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Monday, May 9, 2016

Personal Accident Insurance ~ coverage / exclusion of murder ! - Ombudsman decision

Personal Accident Insurance has been in existence for long. This policy offers compensation in case of death or bodily injury to the insured person, directly and solely as a result of an accident, by external, visible and violent means. The policy operates worldwide and is a 24 hours cover. Different coverages are available ranging from a restricted cover of Death only, to a comprehensive cover covering death, permanent disablements and temporary total disablements.  This policy is basically designed to offer some sort of compensation to the insured person who suffers bodily injury solely as a result of an accident which is external, violent and visible. Hence death or injury due to any illness or disease is not covered by the policy.

In a city beset with traffic problems, road accidents are on the increase. People certainly need insurance protection to take care of the contingencies.  Yesterday, in yet another instance of violence targeted at senior citizen in the city, Rohini Premkumari (67), a well-known oncologist, was found murdered at her home in Egmore.  Dr. Rohini was apparently hit on her head with an iron rod, and her hands and legs were tied with a rope; her mouth was closed with a medical tape, according to police officials investigating the case. The victim’s relatives alleged that Dr. Rohini had an argument a few days ago with a contractor who had reportedly overcharged her for refurbishing her basement.  The police is looking in to all probable aspects of the gruesome murder, which has shocked the residents.

Murder is the killing of another human being without justification or valid excuse, and it is especially the unlawful killing of another human being with malice aforethought. This state of mind may, depending upon the jurisdiction, distinguish murder from other forms of unlawful homicide, such as manslaughter. Most societies, from ancient to modern, have considered murder a very serious crime deserving harsh punishment. In most countries, a person convicted of murder is typically given a long prison sentence, possibly a life sentence or when it is very gruesome, death penalty.   

There have been decisions that a murder cannot be treated as an accidental death unless there are facts to show that the perpetrators had no intention of killing the person.  Often the Q (especially in Insurance parlance) has been – is murder an accident ?   By some explanations, the  difference between a 'murder' which is not an accident, and a 'murder' which is an accident depends on the proximity of the cause of such murder.  If the dominant intention of the act of felony is to kill any particular person, then such killing is not an accidental murder but is a murder simpliciter, while if the cause of murder or the act ofmurder was originally not intended and the same was caused in furtherance of any other felonious act then such murder is accidental murder.

A couple of years back, in Sept 2013, neurosurgeon Dr S D Subbiah was murdered in September 2013, it made city headlines for weeks. Times of India Chennai edition dt 8.5.16 reported on its 1st page an article titled ‘Insurers show fineprint, refuses to pay’ stating - what has so far gone unreported is his family's struggle to get an insurance claim.  Here is the article reproduced :

The insurance company with whom the doctor had taken a personal accident policy refused to pay up, citing murder as an exclusion in the fine print. After more than two years of fighting, the surgeon's widow got the insured sum of Rs 10 lakh in November 2015 after the insurance ombudsman ruled in her favour.  On September 14, 2013, Dr Subbiah was hacked outside his workplace, Billroth Hospitals in RA Puram over a land dispute.He died nine days later. While the case dragged on,  the private General Insurance Company  not only refused to pay the insured sum of Rs 10 lakh, it also asked the doctor's wife to pay the insurance premium.

The only solace was that Subbiah had taken another policy, from LIC. "LIC paid the money within15 days," Shanti said. In August 2015 she took up the matter with the insurance ombudsman of India.

The ombudsman observed that the company was acting in contravention of the Insurance Regulatory and Development Authority of India's (IRDAI) rules with its Rs murder exclusion.' The General Insurer  was asked to produce the IRDAI approval for the policy . "It was found they had modified the policy without IRDAI's approval," said outgoing ombudsman Virander Kumar. Since it was a personal accident claim, the insurer tried to repudiate on the grounds that death of the insured was not due to an accident. "Their contention was that the dominant and primary intention of the attackers was to murder the insured and it therefore comes within the ambit of ‘murder simplicitor' which is excluded under clause 4(g) relating to - culpable homicide' of the policy . We told them the above mentioned exclusion clause was removed from current PA policies. However, they refrained from informing the same to the policyholder," said the ombudsman in his report.

While people talk about fineprints in Insurance contracts, have you ever tried to read (if not understand) the conditions on your air ticket – in earlier days, it was on glossy paper,  where eyes would get strained in reading a line or two – now it is more of stating that the conditions are available on web – the same would be the case of many many commercial contracts.

With regards – S. Sampathkumar

9th May 2016.

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