Cause Arising From Sun Stroke Cannot Be Included Within ‘Scope Of Cover’ In Insurance Policy: Supreme Court

The Supreme Court while allowing an appeal filed by the National Insurance Company Ltd. held that a 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.

The Court was dealing with a matter in which the order passed by the Patna High Court was challenged by the appellant i.e., the insurance company.

The two-Judge Bench comprising Justice Sanjay Kishan Kaul and Justice Abhay S. Oka asserted, “A proximate causal relationship between the accident and the body injury is a necessity. … the cause arising from a sun stroke cannot, in our view, be included within the parameters of the ‘Scope of Cover’ in the insurance policy defining when such insurance amount would become payable. … we are of the view that the Appellant insurance company is not liable.”

The Bench observed that the judgment of the Division Bench of the High Court was clearly unsustainable.

“… the order passed by the learned 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”, the Court said.

Advocates Shantha Devi Raman and Garvesh Kabra appeared for the appellant i.e., the insurance company while Advocate Amit Sharma appeared for the respondents.

Facts –

The appellant i.e., the insurance company, and the respondent i.e., Chief Electoral Officer, Bihar, Patna, entered into a Memorandum of Understanding (MoU) to provide insurance cover to the persons deployed for election-related work for Bihar Legislative Assembly Elections in the year 2000. On the MoU being executed, the State Government opted for a Group Insurance Scheme to cover its premium-paying employees, who were appointed for election-related activities.

During such by-poll elections, a Constable was a member of the Static Armed Force who died due to a sun stroke/heat stroke while performing election duty for the Bihar Legislative Assembly. This was during the extended period of the insurance policy. The wife of the deceased Constable sought to raise the issue of compensation. She filed a writ petition before the High Court seeking compensation of Rs.10 lakhs as per the insurance policy since her husband had died while performing election duty.

The liability to pay the amount to the wife was assigned to the Chief Electoral Officer and the District Magistrate. Thereafter, the Chief Electoral Officer, preferred an appeal before the Division Bench of the High Court. The Court held the insurance company liable to pay the insured amount. Hence, the insurance company approached the Apex Court.

The issues dealt with by the Court were -

1. The consequences of delay in claiming the amount from the appellant insurance company;

2. Whether at all the insurance policy covered the scenario of the death of the constable?

The Apex Court while considering the above issues noted, “… it is quite apparent that the admissibility of the claim is in the event of death. … 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.”

The Court further relied upon the case of Alka Shukla v. Life Insurance Corporation of India (2019) 6 SCC 64 and held that an unexpected accident and unforeseen consequence or result from a normal or routine activity may constitute an accident but it would not qualify as “accidental means”.

“The given type of injury may thus, fall within or outside the policy according to the event which led to the death and it is this particular cause which is required to be examined. The accident, thus, per se postulates a mishap or untoward happening, something which is unexpected or unforeseen”, the Court observed.

The Court however said that as the wife of the deceased enjoyed the benefit for so many years, it would not be appropriate to permit the Chief Electoral Officer to recover any amount from her and that aspect should stand closed.

Accordingly, the Court allowed the appeal of the insurance company and set aside the impugned judgment of the High Court.

Cause Title- National Insurance Company Ltd. v. The Chief Electoral Officer & Ors.

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