Insurance – MOU entered into between Appellant-Insurance company and Respondent No.1 to provide insurance cover to the persons deployed for election related work for Bihar Legislative Assembly Elections in 2000 – Respondent No.2’s husband, a Constable died due to sun stroke while performing election duty – Respondent No.2 sought compensation in 2008 – Respondent No.1 acknowledged the eligibility for payment, Single Judge assigned the liability to pay the amount on the Respondent No.1 and the DM – Appeal filed by Respondent No.1, Division Bench fastened the liability on the appellant – Held: Respondent No.2’s claim was beyond reasonable time period – It was negligence of Respondent No.1 in lodging the claim – If it was not admissible then there was no reason to forward the claim to the Appellant – Further, considering the Specific clause in the MoU governing the insurance policy providing for payment of compensation in the event of death, even in the event of a death, it is only in the scenario where it is solely and directly from an accident caused by external violence – However, the death of Respondent No.2’s husband was by sun stroke – There was no semblance of any violence being the cause of death – A proximate causal relationship between the accident and the body injury is a necessity – The cause arising from a sun stroke cannot be included within the parameters of the ‘Scope of Cover’ in the insurance policy defining when such insurance amount would become payable – Thus, Appellant is not liable – Impugned judgment of the Division Bench set aside – However, the amount already stands paid by Respondent No.1 to Respondent No.2 in pursuance of the judgment of the Single Judge – It would not be appropriate to permit Respondent No.1 to recover any amount from Respondent No.2 and that aspect now stands closed.
Insurance – Insurance contracts – Held: Words used in a contract of insurance must be given paramount importance and it is not open for the Court to add, delete or substitute any words.
Insurance – Law governing insurance contracts – Discussed. Insurance – Insurance claims – Distinction between “accidental means” and “accidental result” – Discussed.
Allowing the appeal, the Court
HELD: 1.1 On consideration of the rival contentions, there are two aspects which needs to be flagged: firstly, the consequences of delay in claiming the amount from the Appellant insurance company; secondly, whether at all the insurance policy covered the scenario of the death of the constable. On the first aspect, the admitted position is that Respondent No.2 never raised a claim even on the Chief Electoral Officer seeking an entitlement of the claim till the letter dated 21.11.2008 after seven and a half years. Thus, by any standards this claim was beyond any reasonable time period. Even if the wife had not claimed and the Appellant insurance company were of the view, that the case was covered by the policy, then it was the bounden duty of Respondent No. 1 to have lodged that claim. It cannot countenance the submission that while on one hand the claim made by the wife was initially rejected, subsequently, it is re-examined, almost as if making it a pre-condition to fasten the liability on the Appellant insurance company. The conditions of the MoU required the claim to be made immediately on the occurrence. It appears that in their own wisdom Respondent No.1 never thought that it was a case for which claim should be lodged with the Appellant insurance company. Thus, whether the claim was admissible under the insurance policy or not, the conduct of Respondent No.1 would not entitle them to fasten the liability on the Appellant and would have to be borne by them if they are of the view that such an amount ought to have been made. It would be negligence of Respondent No.1 in lodging the claim. If it was not admissible then there is no reason to forward the claim to the Appellant. Respondent No.1 has been actually playing ducks and drakes with this issue for reasons best know to them. [Para 21-24][321D-H; 322-B-D]
1.2 Now turning to the specific clause in the MoU, which would govern the insurance policy providing for payment of compensation in the event of death (only) resulting “solely and directly” from the accident caused by external violent and any other visible means. On a plain reading itself, leave aside the question of strict interpretation of the clauses, it is quite apparent that the admissibility of the claim is in the event of death. The second part of the same sentence begins with “only”. Thus, even in the event of a death, it is only in the scenario where the consequent situation arises, i.e., it has to be solely and directly from an accident caused by external violence. Here the death is by sun stroke. There was no semblance of any violence being the cause of death. The last aspect which reads as “any other visible means” would be an expression to be read in the context of ejusdem generis with the external violent death and cannot be read in isolation itself. [Para 31][323-E-G; 324-A]
1.3 The cause arising from a sun stroke cannot be included within the parameters of the ‘Scope of Cover’ in the insurance policy defining when such insurance amount would become payable. Thus, on the second account also, the Appellant insurance company is not liable. [Paras 34 and 35][324-F-G]
Alka Shukla v. Life Insurance Corporation of India (2019) 6 SCC 64 : [2019] 6 SCR 762 – relied on.
1.4 The impugned judgment of the Division Bench of the High Court is clearly unsustainable and is set aside. In fact, the order passed by the Single Judge was predicated on the own admission of Respondent No.1, which is now sought to be resiled from by giving a slightly different interpretation but then if the claim was not admissible, there was no reason for Respondent No.1 to forward the claim to the Appellant insurance company merely because it was made and with the objective of somehow benefiting Respondent No.2 at the cost of the Appellant. That being the position, this Court is quite cognizant of the fact that the amount already stands paid by Respondent No.1 to Respondent No.2 wife in pursuance of the judgment of the learned Single Judge. De hors the complexity of any legal issue, Respondent No.2 having enjoyed the benefit for so many years, the stand as taken by Respondent No.1 qua the liability to pay Respondent No.2, it would not be appropriate to permit Respondent No.1 to recover any amount from Respondent No.2 and that aspect should now stand closed. [Para 36][324-G-H; 325A-C]
Suraj Mal Ram Niwas Oil Mills (P) Ltd. vs. United India Insurance Co. Ltd. 2010 SCC OnLine SC 1148; Export Credit Guarantee Corporation of India Limited vs. Garg Sons International (2014) 1 SCC 686 : [2013] 1 SCR 336; Vikram Greentech India Ltd. v. New India Assurance Co. Ltd. (2009) 5 SCC 599 : [2009] 5 SCR
437 – relied on.
Delhi Electric Supply Undertaking v. Basanti Devi & Anr. (1999) 8 SCC 229 : [1999] 3 Suppl. SCR 219; Oriental Insurance Co. Ltd. v. Sony Cheriyan (1999) 6 SCC 451 : [1999] 1 Suppl. SCR 622; Polymat India (P) Lid. v. National Insurance Co. Ltd. (2005) 9 SCC
174 : [2004] 6 Suppl. SCR 535; Sumitomo Heavy Industries Ltd. v. ONGC Ltd. (2010) 11 SCC 296 : [2010]
9 SCR 176; RashtriyaIspat Nigam Lid. v. Dewan Chand Ram Saran (2012) 5 SCC 599; Lilawanti Devi v. The State of Bihar & Ors. 1998 (2) PLJR 692; Kamlawati Devi v. The State of Bihar & Ors. (2002) 3 PLJR 450 – referred to.
Justice K Kannan, Principles of Insurance Law Chapter
3 (Volume 1, 10th ed. 2017, pg. 31); Colinvaux’s Law of Insurance (11th Edn.) discusses the effect and the impact of the expressions “violent, external and visible – referred to.
As published in the Supreme Court Reports, Supreme Court of India. Text from the Indian Supreme Court Judgments open data set (Dattam Labs), CC BY 4.0.
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