Others v. Oriental Insurance Company Ltd. & Ors.)

2. Petition has been filed challenging judgment and order dated 18.01.2014 passed by Permanent Lok Adalat, Lucknow in PLA Case No.24 of 2013 (Smt. Guddi Devi And 6 Others versus Oriental Insurance Company Ltd. & Ors.).

3. It has been submitted that an agreement dated 19.11.2009 had been entered into between petitioner company and the State of U.P. to cover risk of accidental death of registered farmers owing agricultural land and being in the age group of 12 year's to 70 year's. The said policy was effected for one year from 19.11.2009.

4. It is submitted that in pursuance of the said agreement, the opposite parties filed their claim seeking compensation on account of death of the farmer, who is the predecessor-in-interest of the claimants/ opposite parties.

5. In the impugned judgment, Permanent Lok Adalat has framed three issues with issue no.1 pertaining to whether the insured and her heirs would be covered by the policy and issued no.2 pertaining to validity of rejection of claim. Issue no.3 pertained to relief which could be granted.

6. The claim has been rejected on the ground that deceased died due to his own negligence while crossing a railway track.

7. On the basis of instructions, learned counsel for petitioner does not press the findings recorded in impugned judgment pertaining to jurisdiction of Permanent Lok Adalat of the issue of delay and submits that the dispute in question has already been adjudicated upon by Coordinate Bench of this Court in the case of Oriental Insurance Company Ltd. Versus Abhishek Kumar & Ors.; Writ C No.1000840 of 2015 & other connected matters, which may be followed in the present case.

8. Learned counsel for opposite parties also on the basis of instructions admits that the present petition is squarely covered by the aforesaid judgment and order dated 29.07.2022 in the case of Abhishek Kumar (supra).

9. The impugned judgment while deciding issues no.1 & 2 has been recorded a finding that the deceased and her heirs were otherwise covered under agreement dated 19.11.2009. It also indicates submission of claimants that death has occasioned due to deceased falling off the plaint while Insurance Company has repudiated the claim on the ground of negligence of deceased while crossing the railway track. The impugned judgment has thereafter referred to exclusion clause of the agreement to record a finding that even admitting the case of Insurance Company, death occasion due such an event does not come within the exclusion clause. It also refers to clause 24 of the agreement that in such cases, Insurance Company was at liberty to have conducted an independent inquiry, which he failed to do. It has also adverted to two conditions of the clause of agreement that the claim shall not be repudiated on any technical ground as contemplated under Clause 24 of the agreement.

10. The aforesaid aspects have already been considered in the Coordinate Bench Judgement of this Court in the case of Abhishek Kumar (supra) in the following manner: "4. It is further submitted that the petitioner-Insurance Company had acted on the basis of Clause 4 of the Agreement which is quoted hereunder for ready reference:- "Scope of Cover:- Oriental Insurance Company Limited hereby agrees, subject to the terms, conditions and exclusions contained or otherwise expressed in the policy document, to pay to the insured a sum not exceeding the sum insured during the tenure of the policy, if any of the insured Person dies due to or suffers disability as mentioned in the benefit table due to sustaining any bodily injury resulting from accident, caused by external, violent and visible means, to the extent and in the manner hereinafter provided. The accident will included death due to snake bite, drowning in River, Tank, Pond or well, collapse of roof or falling of tree, falling from roof or tree, vehicle (including tractor/trolley and tempo) accident, dacoity, riot, scufÒe. Enmity, violence, terrorist activities, fire, flood, lightning thunder & electric shock etc. Necessary documents will be required to establish the cause of death. The following documents will be required to be produced to Oriental Insurance Company Limited for claim processing. (1) Fully complete claim Form (2) Computerized Khatauni (3) Age proof in following order of priority- (a) Matriculation Certificate/High School Certificate (b)Parivar Register (c) Ration Card (d) Voter ID card/Voter List (e) Any other age proof (4) Post Mortem Report (5) Copy of FIR/GD (in case of death due to snake bite) (6) Death Certificate (7) Police panchnama (8) CMO Certificate in cases of disability Postmortem report will not be insisted upon where body is irrecoverable, say due to flood or body is in such a shape after accident the post mortem is not possible. Also in case of drowning and snakebite, FSL/CA report will not be insisted upon to establish the cause of death. Disablement, to the extent mentioned in the benefit table, caused due to an accident defined above, shall be covered. The Policy covers accidental death and disability/arising out of an accident only as elaborated in the policy document."

11. After hearing learned counsel for the respective parties and going through the record, the position which emerges out is that the Agreement has been entered into between the State of UP and the petitioner-Insurance Company on 19.11.2009 with an object to insure the farmers of Uttar Pradesh for Rs. 1 lakh aged between 12 to 70 years whose names were in the revenue records of the State of Uttar Pradesh as the owner of the agricultural land under the Janta Personal Accident Policy.

13. Similarly, Clause 17 of the Agreement deals with exclusion, where the petitioner-Insurance Company shall not be liable under this policy. The Clause 17 is reproduced hereunder for ready reference:- "17. Exclusions: Oriental Insurance Company Limited shall not be liable under this Policy for:- (i) Compensation under more than one of the categories specified in the Basis of Assessment of the JPA Policy document in respect of the same period of disablement of the Insured Person under this Policy. (ii) Any other payment to the same person under this policy after a claim under one of the categories I & II as specified in the Basis of Assessment of the JPA policy document of claims he has been admitted and become payable. However, this exclusion shall apply only to this policy and shall in no way affect benefits derived by the Insured Person or his/her legal heir(s) under any other Insurance Policy or Scheme. (iii) Any payment in case if more than one claim in respect of such Insured person, under this policy during any one period of insurance by which the sum payable as per the Basis of Assessment of Claims of this Policy to such insured person exceeds the maximum liability of Oriental Insurance Company Limited as applicable to such insured person. (iv) Payment of compensation in respect of death, injury or disablement (a) From intentional self-injury, suicide or attempted suicide. person. insured (b) Whilst under the influence of intoxication of liquor or psychotropic drugs. (c) Whilst engaging in aviation or ballooning or whilst mounting into, or dismounting form or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. Standard type of aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned or chartered or operated by a regular airline or whether such a aircraft has a single engine or multi engine. (v) Payment of compensation in respect of death, injury of disablement of the Insured Person due to, or arising but of, or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (where war be declared or not) civil war, rebellion, revolution, insurrection, mutiny military or usurped power, seizure, capture arrests, restrains and detainment of all kinds. Payment of compensation in respect of death or bodily injury on any disease or illness to the Insured Persons:- (a) Directly or indirectly caused by or contributed to by or arising from ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self sustaining process of nuclear fission. (b) Directly or indirectly caused by or contributed to by or arising from nuclear weapon materials. (vi) Death or disablement directly or indirectly caused by an/or contributed to and/or aggravated or prolonged by child birth or pregnancy or in consequence thereof. (vii) Payment of compensation in respect of injury or disablement directly or indirectly arising out of or contributed by or traceable to any disability existing on the date of issue of this policy."

14. Clause 24 of the Agreement provides that, the claim shall not be rejected or repudiated on mere technicalities. The said clause 24 of the agreement is quoted hereunder:- "This Agreement shall be implemented by following a procedure so that the claims are accepted as a rule and are rejected as an exception, in case the farmer dies of accidental death and when this fact comes in the knowledge of Oriental Insurance Company Limited as per this Agreement, and if there is nay shortcoming or deficiency in the documents filed, the Oriental Insurance Company Limited would itself make an inspection for confirming the cause of death and shall make the payment accordingly. The claims shall not be rejected or repudiated on mere technicalities." "15. From the conjoint reading of the aforesaid clauses of the agreement, the position which emerges out is that by not providing the computerized khatauni will not take away the right of the claimants to get insurance amount as per the agreement. More particularly, in the present case, there is a specific finding regarding non providing of the computerized khatauni as the letter of the Board of Revenue dated 30.06.2010, wherein it has been informed that the consolidation proceedings were going on and computerized Khatauni could not be provided. The said findings have neither been disputed in the pleadings of the writ petitions nor urged as erroneous.

16. The genuineness of the khatauni on the record as provided by the private respondents under Clause 2 of the agreement had never been disputed. In the above circumstances, rejection of the claim would only be a technicality, which is not to be resorted to while dealing with such claims as in hand. Non furnishing of computerized Khautauni alone will not come in the way of the claim of farmers claimants, as this would be against the spirit of the beneficial agreement and reading of Clause 4 with other clauses of the agreement."

11. Upon consideration of impugned judgment and alongwith judgment rendered in the case of Abhishek Kumar (supra), it is evident that even as per the story set up by Insurance Company, the claim would not come within the exclusion clause indicated in Clause 17 of the agreement particularly keeping in view Clause 24 of the agreement which stipulates that claim as stand on the rejected on mere technicalities. In terms of Clause 16 of the agreement, it had been open to the Insurance Company to conduct its forged inspection or inquiry, which he failed to do and therefore no benefit can accrue to it therefrom.

12. In view thereof, this Court does not find any occasion to interfere with the impugned judgment on that score.

13. After recorded a finding with regard to the aforesaid clauses, the compensation awarded has thereafter been reduced on the following proposition: "18. In view of the discussions made above, it is found that there is no illegality and perversity in the impugned judgments passed by the Permanent Lok Adalat as far as accepting the insurance claims of the private respondents and hence, no interference is called for in the judgments impugned.

19. From the above discussion made hereinabove, the position with regard to the applicability of Clause 22(b) of the Agreement which emerges out is that as per Clause 4 of the agreement, the computerized khatauni was required for the purpose of the claim and hence it cannot be said that rejection of claim on the said ground is wholly illegal. As the judgments relied by the learned counsel for the petitioner with regard to the quantifying the penalty by this Court in Writ Petition Nos.20736 of (M/S) 2018 and 5324 of (M/S) 2015, this Court has held that the penalty imposed as per Clause 22(b) of the Agreement is exorbitant and quantified the amount of penalty as Rs.50,000/- and 75,000/- respectively.

20. This Court having regard to the facts and circumstances of the case as well as the resultant delay would quantify the amount of penalty at Rs. 75,000/- and to this extent, the impugned judgments are modified. The amount of Rs.1 Lakh along with interest @9% per annum from the date of the order of the Permanent Lok Adalat as well as the amount of penalty of Rs.75,000/- to be deposited before the Permanent Lok Adalat within a period of six weeks and shall be released in favour of the opposite parties forthwith after due verification of their identities. If any amount was deposited earlier that shall be adjusted against the total amount to be paid by the petitioner- Insurance company in pursuance of the order passed today."

14. This Court does not find any occasion to take a view divergent from that already recorded in the case of Abhishek Kumar (supra). Considering aforesaid discussion,

15. impugned judgment and order is modified in terms of paragraph 20 of the judgment and order dated 29.07.2022 passed in the case of Abhishek Kumar (supra).

16. Opposite parties are directed to ensure payment to claimants within a period of four weeks from the date a certified copy of this order is served upon concerned authority.

17. The petition is therefore disposed of in the manner indicated hereinabove. Order Date :- 3.3.2025 Subodh/- SUBODH KUMAR SINGH SUBODH KUMAR SINGH SUBODH KUMAR SINGH High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, Lucknow Bench Lucknow Bench Lucknow Bench

2. Petition has been filed challenging judgment and order dated 18.01.2014 passed by Permanent Lok Adalat, Lucknow in PLA Case No.24 of 2013 (Smt. Guddi Devi And 6 Others versus Oriental Insurance Company Ltd. & Ors.).

3. It has been submitted that an agreement dated 19.11.2009 had been entered into between petitioner company and the State of U.P. to cover risk of accidental death of registered farmers owing agricultural land and being in the age group of 12 year's to 70 year's. The said policy was effected for one year from 19.11.2009.

4. It is submitted that in pursuance of the said agreement, the opposite parties filed their claim seeking compensation on account of death of the farmer, who is the predecessor-in-interest of the claimants/ opposite parties.

5. In the impugned judgment, Permanent Lok Adalat has framed three issues with issue no.1 pertaining to whether the insured and her heirs would be covered by the policy and issued no.2 pertaining to validity of rejection of claim. Issue no.3 pertained to relief which could be granted.

6. The claim has been rejected on the ground that deceased died due to his own negligence while crossing a railway track.

7. On the basis of instructions, learned counsel for petitioner does not press the findings recorded in impugned judgment pertaining to jurisdiction of Permanent Lok Adalat of the issue of delay and submits that the dispute in question has already been adjudicated upon by Coordinate Bench of this Court in the case of Oriental Insurance Company Ltd. Versus Abhishek Kumar & Ors.; Writ C No.1000840 of 2015 & other connected matters, which may be followed in the present case.

8. Learned counsel for opposite parties also on the basis of instructions admits that the present petition is squarely covered by the aforesaid judgment and order dated 29.07.2022 in the case of Abhishek Kumar (supra).

9. The impugned judgment while deciding issues no.1 & 2 has been recorded a finding that the deceased and her heirs were otherwise covered under agreement dated 19.11.2009. It also indicates submission of claimants that death has occasioned due to deceased falling off the plaint while Insurance Company has repudiated the claim on the ground of negligence of deceased while crossing the railway track. The impugned judgment has thereafter referred to exclusion clause of the agreement to record a finding that even admitting the case of Insurance Company, death occasion due such an event does not come within the exclusion clause. It also refers to clause 24 of the agreement that in such cases, Insurance Company was at liberty to have conducted an independent inquiry, which he failed to do. It has also adverted to two conditions of the clause of agreement that the claim shall not be repudiated on any technical ground as contemplated under Clause 24 of the agreement.

10. The aforesaid aspects have already been considered in the Coordinate Bench Judgement of this Court in the case of Abhishek Kumar (supra) in the following manner: "4. It is further submitted that the petitioner-Insurance Company had acted on the basis of Clause 4 of the Agreement which is quoted hereunder for ready reference:- "Scope of Cover:- Oriental Insurance Company Limited hereby agrees, subject to the terms, conditions and exclusions contained or otherwise expressed in the policy document, to pay to the insured a sum not exceeding the sum insured during the tenure of the policy, if any of the insured Person dies due to or suffers disability as mentioned in the benefit table due to sustaining any bodily injury resulting from accident, caused by external, violent and visible means, to the extent and in the manner hereinafter provided. The accident will included death due to snake bite, drowning in River, Tank, Pond or well, collapse of roof or falling of tree, falling from roof or tree, vehicle (including tractor/trolley and tempo) accident, dacoity, riot, scufÒe. Enmity, violence, terrorist activities, fire, flood, lightning thunder & electric shock etc. Necessary documents will be required to establish the cause of death. The following documents will be required to be produced to Oriental Insurance Company Limited for claim processing. (1) Fully complete claim Form (2) Computerized Khatauni (3) Age proof in following order of priority- (a) Matriculation Certificate/High School Certificate (b)Parivar Register (c) Ration Card (d) Voter ID card/Voter List (e) Any other age proof (4) Post Mortem Report (5) Copy of FIR/GD (in case of death due to snake bite) (6) Death Certificate (7) Police panchnama (8) CMO Certificate in cases of disability Postmortem report will not be insisted upon where body is irrecoverable, say due to flood or body is in such a shape after accident the post mortem is not possible. Also in case of drowning and snakebite, FSL/CA report will not be insisted upon to establish the cause of death. Disablement, to the extent mentioned in the benefit table, caused due to an accident defined above, shall be covered. The Policy covers accidental death and disability/arising out of an accident only as elaborated in the policy document."

11. After hearing learned counsel for the respective parties and going through the record, the position which emerges out is that the Agreement has been entered into between the State of UP and the petitioner-Insurance Company on 19.11.2009 with an object to insure the farmers of Uttar Pradesh for Rs. 1 lakh aged between 12 to 70 years whose names were in the revenue records of the State of Uttar Pradesh as the owner of the agricultural land under the Janta Personal Accident Policy.

13. Similarly, Clause 17 of the Agreement deals with exclusion, where the petitioner-Insurance Company shall not be liable under this policy. The Clause 17 is reproduced hereunder for ready reference:- "17. Exclusions: Oriental Insurance Company Limited shall not be liable under this Policy for:- (i) Compensation under more than one of the categories specified in the Basis of Assessment of the JPA Policy document in respect of the same period of disablement of the Insured Person under this Policy. (ii) Any other payment to the same person under this policy after a claim under one of the categories I & II as specified in the Basis of Assessment of the JPA policy document of claims he has been admitted and become payable. However, this exclusion shall apply only to this policy and shall in no way affect benefits derived by the Insured Person or his/her legal heir(s) under any other Insurance Policy or Scheme. (iii) Any payment in case if more than one claim in respect of such Insured person, under this policy during any one period of insurance by which the sum payable as per the Basis of Assessment of Claims of this Policy to such insured person exceeds the maximum liability of Oriental Insurance Company Limited as applicable to such insured person. (iv) Payment of compensation in respect of death, injury or disablement (a) From intentional self-injury, suicide or attempted suicide. person. insured (b) Whilst under the influence of intoxication of liquor or psychotropic drugs. (c) Whilst engaging in aviation or ballooning or whilst mounting into, or dismounting form or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. Standard type of aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned or chartered or operated by a regular airline or whether such a aircraft has a single engine or multi engine. (v) Payment of compensation in respect of death, injury of disablement of the Insured Person due to, or arising but of, or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (where war be declared or not) civil war, rebellion, revolution, insurrection, mutiny military or usurped power, seizure, capture arrests, restrains and detainment of all kinds. Payment of compensation in respect of death or bodily injury on any disease or illness to the Insured Persons:- (a) Directly or indirectly caused by or contributed to by or arising from ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self sustaining process of nuclear fission. (b) Directly or indirectly caused by or contributed to by or arising from nuclear weapon materials. (vi) Death or disablement directly or indirectly caused by an/or contributed to and/or aggravated or prolonged by child birth or pregnancy or in consequence thereof. (vii) Payment of compensation in respect of injury or disablement directly or indirectly arising out of or contributed by or traceable to any disability existing on the date of issue of this policy."

14. Clause 24 of the Agreement provides that, the claim shall not be rejected or repudiated on mere technicalities. The said clause 24 of the agreement is quoted hereunder:- "This Agreement shall be implemented by following a procedure so that the claims are accepted as a rule and are rejected as an exception, in case the farmer dies of accidental death and when this fact comes in the knowledge of Oriental Insurance Company Limited as per this Agreement, and if there is nay shortcoming or deficiency in the documents filed, the Oriental Insurance Company Limited would itself make an inspection for confirming the cause of death and shall make the payment accordingly. The claims shall not be rejected or repudiated on mere technicalities." "15. From the conjoint reading of the aforesaid clauses of the agreement, the position which emerges out is that by not providing the computerized khatauni will not take away the right of the claimants to get insurance amount as per the agreement. More particularly, in the present case, there is a specific finding regarding non providing of the computerized khatauni as the letter of the Board of Revenue dated 30.06.2010, wherein it has been informed that the consolidation proceedings were going on and computerized Khatauni could not be provided. The said findings have neither been disputed in the pleadings of the writ petitions nor urged as erroneous.

16. The genuineness of the khatauni on the record as provided by the private respondents under Clause 2 of the agreement had never been disputed. In the above circumstances, rejection of the claim would only be a technicality, which is not to be resorted to while dealing with such claims as in hand. Non furnishing of computerized Khautauni alone will not come in the way of the claim of farmers claimants, as this would be against the spirit of the beneficial agreement and reading of Clause 4 with other clauses of the agreement."

11. Upon consideration of impugned judgment and alongwith judgment rendered in the case of Abhishek Kumar (supra), it is evident that even as per the story set up by Insurance Company, the claim would not come within the exclusion clause indicated in Clause 17 of the agreement particularly keeping in view Clause 24 of the agreement which stipulates that claim as stand on the rejected on mere technicalities. In terms of Clause 16 of the agreement, it had been open to the Insurance Company to conduct its forged inspection or inquiry, which he failed to do and therefore no benefit can accrue to it therefrom.

12. In view thereof, this Court does not find any occasion to interfere with the impugned judgment on that score.

13. After recorded a finding with regard to the aforesaid clauses, the compensation awarded has thereafter been reduced on the following proposition: "18. In view of the discussions made above, it is found that there is no illegality and perversity in the impugned judgments passed by the Permanent Lok Adalat as far as accepting the insurance claims of the private respondents and hence, no interference is called for in the judgments impugned.

19. From the above discussion made hereinabove, the position with regard to the applicability of Clause 22(b) of the Agreement which emerges out is that as per Clause 4 of the agreement, the computerized khatauni was required for the purpose of the claim and hence it cannot be said that rejection of claim on the said ground is wholly illegal. As the judgments relied by the learned counsel for the petitioner with regard to the quantifying the penalty by this Court in Writ Petition Nos.20736 of (M/S) 2018 and 5324 of (M/S) 2015, this Court has held that the penalty imposed as per Clause 22(b) of the Agreement is exorbitant and quantified the amount of penalty as Rs.50,000/- and 75,000/- respectively.

20. This Court having regard to the facts and circumstances of the case as well as the resultant delay would quantify the amount of penalty at Rs. 75,000/- and to this extent, the impugned judgments are modified. The amount of Rs.1 Lakh along with interest @9% per annum from the date of the order of the Permanent Lok Adalat as well as the amount of penalty of Rs.75,000/- to be deposited before the Permanent Lok Adalat within a period of six weeks and shall be released in favour of the opposite parties forthwith after due verification of their identities. If any amount was deposited earlier that shall be adjusted against the total amount to be paid by the petitioner- Insurance company in pursuance of the order passed today."

14. This Court does not find any occasion to take a view divergent from that already recorded in the case of Abhishek Kumar (supra). Considering aforesaid discussion,

15. impugned judgment and order is modified in terms of paragraph 20 of the judgment and order dated 29.07.2022 passed in the case of Abhishek Kumar (supra).

16. Opposite parties are directed to ensure payment to claimants within a period of four weeks from the date a certified copy of this order is served upon concerned authority.

17. The petition is therefore disposed of in the manner indicated hereinabove. Order Date :- 3.3.2025 Subodh/- SUBODH KUMAR SINGH SUBODH KUMAR SINGH SUBODH KUMAR SINGH High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, High Court of Judicature at Allahabad, Lucknow Bench Lucknow Bench Lucknow Bench