The apex consumer body, the National Consumer Disputes Redressal Commission (National Commission), while hearing an appeal filed against the order of the Maharashtra State Consumer Disputes Redressal Commission (State Commission), has recently held in Royal Sundaram Alliance Insurance Co Ltd v Pawan Balram Mulchandani[] that murder of an Insured is to be treated as an accident under a personal accident policy, unless expressly excluded and/or caused as a result of the Insured's own deliberate acts.
The National Commission's ruling was in relation to an accidental death claim raised by the deceased Insured's son in 2009. The Insured was murdered in relation to a property dispute, while returning from his place of work. The respondent filed a death claim with the Insurer under the personal accident policy, but it was repudiated on the ground that the death was not due to an "accident", but was a case of a "murder simplicitor". The respondent filed a complaint before the State Commission which directed the Insurer to pay the sum assured of ₹2,000,000, along with accrued interest.
This order of the State Commission was the subject matter of challenge in the present appeal.
Before the National Commission, the Insurer primarily raised 3 contentions:
- Since the culprits had intentionally murdered the Insured, it was a case of murder, which did not fall within the scope of the policy;
- That the complaint was filed after considerable delay of 2 years, and was hence barred by limitation under the Consumer Protection Act 1986; and
- That where the dominant intention of the act of felony was to kill any particular person, then such killing was a murder simplicitor, and not an accidental murder.
Scope of the term "Accident":
The National Commission first considered whether the murder was to be considered under the definition of "accident", and subsequently, whether the Insurer's repudiation of the claim was valid. In this regard, the National Commission referred to the UK Court of Appeal's judgment in Nisbet v Rayne and Burn[], where when a cashier was robbed and murdered, it was held that murder was an accident from the stand point of the person who suffered from it. The National Commission noted that the death of the Insured took place due to injuries caused by external, violent, visible means, and did not find any evidence suggesting that the Insured put himself to risk of injury by either an immediate wilful deliberate act or carelessness or instigation or aggression.
The National Commission thus reached the conclusion that in case the immediate cause of injury was not the result of any deliberate or wilful act of the Insured and the incident was not expected on the part of the Insured, the murder was to be considered an "accident".
The National Commission also examined the exclusions under the policy and noted that while the policy contained exclusions for "intentional self injury, suicide or attempted suicide" and "war, rebellion, revolution, insurrection, mutiny, military or usurped power", none of the policy exclusions were applicable in the present facts and circumstances of the case. Since the insurance policy did not explicitly state that the Insurer would not be liable for death caused due to the act of murder, the National Commission was of the view that the Insurer's claim repudiation was unjustified.
Statute of Limitation:
The claim was repudiated on 26th May 2009 and the respondent's complaint before the District Forum was disposed of on 5th August 2011 on the ground of territorial jurisdiction. The National Commission noted that since the limitation period under the Consumer Protection Act was 2 years, and the respondent's right to approach an appropriate forum remained unaffected, the objections on limitation and territorial jurisdiction were erroneous and lacked merit.
Other Issues Considered:
The National Commission also applied the doctrine of "Contra Proferentum"[], noting that the Insurer had left gaps and ambiguity in the policy terms and conditions, and held that in case of ambiguities in adhesion contracts such as an insurance policy, the interpretation is to be done in favour of the Insured. The Commission also held Insurer's actions repudiating the claim per its own interpretation, to be tantamount to unfair trade practice. The Insurer was directed to discontinue its unfair trade practice immediately, unless such claims were expressly excluded and specified to be excluded in its policy terms and conditions.
The Commission directed the Insurer's CEO to file a report-in-compliance before it within a period of 3 months, and noting the difficulty caused to the Insured's family, the Commission further awarded an additional compensation of ₹2,00,000 to the respondent.
On the basis of the foregoing, the National Commission held that an act of the murder must be treated as an accidental death if the same is not the result of any deliberate act of the Insured himself. Consequently, the Insurer's appeal was dismissed, and the State Commission's order was upheld by the apex consumer body.
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  First Appeal No 1357 of 2016 pronounced on 25 September 2018.
   2 KBD 689.
  Latin term which means "interpretation against the draftsman".
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