Senior Divisional Manager, LIC of India vs Surekha

THIS appeal has been preferred by the LIC of India against the order of the District Forum, Dharwad, dated 8.10.1999 in Complaint No. 62 of 1998 directing to pay a total sum of Rs. 2,33,910/- to the complainant with all the benefits and with interest at 12% per annum from the date of repudiation i.e. from 18.2.1997 till payment.

THE brief facts for the disposal of this appeal are that the complainant''s husband, one Manjunath Bagewadi had taken 5 insurance policies total for a sum of Rs. 1,90,000/- with a double accident benefit clause. As per the said clause if the death of the policy holder takes place due to an accident caused by violent and visible means the claimant under the policies would be entitled to receive an additional amount equivalent to the sum assured on the policies. THE said Manjunath Bagewadi was found dead on 9.6.1995 within the jurisdiction of Annigeri Police Station and on the basis of the complaint given to the police a case was registered in Cr. No. 30 of 1995 against the unknown persons for the offence punishable under Section 302 of IPC. After the death of her husband the complainant made her claim before the opposite party/Insurance Company and the Insurance Company settled the amount but not settled the claim of accident benefit in respect of the policies. Hence, the present complaint was filed before the District Forum claiming a total amount of Rs. 2,32,127/- under the accident benefit. The Insurance Company appeared before the District Forum and filed its objection admitting that the deceased Manjunath during his life-time was having 5 policies. It also admitted the death of Manjunath on 8.6.1995 but submitted since the cause of death was not established on the basis of the records submitted by the complainant, the complainant was not entitled for the accident benefit and accordingly they settled the claim amount in respect of the policies except the accident benefit. The District Forum, on the basis of the materials placed by the parties and after going through the documents and hearing the arguments has held that the complainant has satisfied that she is entitled for the relief as prayed for in the complaint and accordingly passed the impugned order.

In this appeal the learned Counsel Mr. R. Rajagopalan, appearing on behalf of the appellant submitted before us that the District Forum was not justified in passing the order in view of the fact that the cause of death of the insured has not been conclusively established as due to accident as could be seen from the post-mortem report in which it is stated that the cause of death could not be established. He has further contended that unless the complainant proves that the insured died due to accidental death, she was not entitled for the accident benefit. He has also further observed that there was no material before the Insurance Company to settle the claim including that of accident benefit since the complainant has not produced sufficient material for the said purpose. He submitted that the District Forum was not justified in passing impugned order.

WE heard Mr. S.N. Patil. learned Counsel on behalf of the respondent. He pointed out that the insured died due to murder which is an accidental death. He has also pointed out that the complainant has produced sufficient material to show that her husband met homicidal death and number of injuries were found on the body of the deceased which was anti-mortem and the Doctor who conducted the post-mortem has mentioned in the said report that the cause of death could not be furnished in view of the decomposed state of the said dead body. She pointed out that the complaint has already been lodged for the murder of her husband before the jurisdictional police and the police have investition the matter and it is proved during investigated that the insured has been prone to death by external violence and under these circumstances he pointed out that the order passed by the District Forum in granting accidental benefit does not suffer from any legal infirmity. We have been taken through the order of the District Forum. There was no dispute that Manjunath met with a homicidal death. The dead body of Manjunath had ante-mortem injuries. Post-mortem was conducted. But the Doctor who conducted the post-mortem was not in a position to furnish his opinion regarding the cause of death in view of the fact that the said dead body was in a decomposed state. The complainant has proved by producing sufficient materials that the said injuries were caused to the deceased due to external violence.

THE specific contention of the Insurance Company in repudiating the claim of double accident benefit was that as per the policy conditions the double accident is payable only if the cause of death is due to accident. According to the District Forum the records submitted by the complainant relating to the death of her husband, the cause of death was due to accident. From the records it is seen a crime has been registered with the police and a post-mortem was conducted in respect of the death and the case of the complainant was that the death was due to murder and the murder is also an accident which is covered under the terms and conditions of the personal accident policy. THE District Forum has placed reliance on the decision of the Gujarat State Commission, reported in II (1995) CPJ 302=1995 (2) CPR 331, Shyampyari v. United India Insurance Company Ltd. & Anr., wherein it is observed in paragraph 4 of the judgment as follows : "4. THE next question is whether the murder of the deceased could be said to be covered under the terms and conditions of the insurance policy. It is the case of the opponent that accidental injury which is covered under the policy is such bodily injury caused to the insured solely and directly from an accident caused by external, violent and visible means. When the deceased was released on bail, he was under threat of murder and, therefore, it could not be said that the deceased died on account of accidental injury. THE relevant dictionary meanings of the word ''accident'' are : (1) unexpected event, one that occurs without design or apparent cause; (2) an unexpected event, or undersigned act, of an unfortunate character; misfortune, injury disaster. One of the dictionary meanings of the word ''accidental'' is ''happening by chance'' or unexpectedly''. THE deceased, even assuming that threat to murder him was given by his enemies, he never expected that he would in fact be killed. He would never have sought his release on bail had he thought he was sure to die. In fact, nobody can be certain as to how or when one would die. THE death of the deceased was undoubtedly an unexpected event which had occurred without design or apparent cause. THE deceased would not have designed his own death. THE deceased was shot dead. THE post-mortem report in regard to the post-mortem examination performed on the dead body of the deceased disclosed that the deceased had died due to shock caused by bullet injuries. It is, therefore, obvious that ''accident'' causing death of the deceased was caused by external violent and visible means. THEre may be design and plan on the part of the persons who shot the deceased but it cannot be said that it was the deceased who designed or planned his death."

The complainant has filed an affidavit to the effect that the death of her husband was due to murder which is an accident. The said allegation made by the complainant has not been denied by the Insurance Company since nobody has filed affidavit on behalf of the Insurance Company denying the said allegation. The Insurance Company has not stated in the letter of repudiation how the death of Mr. Manjunath took place. It has simply repudiated the claim stating that the cause of death is not established and hence the double accident benefit cannot be granted. A dictionary meaning of the word accidental is happening by chance or unexpectedly. The deceased Manjunath was working as a Field Officer in Malaprabha Grameena Bank and he was well-settled in his life. He was found dead with an external injury on his person. That being so, it cannot be said that he himself committed suicide, just because the Doctor who conducted the post-mortem examination was not in a position to give cause of death it cannot be concluded that the death of Manjunath was not due to murder. The Doctor was not in a position to give the cause of death since the dead body was in a decomposed state. However, the learned Counsel Mr. Rajagopalan, appearing for the Corporation has invited our attention to a decision of the Supreme Court reported in IV (2000) SLT 179=II (2000) ACC 291 (SC)=2000 (1) LLJ SC 1656 Rita Devi & Ors. v. Insurance Company Ltd. & Anr. He invited our attention to paragraph 10 of the said judgment, wherein the Hon''ble Supreme Court has observed as follows : "10. The question, therefore is, can a murder be an accident in any given case ? There is no doubt that ''murder'', as it is understood, in the common parlance is a felonious act where death is caused with intent and the perpetrators of that act normally have a motive against the victim for such killing. But there are also instances where murder can be by accident on a given set of facts. The difference between a ''murder'' which is not an accident and a ''murder'' which is an accident, depends on the proximity of the cause of such murder. In our opinion, if the dominant intention of the act of felony is to kill any particular person then such killing is not an accidental murder but is a murder simplicitor, while if the cause of murder or act of murder was originally not intended and the same was caused in furtherance of any other felonious act then such murder is an accidental murder."

WE have carefully considered the said judgment. It will not be applicable to the facts of the present case. Having regard to the facts of the present case, it cannot be said that the murder which has taken place is not an accident. As mentioned above the Insurance Company has not placed any material to show that the murder committed on the insured was not an accidental murder. That being so, the learned Counsel Mr. Rajagopalan cannot take advantage of the decision of the Supreme Court. Hence, this contention has to be negatived.

NOW, coming to the next submission of the learned Counsel for the appellant that the complainant is entitled only for the sum assured of the accident benefit scheme, there is considerable force in this submission. According to Section 10(b), the claimant is entitled to get an additional sum equal to the sum assured under the policy. The total sum assured in the present case in Rs. 1,90,000/-. However, the District Forum, in its order has granted in addition to the sum assured in the policy, the other benefits such as bonus. According to us, the complainant is entitled to get the sum assured only under the accident benefit scheme. Hence, we modify the order passed by the District Forum and instead of the respondent/Insurance Company paying a sum of Rs. 2,33,910/-, it is directed to pay a sum of Rs. 1,90,000/- to the complainant with interest at 12% per annum from the date of repudiation i.e. from 18.2.1997 till payment. We further direct that the said amount should be paid by the Corporation to the complainant within a period of one month from the date of receipt of the copy of this order. However, there will be no order as to costs in this appeal. Appeal disposed of.