Death Claim - Gbic.co.in

act. She stated that as per the station master report, which narrated that, a ‘male agedabout 35 years suddenly trespassed and killed near Egattur railway station’, hence, theInsurer has repudiated the claim under policy condition 10(b) iv and no accidentalbenefit is payable for any breach of law. She also stated that they were not surewhether it was an accident or not. She stated that the word ‘sudden’ given by thestation master clearly established that the deceased life assured was crossing withouttaking precautionary act. During the hearing, it was pointed out to the Insurer that fromthe PIR it was clear that the event was an accident. The Forum stated that underRailway act, trespassing was punishable, but in this case the trespasser could not bepunished since, he was already dead. It was also pointed that trespassing ispunishable under Railway act and Insurance policy was silent in this regard. It isevident that Section 147 of the Railway Act is to help the railways in safeguarding theirproperty and in this instance the insurer has not obtained evidence to prove that thelife assured had committed any breach of law as envisaged under the section.In a recent case the Supreme Court also upheld that the crossing of railway track bynegligence has to be treated as an accident and the relevant extract of the casebetween National Insurance Co. Ltd., Vs Swaran Singh & Ors is reproduced “Accidentincludes negligence. It makes no difference that the accident was caused by thenegligence of the assured (as opposed to his intentional act). Thus there is an accidentwhere the assured crosses a railway line without exercising due care and is knockeddown by an approaching train.”It is also worthwhile to note the extract from the ‘Insurance Treatise of Mac Gillivray’-“Insurance companies have always experienced difficulty in defining the risk which theyare prepared to undertake in an accident policy. In a sense every death or injury,unless intentionally inflicted by the assured himself, is accidental in that its time,manner and cause are unforeseen and unexpected, and insurers have sought to definethe risk much more narrowly.”So it is very clear that the Insurer should have considered all the facts from variousangles before repudiating the accident claim. The argument of the higher office namelythe Zonal Office that some ex-gratia was given purely on humanitarian considerationdid not convince this Forum. Actually the facts of the case do warrant payment ofaccident claim and the Insurer should have paid full amount.The Complaint is allowed.Chennai Ombudsman CentreCase No. : IO (CHN)/21.01.2563Smt. B.Zarina BegumVsLife Insurance Corporation of IndiaAward Dated : 27.03.2007Sri Buruhanudeen submitted a proposal for life insurance on 09.07.2003 to City BranchVI of LIC of India, Chennai Division I. The Insurer issued him a policy under theirMoney Back Plan. Sri H.Buruhanudeen had to pay Rs.904/- as the quarterly premiumfor 20 years. The policy lapsed since he did not pay the quarterly premium due October2005. Sri. H.Buruhanudeen died on 28.11.2005 due to Cerebro Vascular Accident,renal failure and Uremia. Smt.B.Zarina Begum, his wife and nominee under the policy,submitted the death claim papers to the Insurer. The Insurer rejected her claim on thegrounds that the policy was in a lapsed condition and also that the life assured hadwithheld material information regarding his health at the time of effecting insurancewith them.