Proximate nexus between the accident and the body injury is a must for accident claim in insurance matters

Death due to sun stroke during election duty will not come under the scope of the clause “death only resulting solely and directly from accident caused by external violent and any other visible means” said SC, confirming its earlier decision in the matter of Alka Shukla V/S LIC (2019)SC. 

  Dr Prem Lata, Legal Head VOICE 

A proximate causal relationship between the accident and the physical injury is required, according to the principle established on the subject. The rule of thumb for interpreting insurance contracts is to give the clauses a straightforward reading.

National Insurance Company Ltd. versus Chief Electoral Officer & Ors. Civil Appeal No.4769 of 2022; February 08, 2023

Facts leading to dispute  

The Chief Electoral Officer, Bihar, Patna, entered into a Memorandum of Understanding on 09.02.2000 to provide insurance cover to the persons deployed for election related work for Bihar Legislative Assembly Elections in the year 2000 vide letter dated 10.02.2000. Subsequently the duration of the insurance scheme was extended from 24.05.2000 to 23.06.2000 by way of a supplementary policy keeping in mind the period of the by-polls.

Clause 3 in MOU, the claim compensation is as hereunder 

 “The insurance is intended to provide for the payment of compensation in the event of death only resulting solely and directly from accident caused by external violent and any other visible means.”

Deval Ravidas, Constable, Shivhar District Force, was a member of the Static Armed Force, posted at Booth no.67, Primary School, Mathura Sultanpur, Police Station Bidupur, District Vaishali, who died due to a sun stroke/heat stroke while performing election duty for the Bihar Legislative Assembly. This happened during the extended period of the insurance policy. 

After a long period of time, the late Constable Deval’s wife finally brought up the subject of compensation in a letter dated November 21, 2008.

After filing of this writ, The Assistant Election Officer wrote a letter dated 20.11.2009 addressed to the Under Secretary to the Lokayukta, Patna, Bihar, stating that the death of the deceased Constable occurred on account of heat stroke on 26.05.2000 during election duty and had not occurred on account of any external violent activity/accident. Thus, compensation to the wife deceased Constable Deval could not be found admissible for payment.

Writ Petition before High court  

Wife of Deval in Writ Petition, before the High Court of Patna prayed for quashing the above letter and sought payment of compensation amount of Rs.10 lakhs as per the insurance policy since her husband had died while performing election duty. On direction from Single judge the District Election Officer placed a notice of claim dated 24.04.2011 to the insurance company regarding the claim for insurance. 

Insurance company rejected the claim 

The learned Single Judge in the Writ Petition, CWJC No.1781/2011 then decided not to go into the issue whether the accidental death was in terms of the policy because the Chief Electoral Officer in an affidavit had already acknowledged the eligibility for payment to the wife of the deceased police official. Relying upon that admission and also in view of the facts that the claim was required to be lodged within the duration of the policy, i.e., 24.05.2000 to 23.06.2000. The Court opined that the primary responsibility to raise the claim under the policy was with the officials of the State Government and that they did not raise the claim within the duration of the policy and permitted the policy to lapse. Therefore, the liability to pay the amount to the deceased wife was assigned to the Chief Electoral Officer and the District Magistrate, Vaishali.

It was stated by the Chief Electoral Officer that the family of deceased had already been paid during the pendency of writ but the Chief Election Officer preferred appeal against the order of single judge to the Division bench with a plea that insurance company cannot escape from the liability of paying compensation merely because they were late in filing claim. It was said that the election officer was an agent for the purpose of forwarding premium payment to insurance and secondly accident occurred during the tenure of existing policy. Division bench agreed to the point that the incident took place during the policy period, hence liability lies with the insurance company.

Insurance company now comes in appeal before SC

There were two issues before the Supreme Court 

  1. Consequences of delay in filing claim after about seven and a half years  
  2. Whether insurance was covered for ‘accidental death’ under the present facts and situation    

After carefully weighing all the relevant information, previously decided cases, and insurance law, the Supreme Court determined that

  • Admittedly claim was beyond the reasonable time and was not admissible

On the question of liability of Insurance company on merits of the case, it is held that “proximate causal relationship between the accident and the body injury is a necessity as per the definition of Accident Death due to sun stroke during election duty will not come under the scope of the clause “death only resulting solely and directly from accident caused by external violent and any other visible means.” Hence Insurance was not found liable on both the counts.

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