Complaint No. I.O.(HYD) G -11.40.0043 / 2017-18
Mrs. G. Swarupa VS. SBI General Insurance Company Ltd.
Award No. I.O. (HYD)/A/GI/0004/ 2017-18
Insurance Ombudsman Date of award: 10.08.2017
GROUP PERSONAL ACCIDENT
Sri G. Ramulu, a Savings Bank Account holder of SBI Banswada Branch opted coverage under Master Group Personal Accident policy, taken by the bank with the respondent insurer, and covered for a Capital Sum Insured of Rs. 20 Lacs from 10.01.2015 to 09.01.2016. In a land dispute, he was murdered by his own brother Sri G. Srinivas on 24.11.2015. Smt. G. Swarupa, wife and nominee under the GPA policy, filed claim with the insurer for payment of Personal Accident Benefit. The insurer rejected the claim stating that the murder was premeditated and hence not covered under the policy.
The insurer submitted that on perusal of the claim documents submitted by the complainant, it was observed that the insured person acted as an aggressor and the active aggression of the insured person lead to the incidence and his death ultimately. Hence, the claim of the complainant was repudiated invoking exclusion of the GPA policy. The complainant strongly contended that the intention of the murders was not known to her husband nor he could smell it.
The insurer repudiated the claim under the GPA policy for the death of the insured person invoking the clause which stated that the company shall not be liable “the insured persons actual or attempted commission or willful participation in an illegal act or any violation or attempted violation of the law or resistance to arrest or insured person committing any breach of law with criminal intent. “
The contents in the Charge Sheet and FIR were verified to appreciate the repudiation stand taken by the insurer. In the charge sheet it was mentioned that “. … abused him (accused) in filthy language alleging that he had damaged the pipes in his (deceased) fields and threatened him (accused) with dire consequences and pounced on him (accused) then the accused scuffled with his elder brother Gandla Ramulu… ” This statement in the charge sheet confirms that the deceased insured triggered the incident and abetted the crime. Hence, the insurer is justified in repudiating the claim as per the terms of the policy.