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2013 DIGILAW 431 (KER)

Binoma @ Mini v. State of Kerala, represented by the Secretary, Department of Fisheries

2013-06-03

P.R.RAMACHANDRA MENON

body2013
Judgment : 1. Rejection of the insurance claim preferred by the second respondent, Welfare Fund Board in respect of the demise of the husband of the petitioner, who was a fisherman and a member of the second respondent/Board, is the subject matter of challenge. 2. The husband of the petitioner, by name Asokan, fell down in water while fishing in Kalattotil Cannal and was drowned. A case was registered as Crime No.177/08, as borne by Ext.P3. Ext.P2 is the Death Certificate issued by the competent authority and Ext.P4 is the Post Mortem Certificate as to the cause of death. Ext.P1 is a copy of the pass book issued to the petitioner's husband by the 2nd respondent; being a member of the Board. 3 The case of the petitioner is that, by virtue of Ext.P5 'Memorandum of Understanding' executed among the 2nd respondent Welfare Board, the 3rd respondent Insurance Company and the 4th respondent State Insurance Department, the death of the husband of the petitioner by accident stands covered, in view of the specific entry at serial No.1 of Ext.P5. The claim preferred by the 2nd respondent was considered and it was rejected by the 3rd respondent as per Ext.P7, pointing out that the deceased had fallen into the Kalattotil Cannal while fishing due to 'giddiness', which is caused due to diabetes and that as per the 'MOU', particularly Section 4, death due to heart attack while fishing at sea alone was payable; however, adding that 'drowning due to accident' is payable, but not due to any disease. The outcome was communicated to the petitioner by the 2nd respondent vide Ext.P6 dated 24.02.2011, whereupon the petitioner preferred Ext.P8 representation before the 2nd respondent for taking further steps against the Insurance Company to obtain the due amount of Rs. 1,00,000/-(Rupees one lakh) more so since, there was no privity of contract between the petitioner and the 3rd respondent insurer and it was for the 2nd respondent Welfare Board to pursue the matter, based on the Memorandum of Understanding. As nothing transpired in the positive, the petitioner is before this Court by filing this writ petition. 4. The 4th respondent has filed a counter affidavit simply reproducing the version of the 3rd respondent Insurance Company as given in Ext.P7. As nothing transpired in the positive, the petitioner is before this Court by filing this writ petition. 4. The 4th respondent has filed a counter affidavit simply reproducing the version of the 3rd respondent Insurance Company as given in Ext.P7. The 3rd respondent/Insurer has filed a counter affidavit mainly raising two contentions; that the writ petition is not maintainable for the fact that there is no privity of contract between the petitioner and the Insurance Company and that the 2nd respondent who is a party to Ext.P5 MOU, has not preferred any complaint, appeal, proceeding or writ petition. With regard to the merits, it is pointed out that, as per Ext.P3 FIR, there is a reference to the 'giddiness' because of the diabetes, whereby the petitioner fell into the water, leading to drowning and the death followed. Since it was because of the 'giddiness', that he fell down and got drowned, it was not an accident and hence that the claim is not payable; according to the 3rd respondent. 5. The learned counsel appearing for the 2nd respondent Welfare Board submits that, the 2nd respondent fully supports the case of the petitioner and that the death occurred was only because of an accident while fishing and that this risk is clearly covered by Ext.P5 'MOU'. The learned counsel also submits that, Ext.P5 MOU was executed among the parties concerned, for providing a coverage to the beneficiary/fishermen who mostly belong to the poor sector of the society as a measure of helping hand and as such, a liberal interpretation is to be followed, so as to extend the benefits to the deserving and needy lot concerned. 6. The learned counsel for the petitioner submits that, the reliance sought to be placed on Ext.P3 FIR is not at all correct or proper, as the cause of death has been clearly given/certified by the competent authority in Ext.P4 Post mortem Certificate, as 'drowning'. So far as the factual position is not disputed, as to drowning during the course of fishing, it is very much an 'accident' and the claim ought not to have been rejected by the Insurer. 7. With regard to the question of maintainability, this Court finds that the petitioner or her deceased husband was of course, not a party to the MOU, but is a beneficiary thereunder. 7. With regard to the question of maintainability, this Court finds that the petitioner or her deceased husband was of course, not a party to the MOU, but is a beneficiary thereunder. It is in respect of cases of the persons like the petitioner's deceased husband, that membership has been given by the 2nd respondent Welfare Board as borne by Ext.P1 and an insurance policy has been obtained from the 3rd respondent based on Ext.P5 MOU. If there is any lapse on the part of the 2nd respondent Welfare Board in pursuing the matter, the beneficiary who is seeking for the benefits of Ext.P5 MOU cannot be non-suited stating that he/she is not a party to the MOU. This Court holds that the writ petition is maintainable on this count and the plea raised to the contrary is devoid of any merit. 8. With regard to the merits involved, this Court finds that, Section 1 (Serial No.1) of Ext.P5 MOU is in respect of death due to the accident at 'sea' or 'at land'. The specific word used in the said clause is 'sea' and no reference is there with regard to the drowning elsewhere. In response to the doubt raised by this Court as to whether the drowning occurred in 'Kalattotil Cannal' while fishing by the deceased husband of the petitioner will come within the purview of the said provision (as it was not in the 'sea'), the learned counsel for the petitioner points out that, accidental death occurred 'at land' is also covered, and as such, the question to be considered is whether the death was due to any accident, irrespective of the fact whether it was in the course of fishing at 'sea' or in 'river'. It is furhter pointed out that, there is no such dispute for the Insurance Company as well, and no such plea has been raised in Ext.P7 or in the counter affidavit. This Court finds considerable force in the said submission. Considering the beneficial nature and purpose of the Scheme and further since the 3rd respondent Insurer admits that 'drowning' is also covered (if it is by way of 'accident'), this Court does not find it necessary to go for any further microscopic analysis as to the 'terms' used in respect of the coverage provided. 9. Considering the beneficial nature and purpose of the Scheme and further since the 3rd respondent Insurer admits that 'drowning' is also covered (if it is by way of 'accident'), this Court does not find it necessary to go for any further microscopic analysis as to the 'terms' used in respect of the coverage provided. 9. Coming to the question as to whether the death was due to accident or not, the version of the Insurance Company is that, it was because of 'giddiness' due to diabetes, that the husband of the petitioner fell into the water while fishing and got drowned. The stand taken by the 3rd respondent reveals that, they have rejected the claim because of drowning due to 'giddiness'. The point to be considered is not the 'cause for drowning', but the 'cause for the death'. The 'causes for death' has been clearly certified by the competent authority who conducted the post mortem that, it was only because of drowning. This being the position, the observation/reference in the FIR sent at the commencement of investigation does have only little significance and the matter ought to have been finalized on the basis of the contents of Ext.P4 Post mortem Certificate as to the cause of death. Accordingly, this Court holds and declares that the stand adopted by the Insurance Company that, drowning was because of 'giddiness due to diabetes' and hence not payable (as 'Heart Attack' alone is the disease that is covered) is not correct or sustainable. 10. Item 4 of Ext.P5 'MOU' deals with the particular disease which is covered under the policy. 'Accident' is separately covered under item No: 1. The question is whether it was an 'accident' or not. The very word 'accident' as given in Black's Law Dictionary 9th edition reads as follows: "1. An unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonably anticipated. 2. Equity practice. An unforeseen and injurious occurrence not attributable to the victim's mistake, negligence, neglect or misconduct; an unanticipated and untoward event that causes harm." Even going by the general meaning of the term, 'accident' is something which is not foreseen. The fact that the deceased was pursuing fishing operation stands conceded. 2. Equity practice. An unforeseen and injurious occurrence not attributable to the victim's mistake, negligence, neglect or misconduct; an unanticipated and untoward event that causes harm." Even going by the general meaning of the term, 'accident' is something which is not foreseen. The fact that the deceased was pursuing fishing operation stands conceded. It is in the course of fishing, that he fell down into the water and drowned, which was nothing but an accident, as never intentional or which could have been foreseen in any manner. In so far as there is no case for the respondents that it was because of any contribution from the part of the deceased that he fell into the water, it has necessarily to be treated as an 'accident' and nothing else. 11. The sum and substance is that, by virtue of the accident (irrespective of cause for the accident), the deceased fell into water and bid farewell to this world. This in fact stands covered by Serial No.1 of Ext.P5 MOU. In the said circumstance, this Court holds that the claim put forth by the 2nd respondent Welfare Board in respect of the death due to drowning of the husband of the petitioner ought not have been rejected by the Insurer and the same ought to have been considered, so as to give effect to the object of the Scheme/MOU, taking a pragmatic approach, instead of pursuing a pedantic one. The stand taken by the Insurance Company cannot but be declared as a hyper technical one and is not correct or sustainable under any circumstance. 12. Accordingly, Ext.P7 is set aside. There will be a direction to the 3rd respondent to reconsider the claim preferred by the 2nd respondent Welfare Board on behalf of the deceased husband of the petitioner, treating the case as an 'accident' and take necessary steps to disburse the due amount through the 2nd respondent. The proceedings in this regard shall be finalized at the earliest, at any rate, within 'one month' from the date of receipt of a copy of this judgment. Writ petition is allowed. No cost.