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2011 DIGILAW 43 (PNJ)

Bajaj Allianz General Insurance Company Limited, Pune v. Himanshu Gupta

2011-01-05

RANJIT SINGH

body2011
Mr. Ranjit Singh, J.:- Bajaj Allianz General Insurance Company Limited has filed this petition to challenge the order passed by permanent Lok Adalat (Public Utility Service), Union Territory, Chandigarh. The Lok Adalat has allowed the claim of Dr. Himanshu Gupta (respondent No.1), directing the petitioners to make a payment of insurance claim of Rs.50,000/- on account of death of his father. 2. Subhash Chand Garg (father of respondent No.1) had got two telephone connections bearing numbers 2566531 and 2791107. One telephone was installed at his residence whereas the second one was installed at the shop. Bharat Sanchar Nigam Limited (hereinafter referred to as “BSNL) had offered a free insurance coverage scheme to the tune of Rs.50,000/- for each telephone connection to its subscribers in case of accidental death or due to injury, leaving permanent disability due to accident. This offer was given due publicity in the newspapers as well as through intimation to each of the subscriber. Father of respondent No.1 died on 18.1.2008 due to bodily injuries sustained by him in an accident, which took place on 22.12.2007. Respondent No.1 preferred insurance claim due to the policy referred to above from the petitioners. The petitioners honoured the claim and paid a sum of Rs.50,000/- in respect of telephone connection No.2791107 but declined to release the claim in respect of second telephone connection No.2566531. Respondent No.1 accordingly had approached the permanent Lok Adalat at Chandigarh on 5.2.2009. The Insurance Company contested the claim by filing written statement but Permanent Lok Adalat has allowed the claim and has held insurance Company liable for payment of Rs.50,000/- alongwith costs of Rs.1,000/-. The petitioner-Insurance Company has accordingly challenged this order through the present writ petition. 3. Learned counsel for the petitioners has made reference to the policy and would submit that the insurance was for an event and was to cover the death taking place due to those bodily injuries or leaving permanent total disability. The counsel for the petitioners contends that the accident took place on 27.12.2007, whereas the agreement was entered into between BSNL and the petitioner- Insurance Company on 10.1.2008. As per the counsel, the event which was insured was any accident and sustaining of bodily injuries and since this was prior to the agreement, the liability to pay the insurance cover has been wrongly fastened to the petitioner- Company. As per the counsel, the event which was insured was any accident and sustaining of bodily injuries and since this was prior to the agreement, the liability to pay the insurance cover has been wrongly fastened to the petitioner- Company. When asked to explain as to why did the Insurance Company pay a claim in respect of second telephone, the counsel could only answer that this was due to a mistake. 4. On the other hand, counsel appearing for the respondents would say that the policy was to apply to all the existing subscribers and since the death was during the time when the policy was in operation, the claim of respondent No.1 was rightly allowed by the Lok Adalat. 5. I have considered the rival submissions made before me. No doubt, the accident in this case was prior to the date of the agreement between the petitioner-Insurance Company and B.S.N.L but the death took place, when the policy was fully in operation and applicable to all the subscribers, including late father of respondent No.1. Reference made by counsel for the petitioners to paragraph 1.1 of the policy talks about injuries sustained by the insured during the policy period but payment is regulated under the coverage part as are specified in the schedule. Para 1.1 reads as under:- “1. Insured Event 1.1 In the event of any Accidental Bodily injury sustained by the Insured during the policy period, the Company will make payment under such coverage parts as are specified in the Schedule as being operative.” 6. In my view, the above para of the policy can not be read in isolation, especially so when Para 2.1.1 not only talks about event but regulates the payment if the death of the insured takes place within 12 months of the accidental bodily injury being sustained. This paragraph clearly provides that the Company will pay the sum insured in the event of accidental bodily injury causing the insured death within 12 months of the accidental bodily injury being sustained whereafter this policy shall expire. Paragraph 2.1.1 of the policy is as under:- “2.1 Coverage Part A: Death 2.1.1 The Company will pay the Sum Assured in the event of Accidental Bodily Injury causing the Insured's death within 12 months of the Accidental Bodily Injury being sustained, whereafter this Policy shall expire.” 7. Paragraph 2.1.1 of the policy is as under:- “2.1 Coverage Part A: Death 2.1.1 The Company will pay the Sum Assured in the event of Accidental Bodily Injury causing the Insured's death within 12 months of the Accidental Bodily Injury being sustained, whereafter this Policy shall expire.” 7. Concededly, the late father of respondent No.1 was covered by the policy on the date of his death. From reading of Paragraphs 1.1 and 2.1.1 together, reproduced above, it can be said that sum insured would be payable within 12 months of the accidental bodily injury being sustained. It may be significant to notice that even if injury does not lead to death, then also the insurance claim was payable within 12 months of the accidental bodily injury if it leaves permanent total disability. Since the cause of payment of sum insured is on account of death, which took place when the policy was fully operational in the case of father of respondent No.1, it would not be fair to deny respondent No.1 the benefit of sum insured. Though the sum may be payable for those bodily injury sustained during the policy period but para 2.1.1, reproduced above, would give extended cover, as the sum would still be payable upto 12 months of the accidental bodily injury if the death takes place during the said period. Thus, both the paragraphs have to be read together to consider the liability of the Insurance Company. 8. Permanent Lok Adalat has also made reference to Clause 7.2 of letter dated 10.1.2008, as per which, insurance cover was available to existing subscribers as well. The existing subscribers are those who were subscribers as on 30.11.2007, which were 33738495 in number. B.S.N.L had paid premium @ Rs.2.5875 per connection for these subscribers. Thus, the policy was noticed to have covered the existing subscribers i.e. the subscribers before the date the policy was duly signed on 10.1.2008. There is, thus, no infirmity found in the impugned order, which would call for any interference in exercise of writ jurisdiction. The writ petition is accordingly dismissed.