National Consumer Disputes Redressal
National Insurance Co. Ltd. vs Ashokbhai Babarbhai Patel on 10 February, 2011
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION CIRCUIT BENCH AT AHMEDABAD, GUJARAT RP NO.1996 OF 2007 (Against the order dated 20.04.2007 in Appeal No.1383/07 of State Commission, Gujarat) National Insurance Co. Ltd. Petitioner Versus Ashokbhai Babarbhai Patel ..Respondent BEFORE: HONBLE MR.JUSTICE ASHOK BHAN, PRESIDENT HONBLE MRS.VINEETA RAI, MEMBER For Petitioner : Mr.Maulik J.Shelat, Advocate For Respondent : NEMO. Pronounced on 10th February, 2011 ORDER
PER VINEETA RAI, MEMBER The present revision petition has been filed by the National Insurance Co. Ltd. (hereinafter referred to as the Petitioner) being aggrieved by the order of the State Consumer Disputes Redressal Commission, Gujarat (hereinafter referred to as the State Commission) in favour of Mr.Ashokbhai Babarbhai Patel (hereinafter referred to as the Respondent).
The facts of the case are that the Petitioner Insurance Company had issued a Group Janata Personal Accident Insurance Policy to the Member-Secretary, Gujarat Rural Workers Welfare Board for a period from 26.01.2005 to 01.10.2005 under which the accidental death cover for a sum of Rs.1 lakh was provided to all the landless labourers of Gujarat. The deceased wife of the Respondent, Ms.Leelaben Ashokbhai Patel, was also covered under this policy. On 23.01.2005, the deceased Leelaben while cooking the evening meal at her residence suffered severe burn injuries to which she succumbed in Paldi Hospital on 26.01.2005. Her husband, Ashokbhai Babarbhai Patel, the Respondent thereafter lodged a claim with the Petitioner Insurance Company for the assured amount of Rs.1 lakh under the policy. The claim was rejected on the ground that the accident occurred on 23.01.2005 on which date the deceased was not covered under the policy since the policy period commenced w.e.f. 26.01.2005.
Aggrieved by this action, Respondent filed a complaint before the District Forum on the grounds that the claim was wrongly repudiated because on the date of death of the deceased i.e. 26.01.2005 the policy had commenced and it is this date that should be decisive in settling the insurance claim and not 23.01.2005 when the burn injuries occurred. The District Forum accepted the complaint of the Respondent on the grounds that since the deceased died on 26.01.2005, therefore, the date of death should be decisive and it would entitle the Respondent to claim the insurance amount under the policy even though the injuries might have been received on 23.01.2005. The District Forum directed the Petitioner Insurance Company to pay the Respondent Rs.1 lakh with interest @ 9% from 06.12.2005 and a cost of Rs.1,500/-.
Petitioner thereafter preferred an appeal before the State Commission which upheld the order of the District Forum and dismissed the appeal. The State Commission as also the District Forum referred to three decisions of the National Commission wherein the Commission had observed that where there is a difference/inconsistency in the interpretation in the conditions of the policy then the interpretation which is favourable to the complainant should be accepted. It is following this principal that the District Forum allowed the complaint and granted compensation which was also endorsed by the State Commission.
Hence the present revision petition.
Counsel for Petitioner was present. None was present for the Respondent. However, since the service was complete, the case was heard ex parte.
Counsel for Petitioner stated that both the District Forum and the State Commission had failed to appreciate that the principle laid down in the three decisions of the National Commission is not applicable to the facts of the present case because there is no inconsistency or ambiguity in the conditions of the insurance policy. In this connection, he quoted Para (a) of the policy which reads as follows:
If the Insured shall sustain any bodily injury resulting solely and directly from an accident caused by outward violent and visible means, then the Company shall pay to the Insured the sum hereinafter set forth that is to say
(a) If such injury shall within 12 months of its occurrence be the sole and direct cause of death of the insured, the Capital sum Insured stated in the Schedule. The amount payable under this clause shall be paid to the title of the said person or persons claiming payment.
Counsel for Petitioner also cited a judgement of the National Commission in National Insurance Co. Ltd. Vs. Rajbala III(2007) CPJ 19(NC), in which one Jagbir Singh who was insured under a Group Insurance Policy w.e.f. 02.10.1993, was bitten by a snake on 30.09.2003 when the insurance policy was not in force and he died on 21.10.2003 when the policy was in force. The National Commission relying on the principal deduced from the decision in Kelly Vs. Norwich Union Fire Insurance Society Ltd. (1989) 2 All.E.R. 888 confirmed that as the peril of snakebite had not occurred during the insurance period, the Petitioner Insurance Company was not liable to pay any amount on the ground of Jagbir Singh having died during the currency of the policy/scheme. The principal deduced from the policy quoted in the judgment was reproduced in the National Commissions judgment and is as follows:
On the true construction of the policy, the events referred to therein were the happenings of any of the specified insured perils and not the loss or damage to the house caused by any of those perils.
Accordingly, the defendants liability to indemnify the plaintiff could only be brought about by the occurrence of one of the insured perils during the period of policy. The policy therefore protected the plaintiff against specified perils occurring during the period of insurance and not against damage occurring during the period of insurance but resulting from the peril which had occurred before the policy came into effect.
We have heard learned counsel for petitioner and have gone through the evidence on record including the judgment cited above.
The validity of the period of Group Janata Personal Accident Insurance Policy which is for a period from 26.01.2005 to 01.10.2005 is not in dispute. It is also not disputed that while the fire accident in which the life assured was burnt, took place on 23.01.2005 and her death occurred on 26.01.2005. The wordings of the insurance policy are very clear that the occurrence of the incident which was the direct cause of death has to take place during the period of the insurance policy. In the instant case the fire incident that caused the death occurred three days prior to the occurrence of the policy. In view of this fact and respectfully following the principle deduced from Kellys case (supra), we are of the view that the Petitioner Insurance Company was justified in repudiating the insurance claim.
We therefore, set aside the order of the State Commission and accept the revision petition with no order as to costs.
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(ASHOK BHAN J) PRESIDENT Sd/-
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(VINEETA RAI) MEMBER /sks/