Chandigarh Ombudsman Centre
Case No. GIC / 88 / UII / 11 / O5
Smt. Seema Rani
Vs.
United India Insurance Co. Ltd.
Facts : The complainant’s husband late Sh. Sanjeev Kumar served as a constable in the 27th Battalion PAP Jalandhar Cantt. A Group Personal Accident Insurance Policy for the employees of the said battalion was issued by the branch office, Jalandhar for the period 20.11.03 to 19.11.04. Shri Sanjeev Kumar was killed during the currency of the policy while attempting to pacify two warring factions. His wife / nominee filed the claim through Commandant PAP, which was repudiated on the grounds that as per the FIR report, the death of the insured was not caused in an accident. It was a murder which is not covered under the policy. Hence the claim was not payable.
Findings: The investigator concluded that the insured was murdered after having been beaten and hit with a hammer on the head by four culprits. The dispute between the parties started on some minor pretext in which Sh. Raj Kumar, brother of the insured was thrashed by the accused. The insured happened to be there by chance. When he tried to rescue his brother, he was hit on the head. He succumbed to injuries on the way to hospital. The investigation report confirmed that the insured came on the scene by chance. The legal counsel, however, opined that the claim under personal accident policy is payable only if there is bodily injury solely and directly from an accident. He expressed the view that an accident would include such occurrences as death from fall or collision and there has to be an element of negligence for accepting the liability under the policy. In the instant case, murder was designed and therefore not covered under the policy.
Decision: Held that the insured’s death could not be considered as murder as it was not designed; it was the result of an injury which was violent, external and grave and proved to be fatal. The death was a result of sheer accident. He got killed, but it was not a premeditated or pre-planned murder. The insured had no scores to settle with the culprits. As the deceased was not the object of wrath of the accused, it would be perverse to conclude that it was a premeditated murder. He was hit accidentally and the resultant injury proved fatal. Held that the insurer had erred in disowning liability and the claim was payable.
