Death due to sun-stroke during election duty will not come within scope of accident under insurance policy: SC

Death due to sun-stroke during election duty will not come within scope of accident under insurance policy: SC

According to the Supreme Court, the insurance policy's clause that states "death only resulting purely and directly from accident caused by external violent and any other visible means" does not apply to deaths caused by sunstroke that occur while serving as an election official. 

The Supreme Court had to decide whether the widow of the deceased had the right to request insurance coverage under the MoU by referencing the aforementioned paragraph. Following the widow's relief from the Patna High Court, the insurance firm appealed to the Supreme Court. 

A bench of Justices SK Kaul and AS Oka upheld the insurer's appeal and determined that death from sunstroke did not fall under the terms of the policy agreement.

According to the Court, the best way to understand an insurance policy is to read it clearly and strictly. The Alka Shukla v. Life Insurance Corporation Ltd. 2019 precedent was used, which clarified what constitutes a "accidental death" in the context of an insurance policy. 

A "proximate causal relationship between the accident and the body injury is a need," the Court said, citing the prior cases. The significance of reading the insurance policy clearly was also emphasised as a guiding principle.

"On a plain reading itself, leave aside the question of strict interpretation of the clauses, it is quite apparent that the admissibility of the claim is in the event of death. The second part of the same sentence begins with “only”. Thus, 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 therefore finally opined, “If in the aforesaid context, the policy is analysed, 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.”

The court further held, “It was the responsibility of the Respondent No. 1 to file the claim within the time period.”

The court held the following, restating the law regarding the interpretation of insurance policy clauses: 

It is cliché to suggest that the insurance policy's provisions should be read strictly. 

b. Insurance contracts have the characteristics of a special class of contracts with unique features like the highest good faith, insurable interest, indemnity subrogation, contribution, and proximate cause, which are shared by all types of insurances. Additionally, each type of insurance has unique characteristics of its own. 

c. The words used in an insurance contract must be given the utmost weight, and the court cannot add, remove, or substitute any words.

d. Because of the nature of insurance contracts, exceptions cannot be made on the basis of equity, and courts should avoid interfering with the terms of an insurance agreement. 

e. The insured may not seek benefits beyond those specified in the insurance policy. The contract's provisions must be interpreted carefully, without changing its fundamental terms because doing otherwise could harm the parties' respective interests. 

f. An insurance policy's clauses must be read exactly as written. 

g. The insurance contract must be read in its entirety, and all efforts should be made to harmonise its terms. 

H. The fundamental rule should be to read the policy clearly. 

i. A direct causal link between the accident and the body injury is a necessity.

Citation: CIVIL APPEAL No.4769 OF 2022

Read the complete judgment

Appearance of the Advocates:-

For Appellant(s)
Ms. Shantha Devi Raman, Adv.
Mr. Garvesh Kabra, AOR
Mr. Arihant Jain, Adv.

For Respondent(s)
Mr. Amit Sharma, AOR
Mr. Dipesh Sinha, Adv.
Ms. Pallavi Barua, Adv.

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