The conduct of the insurance company in disputing the claim on absolutely frivolous grounds cannot be overlooked by the HC

High Court: The conduct of the insurance company in disputing the claim on absolutely frivolous grounds cannot be overlooked by us.

Definition of Accident: an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury.

An event that happens by chance or that is without apparent or deliberate cause.

With the development of civilization, act of negligence have become actionable wrong negligence accompanied with losses to the other party give rise to an action.

A perusal of the relevant clauses did not indicate any exclusion by describing an accident and only talks of death on account of an accident:

"1. Accident, Accidental - An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means."

Evidently, a death on account of a snake bite would be attributable to sudden, unforeseen and involuntary event caused by external, visible and violent means. There would be thus hardly any occasion for the appellant to dispute the claim of the nominees of the insured.

The matter was then taken to the Lok Adalat which granted the relief to the nominees of the insured but was challenged by the Insurance Company in the writ proceedings resulting in the impugned order.

The observation on harassment and apathy of insurance company to already distressed and traumatized family made the Bench of Judges in High Court to come down heavily on insurer.

Deceased Iqbal Singh, who was insured with the present appellant, took out a policy which enabled him to get the insured amount of Rs.18 lakhs in the event of his death.

The insured having died, his legal representatives put forward the claim within 23 days but the same was refuted on the ground that the death occurred on account of a snake bite which was not contemplated an accident in the policy to admit the insured or his nominees to compensation.

The matter was then taken to the Lok Adalat which granted the relief to the nominees of the insured but was challenged by the present appellant in the writ proceedings resulting in the impugned order.

The existence of the policy and its validity is not in question. The death of the deceased on account of snake bite is also not in dispute.

There was sufficient verification by the appellant and other authorities establishing the cause of death but the appellant disputed the accrual of the benefits of the policy to the claimants on the ground that it was not an accidental death.

The copy of the policy is on record appended to C.M.No.147- LPA of 2017.

A perusal of the relevant clauses does not indicate any exclusion by describing an accident and only talks of death on account of an accident, in which eventuality the nominees of the insured were to get 100 per cent of the sum assured.

The accidental death has been described as follows:-

"1. Accident, Accidental - An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means."

Evidently, a death on account of a snake bite would be attributable to sudden, unforeseen and involuntary event caused by external, visible and violent means.

There would be thus hardly any occasion for the appellant to dispute the claim of the nominees of the insured.

The conduct of the insurance company in disputing the claim on absolutely frivolous grounds cannot be overlooked by us, particularly when the family of the deceased which is already distressed and traumatized is forced into unwarranted litigation on account of the stubborn resistance by such companies which is evident that even after the writ court declined interference they have chosen to file the appeal to prolong the litigation.

Therefore, finding no merit in the appeal, we dismiss the same with costs of Rs.1 lakh which shall be compensatory to the nominees of the deceased insured considering they would have spent money on pursuing the forced litigation and shall be disbursed to them along with insured amount and interest within a period of four weeks from today.

Appeal dismissed.

IN THE HIGH COURT OF PUNJAB AND HARYANA AT CHANDIGARH

LPA No.2455 of 2016 (O&M)
Bajaj Allianz General Insurance Company Ltd. ....Appellant
Versus
Permanent Lok Adalat (PUS) and others ....Respondents
CORAM : HON'BLE MR.JUSTICE MAHESH GROVER
HON'BLE MRS.JUSTICE SNEH PRASHAR

Earlier on  Dated : 12 May 2016: The National Consumer Disputes Redressal Commission had held that death due to mosquito bite causing malaria is an accident.

The ruling by apex consumer forum benefitted many insurance holders.

Justice V K Jain said that "It can hardly be disputed that a mosquito bite is something which no one expects and happens all of a sudden. It is difficult for us to accept that the death due to a mosquito bite would not be a death due to an accident".

The insurance company; National Insurance Co. Ltd had advertised on its website that ‘an accident may include events like snake bite, frost bite and dog bite.’

Therefore National commission observed that "Hence it would be very difficult to accept the contention that malaria due to mosquito bite is a disease and not an accident."

An accident is something that happens unexpectedly and is not planned in advance.  It is defined as (i) an unpleasant event, especially in a vehicle, that happens unexpectedly and causes injury or damage, (ii) something that happens unexpectedly and is not planned in advance, in the Oxford Advanced Learner’s Dictionary (New 8th Edition).  The word ‘accident’ is defined as (i) as incident, an unforeseen injurious occurrence, something that does not come in the usual course of event or that cannot be reasonably anticipated, (ii) an unforeseen and injurious occurrence due to mistake, negligence, neglect or misconduct; an unanticipated and untoward event that cause harm, (In Black’s Law Dictionary (Ninth Edition).

THE BRANCH MANAGER, NATIONAL INSURANCE CO. LTD. V/S MOUSUMI BHATTACHARJEE & OTHERS,

(Against the Order dated 02/02/2016 in Appeal No. 469/2014 of the State Commission West Bengal)

REVISION PETITION NO. 1270 OF 2016
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
RP/1270/2016
Dated : 12 May 2016

However:

The customer/consumer/citizens should be extra –careful while buying an Insurance Policy, and must go through all policy brochure, MOU, carefully before signing on the proposal Form and contract with insurer.

Like in the following case the claim was rejected by State Consumer commission.

2. The facts leading to filing of the appeal are that the first respondents husband Korrapati Subba Reddy was an account holder with account bearing number ABJ 1437 with the second respondent bank. The appellants issued insurance policy covering risk due to accident to the account holders of the second respondent bank who include the first respondents husband. On 05-07-2006 the first respondents husband stated to have been bitten by a snake while attending to his agriculture work at Cheralkottur village and he died on the same day while undergoing treatment in the Government Hospital, Banaganapalli.

3. The first respondent lodged claim with the appellant insurance company through the second respondent bank. The appellant insurance company settled the claim on 28-03-2007 to the extent of the sum insured of Rs. 94,814/- and refused to pay the accident benefit covered by the insurance policy.

18. Rule 16 of Memorandum of Understanding which provides for coverage of accident benefit is regulated by the exclusionary clause immediately following it, incorporated at 7th page of the Memorandum of Understanding. The exclusionary clause specifically excludes the coverage of the accident benefit in case of death of the life insured as a result of suicide, war, terrorism, invasion, assault, bodily or mental infirmity or death due to snake bite.

19. By virtue of operation of exclusionary clause which governs the accident benefit clause of the memorandum of understanding which is the mother of the insurance policy issued by the appellants, the claim for accident benefit by the first respondent cannot be considered as sustainable. The findings returned by the District Forum, as such are liable to be set aside.

20. In the result the appeal is allowed by setting aside the order of the District Forum. Consequently, the complaint is dismissed. There shall be no order as to costs.

BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL
COMMISSION AT HYDERABAD
F.A.No.45 OF
2010 AGAINST C.C.NO.194 OF 2008 DISTRICT
FORUM KURNOOL

1. The Branch Manager, LIC of India, D.No.40/2, R.S.Road, Nandyal-501

2. The Divisional Manager Pension and Group Scheme Divisional office, Jeevan Prakash Bldgs D.No.40-80-601, Hyderabad-003 Appellant/opposite parties A N D

3. Smt K.Rama Thulasamma @ Thulasamma W/o late Korrapati Subba Reddy D.No.5/20, Cherla Kottur Village Banaganapally Mandal, Kurnool Dist.-124 Respondent/complainant

State Consumer Disputes Redressal Commission

LIC Of India And Another vs Smt K.Rama Thulasamma@  on 24 January, 2012

The customer/consumer/citizens should be extra - careful while buying an Insurance Policy must compare the cost and benefits and the inclusion and exclusion criteria of the plan offered by various insurers and any other agency and choose the most suitable one.

Some agencies may offer plans that might offer best benefits at virtually: NO cost.

e.g. Reserve Bank of India promoted National Payments Corporation of India, the issuing agency for Rupay cards, today announced that it will extend its insurance coverage to death or permanent total disability caused due to snake bite, drowning or electric shock. The insurance coverage will be for Rs. 1 lakh and no premium will be charged from the customers. It will be at free of cost. For premium card holders the insurance coverage will be of Rs. 2 lakhs.

 

Kumar Doab 
on 22 February 2017
Published in Civil Law
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