Judgment:
Oral Order : (Smt. M. Shreesha, Honble Member)
Aggrieved by the order in C.C.No.294/2007 on the file of Dist. Forum, Guntur, the opposite party preferred this appeal.
The brief facts as set out in the complaint are that the first complainants father took insurance policy while he was alive which is called âTAILOR MADE PERSONAL ACCIDENT SCHEME FOR ENGINEERING STUDENTS AND PARENTSâ. The said policy was issued by the opposite party on 18.10.2005 and was valid upto 17.10.2009 . The nature of policy is an educational policy for engineering students who qualified in the EAMCET rank and the policy is issued jointly in the name of student, parent or his guardian and this student paid Rs.680/- towards premium and the policy specifies that in case of an accidental death of the parent or guardian Rs.3 lakhs will be paid to the nominee+ tuition fee upto Rs.25,000/- p.a. and boarding charges upto Rs.25,000/-p.a. and if there is an accidental death of student Rs.2 lakhs would be paid to the insured parent or guardian. While so on 4.3.2006, the father of the first complainant went missing and the police report was also lodged on 7.3.2006 and the same was registered as Cr.no.46/2006 under âMan Missing and the police finally traced the body of the complainants father and conducted inquest and sent the body for Autopsy. The Post Mortem certificate has also been issued and a sessions case is pending against offenders. The first complainant informed about the death of his father to the opposite party along with the relevant documents but the opposite party on 24.10.2006 repudiated the policy on the ground that the murder is not covered under Accident. Due to the repudiation of the claim , the first complainant suffered lot of hardship in continuing his studies and borrowed hand loans from his friends and relatives at higher rate of interest for pursuing his studies. Vexed with the attitude of the opposite party, the complainants approached the District Forum seeking direction to the opposite party to pay in total Rs.5,65,500/- i.e. Rs.3 lakhs towards policy amount, Rs.75,000/- towards Tuition fee for 3 years, Rs.75,000/- towards boarding charges for 3 years, Rs.40,500/- towards interest , Rs.50,000/- towards mental agony and Rs.25,000/- towards legal expenses.
Opposite party filed their version stating that the letter intimating the death of the deceased received on 20.4.2006 and immediately on the same day the claim form and the letter calling for the relevant documents were sent to the complainant and on receipt of the completed claim form and other documents an investigation was carried out which revealed that Kota Anjaneyulu was murdered due to business rivalries. The murder was preplanned and done with a motive to kill the said Anjaneyulu for personal reasons and not of an accidental nature. They relied on the following condition of the policy:
âIf at time during the currency of this policy, the insured shall sustain any bodily injury resulting solely and directly from accident caused by external violent and visible means, then the company shall pay to the insured or his legal personal representatives ( s), as the case may the sum or sums hereinafter set for that is to say.
(a). If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause of the death of the insured or the insured parent stated in the certificate of insurance, Rs.3,00,000/- and of student named in the certificate of Rs.2,00,000/-.
(b). In the event of death of the insured parent, tuition fee not more than Rs.25,000/- per annum and hostel fee not more than Rs.25,000/- per annum for the balance period of studies shall be reimbursed.â
Opposite party also relied on the decision of the Apex Court in RITA DEVI AND OTHERS vs. NEW INDIA ASSURANCE CO.LTD. AND ANOTHER reported in 2000(3) ALT 44 SC in which Apex Court held that 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. Since the Apex Court held that the âMurder with motive is not an accidentâ , the opposite party contends that there is no deficiency in service on their behalf.
The District Forum based on the evidence adduced i.e. Exs.A1 to A10 allowed the complaint with costs directing the opposite party to pay to the complainants an amount of Rs.5 lakhs including costs in a sum of Rs.10,000/-.
Aggrieved by the said order, the opp.party preferred this appeal.
The learned counsel for the appellant/opp.party submitted that the Insurance Policy was given to cover only âaccidental death and that murder is out of purview of the insurance coverage since the death of the insured arose with a criminal intent. He further contended that the complainant was not prosecuting the studies by staying in the hostel and he did not incur any expenditure towards hostel charges and therefore the District Forum has erroneously awarded of Rs. 5 lakhs
We have perused the material on record. The issuance of the policy on 18.10.05 is not in dispute. The amount payable is Rs.3 lakhs to the nominee in case of accidental death of the parent or guardian, together with Rs.25,000/- p.a. towards tuition fee and Rs. 25,000/- p.a. towards boarding charges for the balance period of studies. It is the case of the 1st complainant that he is a student of B.Tech Engineering and suddenly his father was missing on 4.3.2006 and the same was reported to the police on 7.3.06 and thereafter the police traced the body and arrested the offenders and filed charge sheet against accused and the sessions case is pending . The first complainant submitted claim on 29.5.06 which was repudiated by the opp.party on 24.10.06 on the ground that âmurder is not covered under âaccident. It is the case of the appellant/opp.party that it is a murder by motive and is covered under the judgement of the Apex Court in RITA DEVI AND OTHERs V. NEW INDIA ASSURANCE CO.LTD. reported in 2000(3) ALT SC wherein it was held by the Apex Court that with a dominant intention of act of felony is to kill any particular person then such killing is not an accidental murder but murder simplicitor. It is not in dispute that the deceased Kota Anjaneyulu was found missing on 4.3.06 and was traced inspite of best efforts only on 7.3.06 and it remained a mystery whether his death was intended, even from the commencement of the felony that led to his death or some time half way through . The appellant/opp.party failed to establish that it is a murder caused by motive or intention and the death of the deceased was undoubtedly an unexpected event which occurred without any apparent cause. The deceased did not design his own death and in the instant case the murder can be termed as âaccidental which is covered under the policy in as much as the bodily injury caused to the deceased is solely and directly from an accident caused by external, violent and visible means. The learned counsel also cited the decision of the National Commission in F.A.204/99 between Prithwiraj Bandari v. LIC of India in which the National Commission also relied on the decision of Apex Court in RITA DEVI AND OTHERs V. NEW INDIA ASSURANCE CO.LTD. and held that the murder in that case is an intentional killing and murder simplicitor but in this case, to reiterate, the deceased was found missing on 4.3.06 and his body was traced on 7.3.06 and the complainant came to know about his death only thereafter and the appellant/ opp.party could not prove that the death was intended to cause an act of felony from their own commencement or sometime half way through. Therefore we are of the considered view that it is reasonable to hold that this murder in question is more an accident technically so called than murder pure and simple. Hence the repudiation of the opp.party on the ground that this murder is not an âaccident is unjustified.
We rely on the judgement of High Court of Andhra Pradesh in Writ Petition No. 9516 and 9933 of 2007 wherein they relied on the judgement in THE CENTRAL BANK OF INDIA LTD. AMRITSAR v. THE HARTFORD FIRE INSURANCE CO.LTD. wherein it was held at para 11 as follows:
â Then it was said that what is called contra proferentem rule should be applied and as the policy was in a standard form contract prepared by the insurer alone, it would be interpreted in a way that would be favourable to the assured. It is well known however that the rule has no application where there is no ambiguity in the words in the standard form contract: London and Lancashire Fire Insurance Co. Ltd. v. Bolands, 1924 AC 836 at p. 848. We have already stated that the words in cl.10 give rise to no doubt as to their meaning . There is, therefore, no scope for applying that rule hereâ
Having regard to the facts and circumstances of the case and having regard to the fact that cause of the death is only because of the accident but not due to premeditated motive, therefore, repudiation by the Insurance Company, in our view is unjust and improper as per the dicta laid down in Smt.Manda Savarna v. The Branch Manager, L.I.C. of India and Another wherein it was held that the cause of the injury was accidental in the sense that the injury was and unforeseen and unexpected. â
Now we address ourselves to the contention of the learned counsel for the appellant/opp.party that the Dist. Forum. erred in awarding boarding charges for 3 years since the complainant did not prove that he was staying in a hostel. The complainant filed student I.D card and moreover there is no such condition in the policy which states that the student should submit the receipts of payment of hostel charges and only then the amount would be reimbursed. In the absence of any precondition in the terms of the policy, the appellant cannot raise such a ground justifying their non settling of the claim. To reiterate, no such clause has been brought to our notice and hence stating that these two benefits are in the nature of reimbursement, is unsustainable. Hence we see no grounds to interfere with order of the Dist. Forum.
In the result this appeal is dismissed without costs. Time for compliance six weeks.