WP/16558/1999 of Smt K.Nirmala, Vs The Life Insurance Corporation of India, on 30 December 2005

ORDER:

WRIT PETITION No.16558 of 1999

The petitioner’s husband, Sambaiah, obtained L.I.C Policy known as Double BenefitPolicy bearing No.680308142 for a sum of Rs.30,000/-. The Policy was taken on31.07.1992. As per the Policy, if the insured dies due to accident, the L.I.C would beliable to pay additional sum equal to the sum assured under the Policy.

It appears, Sambaiah went to Janakipuram in Warangal District on 21.03.1995.While he was in the Village, he suffered stomach pain and was treated by theRegistered Medical Practitioner (RMP) of the Village. Whatever the cause,Sambaiah developed complications and on 23.03.1995 he breathed his last whileundergoing treatment at Mahatma Gandhi Memorial Hospital, Warangal. A claim forthe sum assured was made by the petitioner before the respondent, who settled theclaim and paid a sum of Rs.30,000/- on 30.03.1996. Additional sum equal to the sumassured was however denied. Aggrieved by the same, the present writ petition isfiled.

The respondent has filed a counter affidavit disputing the claim of the petitioner. It isstated that the petitioner’s husband died of acute cellulites, while undergoingtreatment at the Hospital and the cause of death was determined as abdomen pain.Therefore, the life assured cannot be said to have died of an accident enabling thelegal heirs to claim the double benefit under the Policy. Reliance is placed onCondition 10(b) of the Policy taken by Sambaiah.

Condition 10 deals with accident benefit. Clause (a) of Condition 10 deals with thedisability of the life assured, whereas Clause (b) deals with the death of the lifeassured, and reads as under.

Condition 10(b):

“To pay an additional sum equal to the sum assured under this policy, if theLife Assured shall sustain any bodily injury resulting solely and directly fromthe accident caused by outward violent and visible means and such injuryshall within 90 days of its occurrence solely, directly and independently of allother causes result in the death of the Life Assured.

The Corporation shall not be liable to pay the additional sum referred in (a) or(b) above, if the disability or the death of the Life Assured shall:

i. be caused by intentional self injury, attempted suicide, insanity orimmorality or whilst the Life Assured is under the influence ofintoxicating liquor, drug or narcotic; orimmorality or whilst the Life Assured is under the influence ofintoxicating liquor, drug or narcotic; or

ii. take place as a result of accident while the Life Assured is engaged inaviation or aeronautics in any capacity other than that of a fare-paying, part-paying or non-paying passenger in any air craftwhich is authorized by the relevant regulations to carry suchpassengers and flying between established aerodromes, theLife Assured having at that time no duties on board the aircraftor requiring descent therefrom; oraviation or aeronautics in any capacity other than that of a fare-paying, part-paying or non-paying passenger in any air craftwhich is authorized by the relevant regulations to carry suchpassengers and flying between established aerodromes, theLife Assured having at that time no duties on board the aircraftor requiring descent therefrom; or

iii. be caused by injuries resulting from riots, civil commotion, rebellion,war (whether war be declared or not) invasion, hunting,mountaineering, steeple-chasing or racing of any kind orwar (whether war be declared or not) invasion, hunting,mountaineering, steeple-chasing or racing of any kind or

iv. result from the Life Assured committing any breach of law; or

(v) arise from employment of the Life Assured in the armed forces or militaryservice of any country at war (whether war be declared or not) orfrom being engaged in police duty in any military, naval or policeorganization”.service of any country at war (whether war be declared or not) orfrom being engaged in police duty in any military, naval or policeorganization”.

The above Condition 10(b) is in two parts. The first part stipulates that additionalsum equal to the sum assured shall be payable if the life assured sustains anybodily injury resulting solely or directly from the accident caused by outward violentand visible means. Part 2, which conditions sub clauses (i) to (v), is by way ofexplanation to Part 1, and even if death occurs by otherwise than accident, in suchcircumstances as seen in Part 2 of Condition 10(b), the Corporation shall not beliable to pay the additional sum referred to in Condition 10(a). If the death does notoccur due to violent outward incident and occurs due to any other reason as enumerated in Part 2 of Condition 10(b), L.I.C would not be liable to pay theadditional sum assured. In this case, admittedly, the petitioner died of stomach painand acute cellulites, which presumably resulted in administering injection by theRMP. Therefore, the death of Sambaiah cannot be said to have occurred due tooutward violent incident or accident. In that view of the matter, there cannot be anyinfirmity in the action taken by the respondent in denying additional sum equal to thesum assured to the petitioner on account of death of her husband, Sambaiah.

The Writ Petition is devoid of merits and is accordingly dismissed. No costs.

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(V.V.S.RAO, J)

30.12.2005

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