Allahabad High Court
Oriental Insurance Co.Ltd vs Smt. Kuntesh And 2 Others on 6 April, 2022
Author: Saumitra Dayal Singh
Bench: Saumitra Dayal Singh
HIGH COURT OF JUDICATURE AT ALLAHABAD AFR Court No. - 38 Case :- WRIT - C No. - 5317 of 2022 Petitioner :- Oriental Insurance Co.Ltd Respondent :- Smt. Kuntesh And 2 Others Counsel for Petitioner :- Parv Agarwal Counsel for Respondent :- C.S.C.,Satya Deo Ojha Hon'ble Saumitra Dayal Singh,J.
1. The present and the connected matters involve a common question of law. The facts are not in dispute. Accordingly, these petitions have been heard together. Upon hearing, other petitions have been de-tagged owing to other issues found involved in those cases, requiring affidavits. However, all counsel (for the respective parties), were heard, on the following common question of law.
"Whether all and/or any bread winner (of an eligible family) were insured under the Insurance Policy, or the 'Mukhiya'/head of the family or the sole bread winner of the eligible family alone was insured?"
2. Heard Sri Parv Agarwal, Sri Pawan Kumar Singh, Sri Komal Mehrotra and Sri Ajay Singh, learned counsel for the petitioner - insurance company (appearing in different petitions); Sri Satya Deo Ojha and Sri Vidya Kant Shukla, learned counsel for the respondent-claimant (appearing in different petitions), on the common question of law, noted above.
3. Present writ petition has been filed by the insurance company against the order dated 24.08.2021, passed by the Permanent Lok Adalat, Muzaffarnagar, in Claim Petition - Case No. 191 of 2020 (Smt. Kuntesh Vs. Oriental Insurance Co. Ltd. & Ors.). Earlier, the petitioner-insurer had repudiated the claim made by the respondent-claimant. Presently, the claim petition instituted with respect to the tailor-made Group Personal Accident Insurance Policy (hereinafter referred to as the Insurance Policy) has been allowed. The Insurance Policy was taken out by the State of U.P., with the petitioner-insurer, pursuant to a Memorandum of Understanding (M.O.U. in short) dated 14.09.2016 (as amended), entered into between the State Government and the petitioner insurer (hereinafter referred to as the Agreement), to implement the State Government's welfare policy measure - the 'Mukhyamantri Kisan Evam Sarvhit Bima Yojna' (hereinafter referred to as the Government Policy). Earlier, it was known as the 'Samajvadi Kisan Evam Sarvhit Bima Yojna', for the term 14.09.2018 to 13.09.2019.
4. Further, the answer to the question of law noted above involves interpretation of the Insurance Policy and the Government Policy, already on record. The parties do not intend to file counter affidavits (to this writ petition). Accordingly, with the consent of parties, this case has been heard finally, at fresh stage. In other matters, affidavits have been called, owing to other issues involved.
5. Briefly, on 14.10.2018, a road accident took place. Therein, Rahul Kumar S/o Smt. Kuntesh/respondent no.1 suffered grievous injuries. He died. His mother/respondent no.1 made a claim for payment of Rs. 5 lacs under the Insurance Policy. It was repudiated by the petitioner-insurer, on 28.11.2019 on account of delay and also for the reason the 'Mukhiya / head of the family' (of the deceased), i.e. father of the deceased Rahul Kumar, namely, Raj Kumar was alive on the date of death of Rahul Kumar.
6. Being aggrieved, respondent no.1 preferred the claim petition before the Permanent Lok Adalat being PLA Case No. 191 of 2020. After efforts to conciliate failed, the Permanent Lok Adalat proceeded to adjudicate the dispute. Accordingly, it has framed the impugned award dated 24.08.2021. Thereby, the petitioner-insurer has been directed to pay Rs. 5 lacs to the claimant-respondent under the Insurance Policy, within a period of three months from the date of award. Failing that, interest @ 6% (from the date of presentation of the claim petition to the date of actual payment), has been awarded. The objection as to delay was decided against the petitioner-insurer since the claim was made within 30 days from the end of the policy term. No challenge has been pressed to that finding reached (by the Permanent Lok Adalat), in this writ petition.
7. Learned counsel for the petitioner have vehemently urged - the coverage under the Insurance Policy was to a pre-identified, single family member. The risk covered was accidental loss of life of the 'Mukhiya / head of the eligible family' who would have been the 'Roti Arjak' - bread earner (winner), of such family. On him, his family would have been wholly dependent, for its economic needs. No other risk - of accidental loss of life (of any other member of such family), was insured. Even if such other member may have had an income, he was not insured against accidental loss of life. Any other interpretation would violate the single person coverage (against accidental loss of life) offered by the Insurance Policy taken out by the State Government and the Agreement reached between the insurer and the State Government. The only contingencies involving other family members of the eligible family could arise in case(s) of accidental injury suffered or complete dependency of 'Mukhiya / head of the family' on his son. In those contingencies, the petitioner-insurer would be liable to the extent agreed.
8. In support of their submissions, learned counsel for the petitioner have extensively referred to the Insurance Policy and the Agreement/MOU dated 14.09.2016 (as amended from time to time) entered between the Oriental Insurance Company and the Governor of U.P. Those documents have been annexed to Writ - C No. 6995 of 2022 (The Oriental Insurance Company Ltd vs. State of U.P. & 2 Ors.). The same have been read in this proceeding.
9. Thus, reference has been made to the gross premium - Rs. 54,03,58,132.00 paid by the State Government to cover the risk of accidental loss of life - of an estimated 29,39,000 citizens (of the districts included in and collectively described as Meerut Cluster of the State of Uttar Pradesh), for the policy term 14.09.2018 to 13.09.2019. Relying on Clause 4 of the Insurance Policy, it has been urged, the total number of eligible families in Meerut Cluster was first estimated at 29,39,000. Therefore, exactly that many lives/risk to life were insured, assuming one 'Mukhiya'/ 'Roti Arjak' i.e. head-of-family/bread winner, per eligible family. Clause 5 of the Insurance Policy clearly makes applicable the terms of the MOU dated 14.09.2016, entered between the Governor and the Oriental Insurance Company.
10. Referring to the Agreement as last amended on 13.09.2018, it has been submitted, different premium amounts were worked out for different Clusters (of districts) of the State, depending upon estimated number of eligible families residing in each Cluster. Thus, Clause 1 of the Agreement reads as below:
"1. Insurance Company i.e. The Oriental Insurance Company Limited undertakes that it shall provide services for the implementation of Mukhyamantri Kisan and Sarvhit Bima Yojna as per the conditions laid in para (e & f) as mentioned above for below cluster(s) S No Cluster Annual Premium Amount Inclusive of all taxes, applicable duties and other charges (in INR) 1 Agra Rs. 105,93,81,344 (One Hundred Five crores Ninety Three lacs Eighty One Thousand Three hundred fourty Four) Only 2 Meerut Rs. 54,03,58,132 (Fifty four crores Three lacs Fifty Eight Thousand One hundred Thirty two) Only 3 Bareilly Rs. 74,22,45,091 (Seventy Four crores Twenty Two lacs Forty Five Thousand Ninety One) Only 4 Kanpur Rs. 76,09,84,705 (Seventy Six crores Nine lacs Eighty Four Thousand Seven hundred Five) Only 5 Basti Rs. 25,74,05,500 (Twenty Five crores Seventy Four lacs FiveForty Five Thousand Ninety One) Only Thousand Five hundred) Only
11. Also, reference was made to Clause 3 of the Agreement. It contains the text of the 'Mukhyamantri Kisan Evam Sarvhit Bima Yojna' (as amended) / Government Policy. The opening clause of the Government Policy recites its object. It reads:
"योजना का उद्देश्य विभिन्न प्रकार की अनिश्चित दुर्भाग्यपूर्ण घटनायें जिससे परिवार के मुखिया की मृत्यु हो सकती है/ विकलांग बना सकती है जो पूरे परिवार के लिये असुरक्षा /विपत्तियां ला सकती है, की सहायता हेतु।"
(emphasis supplied)
12. Next, Clause 1 of the Insurance Policy taken out pursuant to the aforesaid Government Policy reads:
"Personal Accident Insurance benefit up to a maximum of INR 5 lakhs to the Head of the Family/Bread Earner (Policy holder) of the covered family."
(emphasis supplied)
13. Also, Clause 4 of the Insurance Policy reads:
"Estimated number of families for this cluster are 29,39,000 for Meerut, Gautam Budh Nagar, Baghpat, Ghaziabad, Hapur, Moradabad-Amroha, Rampur, Bijnour, Saharanpur,-Muzaffarnagar, Shamli, Sambhal."
(emphasis supplied)
14. Thus, it has been submitted, the insurance cover provided to the State Government under the Insurance Policy was to cover the risk of accidental loss of life of 29,39,000 'Mukhiya' / respective heads of families of the most vulnerable and therefore eligible families, in Meerut cluster, against payment of premium, Rs. 54,03,58,132/-. That is clear from the object clause of the Government Policy. It covered the risk of accidental death of the ''Mukhiya / head of the eligible family', alone.
15. Learned counsel for the petitioner would further submit, the word 'Roti Arjak / bread winner' (in English), appears only by way of clarification made i.e. 'Mukhiya / head of the family' would be the bread winner for the purpose of coverage offered under the Insurance Policy. Only, in case of such person being aged more than 70 years on the date of commencement of the Insurance Policy, his son (unmarried or married), on whom he may be wholly dependent, would become the person insured under the Insurance Policy, to the exclusion of the 'Mukhiya / head of the family', himself. As to the other persons or family members, coverage of accidental injury was provided, under Clause 2 of the Insurance Policy, only. It reads:
"Post accidental medical treatment benefits on floater basis shall be provided to Head of the Family/ Bread Earner/ family members as follow:
a) Primary medical treatment benefit (on need basis) up to a maximum of INR 25,000/- (INR Twenty Five Thousand). b) Medical treatment benefit up to a maximum of INR 2,50,000/- (Two Lakh Fifty, Thousand) (inclusive of primary medical treatment benefits of INR 25,000, wherever applicable).
c) On need basis, artificial limb replacement up to a maximum of INR 1,00,000 (One Lakh).
The aforementioned amount of INR 2.5 Lakhs for Maximum Accidental Medical treatment cover is inclusive of primary medical treatment benefits of INR 25,000, wherever applicable and exclusive of maximum of INR 1 Lakh for artificial limb, as the case may be."
(emphasis supplied)
16. Also, the clauses pertaining to ''Parivar Aachhadan' i.e. Eligible Family and ''Bima Aavran Ki Avadhi' i.e. Period of Insurance Cover, of the Government Policy read as below:
"परिवार आच्छादन - आच्छादित परिवार का मुखिया / रोटी अर्जक (बीमा धारक) रू0 5.00 लाख तक का व्यक्तिगत दुर्घटना बीमा लाभ एवं मुखिया/ रोटी अर्जक / परिवार के सदस्य दुर्घटना के उपरान्त रू० 25,000 तक प्राथमिक चिकित्सा एवं रू0 2.25 लाख तक वृहद्ध चिकित्सा लाभ तथा आवश्यकतानुसार अधिकतम रू० 1.00 लाख तक का कृत्रिम अंग प्राप्त कर सकेंगे।
बीमा आवरण की अवधि - बीमा आवरण की अवधि संस्थागत वित्त, बीमा एवं वाह्य सहायतित परियोजना महानिदेशालय, उ0प्र0 एवं बीमा कम्पनी के मध्य मेमोरेण्डम आफ अण्डरस्टैंडिंग (एम0ओ०यू०) हस्ताक्षरित होने की तिथि से एक वर्ष के लिए मान्य होगी तदोपरान्तु इसे वर्षवार बढ़ाया जायेगा। यह योजना 03 वर्ष + 03 वर्ष से अधिक नहीं होगी।"
(emphasis supplied)
17. Sub-clause (2) of the Clause - ''Yojana Ki Visheshtaayein' i.e. Special Features of the Policy, reads as below:
"व्यक्तिगत दुर्घटना बीमा - परिवार के मुखिया / रोटी अर्जक की दुर्घटना में मृत्यु / स्थाई पूर्ण विकलांगता / स्थायी और लाईलाज पागलपन / कुल दो अंगों के स्थायी नुकसान / दोनों आंखों में स्थायी दृष्टि का नुकसान / एक अंग और एक आंख की दृष्टि का स्थायी नुकसान / वाक् का स्थायी नुकसान / निचले जबड़े की पूरी हानि/ चबाने की स्थिति का स्थायी नुकसान पर बीमित राशि रू0 5.00 लाख, दोनों कानों से बहरेपन की स्थिति में बीमित राशि रू0 5.00 लाख का 75 प्रतिशत तथा एक अंग का स्थायी नुकसान या एक आंख की दृष्टि हानि के स्थायी नुकसान पर बीमित राशि रू0 5.00 लाख का 50 प्रतिशत लाभ दिया जायेगा ।"
18. It is undisputed - the father of the Rahul Kumar namely Rajkumar was the ''Mukhiya / head of his family'. He had an earning. He was alive on the date of the road accident suffered by Rahul Kumar, on 14.10.2018. Therefore, the petitioner-insurer claims, insurance claim made, on the death of Rahul Kumar, was ineligible (under the Insurance Policy read with the Government Policy). The fact - later, during the term of the Insurance Policy, Rajkumar also suffered an accidental death, would make no difference to the ineligibility of the claim arising on the prior death of Rahul Kumar.
19. In short, the petitioner-insurer has invoked the principle - a stipulation in the Insurance Policy may be interpreted upon a complete reading of that contract. A contract is not to be read as a statute but as a whole document, in the context of the general object for which it was executed. Therefore, laying heavy emphasis on the 'Object' clause of the Government Policy and the 'Coverage' clause of the Insurance Policy, it has been vehemently urged, the coverage was singular. It was extended only to the ''Mukhiya / head of the family' who would have been the bread winner of his family.
20. Sri Parv Agarwal has placed reliance on a decision of the Supreme Court in Vania Silk Mills Ltd. Vs CIT, AIR 1991 SC 2104, to suggest, ordinary, popular and natural meaning is to be given to the word 'Mukhiya', used both under the Insurance Policy and the Government Policy.
21. Sri Pawan Kumar Singh has referred to Glynn Vs. Margetson, (1893) A.C. 351, to submit, all provisions of a contract should be read together. The intent of the parties to the contract must be clearly understood, therefrom. Only then a clear picture may emerge as to the true interpretation of the contract. Contrary to the purpose of the contract (thus determined), an inconsistent word or provision may be rejected, in entirety. Relying on Investors Compensation Scheme Ltd. Vs. West Bromwich Building Society, (1998) 1 WLR 896, he would submit (as per his written note) - the following five principles are useful to interpret contracts, exist :
"1. Contextual approach to interpretation
(i) Interpretation is the ascertainment of the meaning of the document to the reasonable person having all the background knowledge which would be reasonably available to the parties in the circumstances
2. Wide scope of background knowledge
(i) Relevant background knowledge of the includes "absolutely anything" which would have affected the understanding of the reasonable man
3. Pre-contractual negotiations are inadmissible
(i) Previous negotiations of the parties and their declarations of subjective intent are inadmissible as background
(ii) The only exception is in an action for rectification This distinction is made for practical policy of reducing litigation time and costs
4. Substitution of words and syntax
(i) The background circumstances "may not merely enable the reasonable man to choose between the possible meanings of words which are ambiguous but even (as occasionally happens in ordinary life) to conclude that the parties must, for whatever reason, have used the wrong words or syntax."
(ii) Meaning is contextual not literal
5. Business common sense
(i) The natural and ordinary meaning must yield to business common sense if it flouts it
(ii) However, there is the presumption that people do not easily make linguistic mistakes
(iii) The natural and ordinary meaning is not unhelpful when words have not been used in a natural and ordinary way"
22. Then, reliance has been placed on the following two decisions of the Supreme Court and a decision of the Madras High Court to submit, the coverage granted to the 'Mukhiya' may not be enlarged as it would conflict with the policy terms:
(i) South East Asia Marine Engineering & Constructions Ltd. Vs. Oil India Ltd., AIR 2020 SC 2323
(ii) M.O.H. Uduman & Ors. Vs. M.O.H. Aslum, AIR 1991 SC 1020
(iii) M/S Sha Moolchand Kesarimull Vs. M/S Associated Agencies, AIR 1942 Mad 139
23. Contesting the above, learned counsel for the claimant-respondents submits, the Insurance Policy was taken out by the State Government, to fulfil welfare objective. It covers both, the head of every eligible family as also every bread earner of every eligible family. Thus, they have relied on the eligibility-clause under the Insurance Policy and also the eligibility / 'Patrata' clause under the Government Policy (with reference to the other stipulations contained therein). It has been submitted, there is no exclusion made and there is no intent emerging from the reading of any of the clauses of the Insurance Policy or the Government Policy as may restrict the coverage under the Insurance Policy to a single person, namely, the ''Mukhiya' who may or may not be the sole bread winner of the eligible family. For ready reference, Eligibility clause of the Insurance Policy reads as below:
"ELIGIBILITY CLAUSE - All farmers of Uttar Pradesh (without any Income limit), Landless farmers, those related to Agriculture related activities, (Fishery, milk producing, pig farming, goat farming, Bee keeping etc.) nomadic/ roaming families, businessmen (who are not covered under any other Governmental Scheme), forest workers, retailers, Rickshaw pullers, porters and those engaged in other activities who are residents of rural or urban areas whose annual income is less than INR 75,000/- and age limit in between 18 to 70 years shall be eligible for this Scheme. During the currency of the Scheme, If a person attains the age of 18 years or a person crosses the age of 70 years, that person shall also be covered."
(emphasis supplied)
24. Also, the Eligibility clause of the Government Policy reads as below:
"पात्रता- उत्तर प्रदेश राज्य के समस्त कृषक (असीमित आय सीमा) भूमिहीन कृषक, कृषि से संबंधित क्रियाकलाप करने वाले, (मत्स्य पालक, दुग्ध उत्पादक, सूकर पालक, चकरी पालक मधुमक्खी पालक इत्यादि)घुमन्तू परिवार, व्यापारी (जो कि किसी शासन योजना से आच्छादित नही 8). पन श्रमिक, दुकानदार, फुटकर कार्य करने वाले, रिक्शा चालक. कुली एवं अन्य कार्य करने वाले ग्रामीण क्षेत्रों अथवा शहरी क्षेत्रों के निवासी जिनकी पारिवारिक आय रू० 75.000/- प्रति वर्ष से कम हो एवं जिनकी आयु 18 वर्ष से 76 वर्ष के मध्य है पात्र होंगे। इसमें राज्य सरकार एवं भारत सरकार तथा राज्य एवं केन्द्र सरकार के पी०एस०यू० के वित्तीय सहायता प्राप्त संस्थानों के निजी क्षेत्र के तथा स्वशासी निकायों / सार्वजनिक उपक्रमों / निगमों / बोर्ड एवं प्राधिकरणों के कर्मचारी जो किसी बीमा कम्पनी की बीमा योजना से लाभान्वित हो रहे हैं, शामिल नहीं होंगे। बीमा आवरण की अवधि में 18 वर्ष की आयु पूर्ण करने वाले उक्त सभी योजना के अन्तर्गत पात्रता की परिधि में आयेगे। इसी प्रकार बीमा आवरण अवधि में 70 वर्ष पूर्ण हो जाने पर उक्त सभी पात्रता श्रेणी में माने जायेगें।
कृषक - कृषक का तात्पर्य राजस्व अभिलेखों अर्थात खतौनी में दर्ज खातेदार / सहखातेदार से है, जिसकी आयु न्यूनतम 18 वर्ष तथा अधिकतम 70 वर्ष हो ।
भूमिहीन कृषक एवं कृषि से संबंधित कियाकलाप - ऐसे ग्रामीण भूमिहीन परिवार जो प्रत्यक्ष या अप्रत्यक्ष रूप से कृषि कार्य से जुड़े हुए हों।
अन्य - कृषकों के अतिरिक्त जिनकी आयु 18 वर्ष से 70 वर्ष के मध्य है तथा पारिवारिक आय रू० 75,000/- प्रति वर्ष से कम हो योजनान्तर्गत पात्र होंगे। इसमें राज्य सरकार एवं भारत सरकार तथा राज्य एवं केन्द्र सरकार के पी०एस०यू० के, वित्तीय सहायता प्राप्त संस्थानों के निजी क्षेत्र के तथा स्वशासी निकायों / सार्वजनिक उपक्रमों/निगमों/ बोर्ड एवं प्राधिकरणों के कर्मचारी जो किसी बीमा कम्पनी की बीमा योजना से लाभान्वित हो रहे हैं, शामिल नहीं होंगे। प्रदेश सरकार के किसी भी विभाग द्वारा संचालित किसी भी दुर्घटना बीमा योजना में आच्छादित लाभार्थी मुख्यमंत्रीकिसान एवं सर्वहित बीमा योजना के लिए पात्र नहीं होंगें।"
(emphasis supplied)
25. Thus, it has been submitted, the insurance company had taken a heavy premium to cover the risk of accidental loss of life - to the most vulnerable and the weakest in the economic ladder of our society. Each 'Roti Arjak / bread earner' of an eligible family, stood insured under the Insurance Policy, read with the Government Policy. The petitioner insurer has repudiated its liability on a fallacious ground of single risk coverage, that too to a ''Mukhiya / head of the family'. The coverage was, clearly plural.
26. Having heard learned counsel for the parties and perused the record, there can be no dispute to the fact that the occurrence (of accidental death of Rahul Kumar on 14.10.2018), fell within the contingencies covered by the Insurance Policy. It is also not in dispute that the total family income (of the family to which Rahul Kumar belonged), did not exceed Rs. 75,000/- per annum and that he was more than 18 years, but less than 70 years of age on the date of occurrence of his accidental death. To that extent, there is no dispute.
27. In absence of person identification or name specification made while providing for the risk cover under the Insurance Policy, a dispute exists - which lives of an eligible family or contingencies faced by an eligible family would be covered and which would be not ?
28. Since the Insurance Policy and the Government Policy do not offer a direct answer to that issue, the terms and conditions of the Insurance Policy, the Government Policy (that has been made part of the Insurance Policy), and the Agreement would have to be examined in entirety to determine the same. To that extent, the principle being invoked by learned counsel for the petitioner is true and correct.
29. Examined in that light, first, under Clause 1 of the Insurance Policy, coverage of personal accidental death insurance benefit, Rs. 5,00,000/- was provided to the 'Mukhiya / head of the family / bread winner of an eligible family'. The person/s covered has/have been described as "Policy holder". It also cannot be denied, in that policy document, a clear reference exists - to the number of estimated persons covered, being 29,39,000, in the Meerut Cluster.
30. Then, in the eligibility clause of the Insurance Policy, persons engaged in various activities/vocations, whether residing in urban or rural areas were covered. First, all farmers (without income ceiling) were covered. Second, all landless labourers; all types of nomadic families; businessmen (not covered under any other government schemes); forest workers; retailers; rickshaw pullers; porters; etc. were covered, subject to their annual family income being less than Rs. 75,000/-.
31. Then, by way of general exceptions, that eligibility was made subject to age limit 18 to 70 years (of the insured person), provided further, if the insured person attained the age of 18 years or crossed the age of 70 years during the currency of the insurance term, he would still be covered thereunder. Further, by way of specific exclusion, the Insurance Policy provided as below:
EXCLUSIONS- Employees of Central Government, State Government, Public Sector Units (PSU) of Central Government or State Government, Financially aided Organizations, Private Sector, Autonomous Bodies/ Public Undertakings/ Corporations Boards and Authorities who are covered under any insurance scheme shall not be covered under the Samajwadi Kisan & Sarvhit Bima Yojna Scheme.
EXCLUSIONS- Any beneficiary who is covered under any accidental Insurance scheme operated by any of the department of State Government shall not be eligible under the Samajwadi Kisan & Sarvhit Bima Yojna Scheme.
(emphasis supplied)
32. Similar clauses existed under the Government Policy, as well. Thus, it appears, the two documents are not conflicted. The Government Policy was framed earlier. Against that, the petitioner insurer was selected, through open tender process. The agreed premium was paid by the State Government and Insurance Policy taken out, by it. In such facts, the above two documents do not attempt to cover two different risks or contingencies. In fact, largely, one is the reflection of the other. The choice of exact words and elaborations made apart, per se, no clause has been shown to exist in either document that may conflict with any clause contained in the other. Then, Clause 5 of the Insurance Policy makes the Agreement (of which the Government Policy is a part), a part of the Insurance Policy.
33. Undisputedly, the risk of an accidental injury, was insured to the "head of the family" or "bread winner" and other members of an eligible family. While providing for that contingency and cover against accidental injury, the Insurance Policy did not specifically or by direct reference made, provide for coverage of risk to life against accidental death, of all or any other family member/s. Thus, exclusion is claimed to arise on a comparative reading of the relevant Clauses of the Insurance Policy. Yet, no contrary intention is expressed in the Government Policy or the Agreement.
34. Then, the opening Clause of the Government Policy discloses its object. It was to provide financial assistance to the eligible families against ''Asuraksha/Vippatti' i.e. insecurity/calamity arising from the sudden accidental death of the ''Mukhiya' i.e. the head of an eligible family.
35. At the same time, in the very next Clause, while providing for eligibility, that Government Policy includes within the sweep of the Insurance Policy, all members of eligible families. It includes citizens from all walks of life, subject to specific general exclusions, noted above.
36. The term ''Mukhiya / head of the family' is not a term defined, either under the Government Policy or under the Insurance Policy. It is also not a term defined by legislature. Primarily, it is a social construct. Commonly, the eldest member of any family is described as its ''Mukhiya'. The Government Policy is progressive inasmuch as it has used the term ''Mukhiya / head of the family', in a more gender plural sense by using the words male/female.
37. If the intent of the Government Policy and, therefore, if the coverage under the Insurance Policy were to be confined to the 'Mukhiya' only, there would have arisen no need to mention ''Roti Arjak / bread earner'. The fact that such terms had been used by adding ''/' (stroke) after the word ''Mukhiya', indicates the intent to cover either the head of the family, or its bread winner, during the term of the Insurance Policy - from 14.09.2018 to 13.09.2019. Clause 3 of the Insurance Policy reads as under :
"3. Below individuals shall be considered as family members under the Samajwadi Kisan & Sarvhit Bima Yojna Scheme:
a) Head of the Family/Bread earner (Male/Female)
b) Husband/Wife of Head of the Family/Bread earner
c) Unmarried daughter
d) Dependent son
e) Dependent parents of unmarried son (where unmarried person is Head of the Family/Bread Earner)
f) Dependent parents of Head of the Family/Bread Earner (only in cases where husband is the Head of the Family) Note: Parents of wife shall not be covered."
(emphasis supplied)
38. Then, the clause pertaining to ''Parivar Nirdharan' contained in the Government Policy reads as below:
"परिवार निर्धारण -परिवार के अन्तर्गत परिवार का मुखिया/रोटी अर्जक (पुरुष /स्त्री) उसकी पत्नी/पति, अविवाहित पुत्री, आश्रित पुत्र, मुखिया पति एवं अविवाहित पुरुष के आश्रित माता-पिता बीमा का लाभ प्राप्त करने हेतु आवृत्त होगें।"
(emphasis supplied)
39. Thus, for the purpose of determining the family members/persons insured under the Insurance Policy, the 'Mukhiya / head of the family' could be both - the person insured as also a beneficiary. As 'Mukhiya / bread winner', such person was included as family member under Clause 3(a) of the Insurance Policy. He would be the 'policy holder'. At the same time if such person's unmarried or married son was a bread earner, such person though 'Mukhiya' would be a beneficiary, in case of occurrence of death of such married son [under Clause 3(e) & 3(f) of the Insurance Policy], subject to him being dependent on his son, now described as 'Head of the family / Bread Earner'.
40. Therefore, the Insurance Policy does seek to insure the risk to life of a person other than a 'Mukhiya / head of the family' also, in certain situations. In absence of the words "Ek Matra"/ sole prefixed to the phrase ''Roti Arjak / bread earner' and in absence of any exclusion clause to oust a claim of a partly dependent 'Mukhiya', in the case of death of his married or unmarried son, it is to be seen if by use of word 'dependent' under Clause 3(e) and 3(f) of the Insurance Policy, only non-earning 'Mukhiya / head of the family', may become a beneficiary in the event of death of their earning son (married or unmarried).
41. While the Insurance Policy is silent in that regard, the object clause of the Government Policy makes it plain that the object was to take out an Insurance Policy to provide for vital aid to the financially most vulnerable and exposed families who may be faced with 'Asuraksha / Vippati' i.e. insecurity / calamity upon occurrence of accidental death of its 'Mukhiya' or 'Bread Earner'. A minimum amount of money as may help them avoid destitution, upon the loss of vital minimum earning was sought to be provided, to an eligible family, to address the insecurity or extreme hardship arising upon being faced with the calamity of death taking away the hope of minimum means to survive.
42. The Eligibility clause under the Government Policy, includes all citizens from different walks of life engaged in different professions and vocations, residing in different parts of the State. It includes all farmers (irrespective of their annual earning) and, others having family income less than Rs. 206/- per day (Rs. 75,000 / 365 days). Also, the insured ''Mukhiya / head of the family / Roti Arjak / bread earner' could be a person in the age bracket of 18 years to 70 years. It is apparent that the intent of the Government Policy was to insure all adult active members of an eligible family who may have had an earning.
43. Thus, a person below 18 years of age was treated to be ineligible. He would remain not - insured on deemed basis, though such person (in a given unfortunate situation), may have been the sole bread winner of his family. Correspondingly, any person above 70 years of age was treated to be the person not insured as he was deemed to be not contributing economically to his family.
44. Therefore, there may be no dispute to rejection of a claim made on occurrence of death of a person below 18 years of age or above 70 years of age. There, upon fiction introduced, the dead would not be of a person insured. Yet, a conflict would arise if interpretation made by learned counsel for the insurer is accepted with respect to a person aged below 70 years of age who may be the eldest member of an eligible family and who may (speaking hypothetically), be earning a frugal sum of say Rs. 24,000/- per annum. In that case, such a person would be included under the cover of the Insurance Policy in his capacity as ''Mukhiya'. Yet, as a beneficiary he would be ineligible to claim insurance money if his unmarried son (who may have been earning Rs. 50,000/- per annum), died an accidental death. It would be so because according to learned counsel for the petitioner-insurer, the claimant would not be wholly dependent on his son. At the same he would be eligible if his earning were nil.
45. The test of full dependency neither appears to exist under the Insurance Policy or the Government Policy or the Agreement nor it may be practicable to satisfy. Also, if strictly applied it may allow any and every such claim to be defeated upon the insurer being able to satisfy that the 'Mukhiya' / parent of the head of the family had earned, say Rs. 100/- per month, through any manual labour performed. That result would be plainly absurd. The Insurance Policy may not be interpreted to include and exclude the same person from the scope of insurance/beneficiary, simultaneously. Clearly, an ambiguity exists.
46. Undeniably, the Insurance Policy is a contract entered into between the petitioner-insurer & the State Government. Though it has been reached in furtherance of the Government Policy yet, its terms were drafted by the petitioner-insurer. It is those terms that bind it. Therefore, if the words used in the Insurance Policy give rise to two alternative interpretations, one in favour of the petitioner-insurer and the other in favour of the insured, the rule of Contra Preferentum would apply. It thus commends to the Court to read the words 'Roti Arjak / bread earner', used in the coverage Clause (1) of the Insurance Policy to include all bread winners of an eligible family. Similarly the word 'dependent' used in 'Family Composition' - clause (3) of that policy includes partial dependency and/or inter-dependency. To that extent, those words have to be read against the petitioner-insurer as it was itself the draftsman of the Insurance Policy. Unless read in that manner, the core objective of the Insurance Policy - to preserve the most vulnerable lives of our society, would fail. In General Assurance Society Ltd. Vs. Chandumull Jain & Anr., AIR 1966 SC 1644 a Constitution Bench of the Supreme Court noted the applicability of rule Contra Preferentum, to insurance contracts. The said rule has been applied by the Supreme Court, recently, in Manmohan Nanda Vs. United India Assurance Co. Ltd. & Anr., 2021 SCC Online SC 1181.
47. Clearly, it is the risk/contingency of loss of life of either the ''Mukhiya / head of the family' or a bread winner (described as ''Roti Arjak / bread earner') that is insured. The object of that coverage is not simple life insurance, but, to prevent extreme destitution described under the Government Policy as 'Asuraksha / Vippati'. It would be unreasonable to conclude that the coverage is to be confined to the ''Mukhiya / head of the family who is the sole ''Roti Arjak / bread winner of the family'. A parent who may be dependent either, wholly or in part. In that case his earning son/s may also stand insured against risk of loss of life to the extent they would both be contributing to the minimal earnings of their family.
48. In absence of any specific exclusion under the Insurance Policy, there is no inherent logic to exclude the unfortunate occurrence of accidental death of any bread winner i.e. ''Roti Arjak / bread earner' (as described under Insurance Policy) from the cover of insurance. Here, the underlying object of the policy must be given primacy. It is to offer minimal succour to the poorest of the poor i.e. families having income less than Rs.75,000/- per annum and who may suffer further hardship upon being confronted with more cruel and merciless circumstance of occurrence of sudden death of any adult earning member.
49. It has to be remembered, in that extreme circumstance, each grain would go to make the smallest of small bread needed to keep the hope of life alive for the eligible family, as a unit. It is not uncommon that amongst the poorest of the poor, every hand whether tender and under age or withered and frail, upon hard labour performed, makes vital and decisive contribution to prepare the daily bread / 'Roti'. It is those unfortunate families that fall within the sweep of the Insurance Policy and the Government Policy.
50. At Rs. 206/- per day, the eligible family may barely have enough to keep its life boat afloat, if no illness or other such circumstance cuts a hole in that. In the precarious financial situation such as that (of an eligible family having annual income of less than Rs. 75,000/- i.e. Rs. 206/- per day), no earning member of that family, including its 'Mukhiya / head of the family' whether the eldest member of the family or the one with highest earning would be financially independent. He alongwith all earning members of his family would remain financially inter-dependent on each earning hand of that family. Hence, the word 'dependent' used in Clause 3(e) and 3(f) of the Insurance Policy only refers to a condition of joint living and not of complete loss of earning, suffered by the eligible family.
51. Thus, the principle being invoked by learned counsel for the petitioner - of 'main'/'sole' bread winner or of 'wholly/solely dependent' is unreal and artificial. If applied it would lead to absurd results. Looked through the eyes of the beneficiary, it may appear a bourgeois construct. It would stand in direct conflict to the socialistic soul of our Constitution. In that circumstance, the principle - each drop fills the bucket is more appropriate and apt. There, may not arise any surplus to such family and all money earned by different hands may, at best, be just enough. Each rupee or each hand full of grain earned would be equally valuable. It is impossible to differentiate between hands when each brings only a handful. In such an unfortunate and extreme circumstance, the concept of 'wholly dependent' is purely academic and a thought that may lead to absurd results. It is therefore, rejected.
52. Therefore, the only reasonable construction that may be given to the coverage clause under the Insurance Policy read with the Government Policy is to allow for coverage of each adult earning hand of an eligible family (below 70 years of age), including its ''Mukhiya / head of the family'. The fact that he may or may not be the sole bread winner, to a lesser or greater extent, would not be relevant. The eligibility would be subject to the general exclusions provided under the Insurance Policy, noted above.
53. That said, in the unfortunate occurrence of more than one death during the policy period, the insurer may be exposed to honour only the first claim per eligible family. It is so because as noted above, the 'Object' and 'Eligibility' clauses of the Government Policy and the Insurance Policy contemplate insurance coverage to overcome destitution described as 'Asuraksha / Vippati' arising from the death of an earning hand. Second, the coverage of life was provided (under the Insurance Policy) to an estimated 2939000 persons being the exact number of eligible families estimated and as recorded in Clause 4 of the Insurance Policy, against accidental loss of life of an earning member, as may plunge the family income below Rs. 206/- per day. That is the level of family income that the Government Policy (that is part of the Insurance Policy) recognised, both as the money required to survive and also as a factor to identify the beneficiaries who need the insurance cover to sustain basic human existence. The quantum of compensation is also equal to about 6-7 years of that minimum income support.
54. Further, in absence of any clause, words and expressions used, either under the Insurance Policy or the Government Policy to provide individual coverage to all bread winners, in an eligible family, it appears, during the policy term from 14.09.2018 to 13.09.2019, death of only one earning member of an eligible family would stand covered. The stroke - '/' mark placed between the words 'head of the family' & 'Bread Earner' under Clause 1 i.e. coverage clause of the Insurance Policy also suggests the same intent. To that extent, the submission of learned counsel for the petitioner carries weight. The object was to provide minimum and immediate succour to eligible family and not to compensate for all losses of lives suffered, by an eligible family, in one policy term. If accepted, that may amount to re-writing the contract which the Courts may not do.
55. Insofar as the present case is concerned, at the time of death of Rahul Kumar, he was found to be engaged in agricultural activity, though along with his father. The Permanent Lok Adalat has found, the deceased was also engaged in some manual labour drawing earning therefrom. That finding is not perverse. Undisputedly, he was more than 18 years of age during the policy term. Therefore, he was a person covered under the Insurance Policy as a bread winner of his family though he may not have been its ''Mukhiya'. He was a bachelor, contributing to his family's meagre income below Rs. 75,000/- per annum.
56. To that extent his entire family including his father Rajkumar would have been partly dependent (on deemed basis), on his frugal material contributions, as a means of their daily survival, as a unit. To that extent, his father Raj Kumar would also have been partly-dependent on him. Since Rahul Kumar died during his father's lifetime and the claim therefrom arose first, the Permanent Lok Adalat has not committed any error in allowing the same. The challenge raised in the writ petition is found lacking in merit. Sri Ojha has also stated, similar claim made upon the death of Rajkumar was rejected by the Permanent Lok Adalat. It has attained finality.
57. It is however provided, in the event, petitioner pays up the awarded amount within a further period of one month from today, the petitioner would not be liable to pay any interest. If however such payment is not made within the time thus extended, the petitioner shall remain exposed to interest liability provided under the impugned award.
58. With the aforesaid observations, present petition stands disposed of.
Order date:- 6.4.2022 Abhilash/Prakhar