State Consumer Disputes Redressal Commission
Royal Sundaram Alliance ... vs Manjuben Sanjaybhai Mistri on 28 November, 2022
Details DD MM YY
Date of disposal 28 11 2022
Date of filing 01 05 2012
Duration 27 06 10
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION
GUJARAT STATE AHMEDABAD.
COURT NO: 03
APPEAL NO. 2964 of 2012
Royal Sundaram Alliance General
Insurance Company LTD.
Having its office at 45.46 Sundaram Towers
White House Road, Chennai
At present having office at
Subramaniam Building
Second Floor
No.1, Club House Road
Chennai 600 002 ...Appellant.
V.s
Manjuben Sanjaybhai Mistri
Having address at 16, Divine Park
Science City Road,
Sola, Ahmedabad ...Respondents.
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BEFORE: Mr. I. D. Patel, Judicial Member
APPERANCE: Mr. S. C. Shah L.A. for the appellant,
Mr. Samir I. Doshi L.A. for the respondent.
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ORDER BY Mr. I. D. PATEL, JUDICIAL MEMBER.
JUDGMENT
1. Being aggrieved by and dissatisfied with the judgment and order rendered by the learned Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), in complainant No. 415/2010 dated 29/02/2012 the appellants/original opponents have filed the first appeal against the original complainant under Section 15 of the Consumer Protection Act 1986, before this Commission. The appellants are the K.Navlakha A/12/2964 Page 1 of 12 original opponents and the respondent is the original complainant in this appeal. Hence for the sake of the convenience, parties are hereinafter referred to by their original nomenclature/status.
2. The brief facts of the complaint case before the Ld. District Forum, Ahmedabad City, (Additional), are that the complainant husband deceased Sanjaybhai had taken Individual Personal Accident Policy No. 00011995000100 from the opponent Insurance Company as on 30-05- 2007 for the sum assured of Rs. 10lakh where in the complainant is shown as a nominee. It is further, the case of the complainant that as on 03-01-2008 her husband deceased Sanjaybhai who happened to be the policy holder killed by Commission of murder and to that effect police complaint came to be lodged in the Sola Police Station, Ahmedabad City, for the offences punishable under Section 302 of Indian Penal Code and Section 25(1), of the Arms Act. So as per the case of the complainant the death of the deceased was unnatural therefore, the complainant lodged the claim for getting the amount of the Insurance Policy from the opponent Insurance Company but the Insurance Company has repudiated the claim of the complainant and thereby, adopted unfair tread practice and therefore, the complainant has filed the Consumer Complaint before the Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), for getting Rs. 10lakh with interest at the rate of 18% from the opponent Insurance Company.
3. That the notice of the complaint came to be issued by the Forum, to the opponents and opponents have filed their reply against the complaint where in they have denied all the allegations made by the complainant in the complaint and specifically contended that the accused hatched conspiracy for the murder of the husband of the deceased namely Sanjaybhai and therefore, the death of the deceased insured cannot be said to be an accidental death as per the definition and expression provided in the policy in question and therefore, as per the defence of the K.Navlakha A/12/2964 Page 2 of 12 Insurance Company the Insurance Company has rightly repudiated the claim of the complainant and accordingly the Insurance Company has prays to dismissed the complaint of the complainant.
4. After hearing the ld. Advocate of the parties and after perusal of the documentary evidence in both the sides ld. District Forum, Ahmedabad City, (Additional), is pleased to allow the complaint vide order dated 29- 02-2012 and therefore, being aggrieved by the judgment and order of the ld. District Commission Ahmedabad City, (Additional), dated 29-02-2012 rendered in Complaint No. 415/2010 appellant/ original opponents have preferred his appeal under Section 15 of the Consumer Protection Act 1986, on the ground stated in the appeal memo.
5. I have heard the ld. Advocate Mr. S. C. Shah, for the appellant/original opponents and ld. Advocate Mr. S. I. Doshi for the respondent/ original complainant at great detail.
6. Ld. Advocate Mr. S. C. Shah has submitted that the Insurance Company has issued Personal Accident Care Gold Insurance Policy in favor of the deceased Sanjaybhai subject to the terms and condition provided in the policy which is produced at page No. 70 to page No. 73 in this appeal it is further, submitted by the ld. Advocate Mr. S. C. Shah that as per the complaint and the charge-sheet filed by the Police for the death of the deceased Sanjaybhai the accused had hatch conspiracy to commit the murder of the deceased Sajaybhai. So, it was a well planned murder of the deceased Sanjaybhai by the accused by hatching conspiracy and as per the definition of the word and expression and definition of accidental death as provided on page 70 of the policy Commission of the murder of the deceased Sanjaybhai cannot be said to be accidental death to get the benefit of Policy in question. It is further, submitted by the ld. Advocate of the appellant Mr. S. C. Shah that before Consumer Forum, the complainant has not produced the copy of the judgment of the Sessions Case No. 107/2008 and he has also submitted copy of that judgment of K.Navlakha A/12/2964 Page 3 of 12 the Sessions Court in this appeal which is not relevant to get the benefit of the Policy because the judgment of the Sessions Case is based on benefit of doubt. It is further, submitted by the ld. Advocate of the Insurance Company Mr. S. C. Shah that looking to the findings recorded by the Consumer District Redressal Forum, Ahmedabad City, (Additional), ld. District Forum has given much more weightage on the Exclusion Clause of the Policy without considering the Inclusion Clause of the Policy and the same are not permitted. Hence, the finding recorded by the Ld. District Forum, Ahmedabad City, (Additional), are not correct and the ld. Advocate of the Insurance Company has also place reliance on the decision of the Hon‟ble Apex Court in the case of Ritadevi Vs. New India Insurance Company and submitted that there is a vast deference between the accidental murder and murder simpliciter and in this case looking to the facts of the incident the death of the deceased Sanjaybhai was not an accidental murder but it was murder simpliciter and therefore, the appellant Insurance Company has rightly repudiated the claim of the complainant. However, the ld. District Forum, Ahmedabad City, (Additional), had not considered the same in the right perspective and therefore, as per the submission of ld. Advocate Mr. S. C. Shah appeal preferred by the Insurance Company may be allowed while setting aside the impugned judgment and order of the ld. District Forum, Ahmedabad City, (Additional).
7. Per contra ld. Advocate Mr. S. I. Doshi, for the original complainant submitted that the Insurance Company has repudiated the claim of the complainant only on the basis of the F.I.R and charge-sheet filed by the Police against the accused but looking to the judgment of the Sessions Case No. 117/2008 the accused came to be acquitted by the ld. Sessions Court that means a charge against the accused under Section 302 34 and Section 120(b) of the Indian Penal Code are not duly proved and establish and therefore, as per the decision of the Hon'ble Apex Court, in K.Navlakha A/12/2964 Page 4 of 12 the case of D. Chandran Vs. Branch Manager LIC reported in (iii) 2019 CPJ 370 the F.I.R charge-sheet are not relevant to repudiate the claim of the deceased without conducting any independent investigation by the Insurance Company. Furthermore, ld. Advocate Mr. S. I. Doshi has submitted that the judgment of the Hon‟ble Apex Court, in the case of Ritadevi Vs. New India Insurance Company is not applicable in this case because in the said case Apex Court, considered an interpreted a phrase providing "death due to accident arising out of the use of Motor Vehicle". It is further, submitted by the ld. Advocate of the complainant Mr. S. I. Doshi that as per the decision of the Hon‟ble National Commission in the case of Mayadevi Vs. LIC of India it is categorical held that when the insured was not a party to the murder or he did not give rise to provocation and immediate cause of the injury is not the result of deliberate or wilful act of the insured then the death of the insured was an accidental death and the said decision of the National Commission in the case of Mayadevi is upheld by the Hon‟ble Apex Court and in the decision of the Mayadevi Hon‟ble National Commission, has also considered the decision of the Hon‟ble Apex Court, in the case of Ritadevi Vs. New India Insurance Company LTD. So, as per the submission of the ld. Advocate the complainant S. I. Doshi here in this case also deceased was not a party to the murder nor he had given any rise to provocation and the immediate cause of murder is not the result of the deliberate or Wilful act of the insured. Furthermore, ld. Advocate of the complainant Mr. S. I. Doshi has also submitted that in the case of Royal Sudnaram Alliance Co. LTD. Vs. Pawan Balram Mulchandani reported in 2018(4) CPR 486 the Hon‟ble National Commission, has also held that the death was accidental, because the immediate cause of injury was not the result of any deliberate or wilful act of the insured and the untoward event that had occurred was not expected or designed by the insured and it is also held by the Hon‟ble National Commission, in the said judgment that K.Navlakha A/12/2964 Page 5 of 12 when in to a murder was not specifically excepted in the policy. As reasonable man of normal intelligence would conclude that murder is an accident within the terms of the policy. So, here in this case also as per the submission of the ld. Advocate Mr. S. I. Doshi that in the Exclusion Clause of the Policy the murder is not Excluded and therefore, the Insurance Company is liable to pay the sum insured of the Policy to the complainant and the ld. District Forum, has also considered the said Exclusion Clause of the Policy in question while allowing the complaint of the complainant. So, as per the submission of the ld. Advocate of the respondent original/complainant the finding recorded by the ld. District Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), in the impugned judgment and order while allowing the Complaint of complainant are just and proper and the same findings are based on interpretation of the terms and condition and definition provided for the accidental death the policy and therefore, the same requires to be upheld in this appeal and accordingly he has submitted to dismiss the appeal filed by the Insurance Company with the costs.
8. That this Commission has considered in great detail the submissions mad by the ld. Advocate of the parties as well as the finding recorded by the ld. District Forum, Ahmedabad City, (Additional), in the impugned judgment and order this Commission has also considered the Policy in question issued by the Insurance Company in favor of the insured and more particularly definitions of Words and Expressions and Exclusion provided for the accidental death in the Policy. That herein this case as per the complaint of the murder of the deceased filed by the brother of the complainant it appears that on 03.01.2008 deceased Sanjay went from his factory to Kalhar Bungalows through Science City Road, in his Car and at that time accused stop his Vehicle and open fire at close range from the firearms with the result thereof deceased Sanjay died on the spot in his Car. Therefore, Police has filed the charge sheet under K.Navlakha A/12/2964 Page 6 of 12 section 302 120(b) 34 of the Indian Penal Code and as per the Section 25(1) of the arms act stated that the deceased was murder by his Ex-Wife and other accused by hatching criminal conspiracy to commit the murder of the deceased. That as per the judgment of the Sessions Case No. 117/2008 the prosecution has failed to prove the charge against the accused and therefore, the Sessions Court acquitted the accused from the charges leveled against them.
9. That the Insurance Company has repudiated the claim on the ground that the Policy covers only death due to any bodily injury, resulting solely and directly from the accident caused due to the external violent and visible means and not any intentional or pre-planned murder as in this instant case and for the said reasons the Insurance Company has placed reliance upon the FIR charge-sheet filed by the Police.
10. That the ld. Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), allowing the complaint of the complainant considered the Exclusion Clause of the Policy where in death of the insured by murder is not excluded and that the ld. District Forum, has also considered that the deceased was not a party of the insurance and he was not having knowledge about the conspiracy of the Commission of the murder of the deceased by the accused that the ld. District Forum, has also considered that the judgment of the Hon‟ble Apex Court in the case of Reetadevi is regarding the interpretation of Section 163 (a) of the Motor Vehicle Act.
11. So, in this appeal the State Commission has to considered the only question is whether the death caused due to murder of the deceased insured can be held to be accidental death or murder simplicitor. Hence, it is worthwhile to perused the terms and condition of the Policy in question and more particular definition of words and expression of accidental death and General Exclusion of the Policy.
12. That the Insurance Company has produced the terms and condition of the Policy on Page 70 and 71 in this appeal and on page 70 definition of K.Navlakha A/12/2964 Page 7 of 12 words and expression is provided and the meaning of an Accident means a sudden unforeseen, fortuitous, physical event to the insured person causing by external violent and visible means and word Injury means accidental bodily injury solely and directly caused by external, violent and visible causes and does not include sickness, disease or any naturally occurring condition or degenerative process and on page 70 meaning of the accidental death is provided viz:- If at any time during the period of Insurance, the Insured person shall sustain any bodily injury resulting solely and directly from Accident caused by external, violent and visible means, then the insured person or his/her nominees or legal representatives, as the case may be, will be paid the sum insured mentioned in the Schedule of this Policy, against Accident Death and Dismemberment.
13. That on page 71 General Exclusion of the Policy is provided and Exclusion 4 and 14 are relevant in this appeal which are as under:-
Exclusion:- 4 Any claim arising out of Accident that the Insured Person has caused intentionally or by committing a crime or as a result of drunkenness or addition (drugs/alcohol).
Exclusion:- 14 Any loss of which a contributing cause was the insured person's actual or attempted commission of or willful participation in an illegal act or any violation or attempted violation of the law.
14. 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 external 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 K.Navlakha A/12/2964 Page 8 of 12 violent and visible means which results in the death. That as per the General Exclusion Clause of the Policy if the Company shall not be liable to make any payment in respect of any claim arising out of the accident that the insured person has caused intentionally or committing a crime or as a result of drunkenness or addiction(drugs/alchohol) or any loss of which a contributing cause was the insured person‟s actual or attempted commission of or willful participation in an illegal act or any violation or attempted violation of the law. So, the Policy does not exclude the death due to the murder for any reason.
15. That in the present case:- The insured is not party to the murder, i.e. he did not give rise to provocation. The immediate cause of injury (bullet injury) is not the result of the deliberate or wilful act of the insured;
Hence, it is to be considered that death of the insured was accidental.
16. That the ld. Advocate of the Insurance Company has cited the decision of the Hon‟ble Apex Court in case of Ritadevi Vs. New India Insurance Company to prove that in the case of murder simpliciter the Insurance Company is not liable to pay any amount of the Policy to the legal heirs of the insured but the judgment of the Hon‟ble Apex Court in Ritadevi is to interpret a phrase providing "death due to accident arising out of the use of Motor Vehicle" and considering the facts of that case Hon‟ble Apex Court held that death in such case due to accident and the Court further observed that the deference between the „murder which is not an accident‟ and „murder which is accident‟ depends on the proximity of the cause of such murder. But the said decision pertaining to the Section 163 (a) of the Motor Vehicle Act.
17. That as per the decision of the Hon'ble National Commission the case of Pavan kumar Vs. LIC reported 216(3) CPR 98 when the death of the insured had taken place during firing in the property dispute it can be presumed that the act of the murder was originally was not intended and K.Navlakha A/12/2964 Page 9 of 12 hence, such murder is an accidental murder. Likewise Hon'ble National Commission in the decision of Royal Sundaram Aliance Vs. Pawan Balram Mulchandani, reported 2018(4) CPR 468 held that when the immediate cause of injury was not the result of any deliberate or wilful act of the Insured and the untoward event that had occurred was not expected or designed by the insured. The death of the insured was accidental and in the said judgment Hon‟ble National Commission has also held that 'Murder' was not specifically excepted in the policy. If 'murder is not an accident' had to be adopted by the insurance company, or if every / select murder had to be inquired into and determined whether or not it was an accident covered under the policy, the same should have been explicitly and categorically stated in the policy. In the absence of 'murder' in the exceptions and in the absence of such explicit and categorical averment in the policy, a reasonable man of normal intelligence would conclude that murder is an accident within the terms of the policy. The onus of being ab initio explicit and categorical on its terms and conditions was on the insurance company (not on the insured). First not including murder in the exceptions, then, on murder occurring and claim being filed, raising the plea that 'murder' is not an accident' and repudiating the claim, at its own end, as per its own interpretation, tantamounts to unfair trade practice.
18. So, in view of the above decisions of the Hon‟ble National Commission regarding the interpretation of the Policy and more Particularly definition of the accident deaths and consideration of the General Exclusion Clause of the Policy here in this case looking to the facts and circumstances of the case in the incident in which the murder of the deceased Sanjaybhai had taken place can be said that deceased died on account of the accidental death and it cannot be said that the murder of the deceased was murder simpliciter as per the defence of the Insurance Company and as per the view of this Commission the finding recorded by the ld.
K.Navlakha A/12/2964 Page 10 of 12District Forum, allowing the complaint of the complainant cannot be said to be perverse and erroneous in any manner and therefore, the impugned judgment and order of the ld. Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), rendered in Consumer Complaint No. 415/2010 dated 29.02.2012 requires to be upheld in this appeal and accordingly the same is upheld and resultantly appeal preferred by the appellant Insurance Company deserves to be dismissed. Hence, the following order is passed.
ORDER
1. The present Appeal No. 2964 of 2012 filed by the appellants original opponent is hereby dismissed.
2. The impugned judgment and order passed by the Learned District Consumer Disputes Redressal Forum, Ahmedabad City, (Additional), in Consumer Complainant No. 415/2010 allowing the complaint vide order dated 29.02.2012 is hereby confirmed in this appeal.
3. Appellant is directed to apply to the Account Department of the State Commission with all details of Appeal No. 2964 of 2012, Xerox copy of the receipt to withdraw the amount deposited in the State Commission. The office is hereby ordered to pay deposited amount with occurred interest on proper verification to the appellant by Account payee cheque and the cheque be handed over to the learned advocate for the appellant after obtaining receipt.
4. No order as to costs.
K.Navlakha A/12/2964 Page 11 of 125. Registry is hereby instructed to send a copy of this order in PDF format by E-mail to learned District Forum, Ahmedabad City, (Additional), for taking necessary action.
6. Office is directed to forward a free of cost certified copy of this judgment and order to the respective parties.
Pronounced in the open Court today on 28TH November 2022.
(I. D. Patel) Judicial Member.
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