the District Forum is restored.
The insurance company shall pay the policy amount including Bonus with
accidental benefit with interest at the rate of 12% per annum. The insurance company shall also pay
Rs.5000/- as costs of litigation to the complainant.
Learned counsel appearing on behalf of LIC states
that LIC has deposited a sum of Rs.2 lakh with the State Commission,
Revision Petition stands disposed of
accordingly.
……………………………………….J.
( M.B. SHAH)
PRESIDENT
…………………………………………
(RAJYALAKSHMI RAO)
MEMBER
…………………………………………
(ANUPAM DASGUPTA)
MEMBER
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