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Judgment
Honourable Mrs. Justice S. Vimala
We pay nothing, if there is no death, or if there is no total permanent disability, or if there is no total loss of vision and loss of limb, is the
contention of the Insurance Company while repudiating the liability to pay compensation to the owner of the vehicle under the Personal Accident
Policy. Whether and to what extent this contention is sustainable is the issue canvassed in this appeal. Normally, it is the owner''s pride and
pleasure to claim that they have purchased a car and also that they are safe because of the policy of insurance. A person, by burning his midnight
oil earns money and purchases the car. If that vehicle is damaged, the coverage of insurance compensates that damage. What if the owner of the
vehicle suffers any injury or dies? whether the loss of his life is covered by insurance or not is the million dollar question. It is a poignant NO. Law
has not made it mandatory to insure the life of the owner of the vehicle. By virtue of the contract, which is entered into on a case-to-case basis the
insurance company collects premium to cover the risk of the owner of the vehicle and that too in respect of enumerated injuries and death. The
extent of coverage is also limited.
Here is one such case, where the insurance company contends that the company is liable to pay compensation only if the injury sustained by the
victim matches the injuries specified in the policy. It is equally contended that the insurance company is not at all liable to pay any compensation
under Motor Vehicles Act.
Whether a claim petition by the tort-feasor i.e., the owner-cum-driver of the offending vehicle is maintainable against the tort committed by the
tort-feasor himself u/s 163(A) of Motor Vehicles Act, is the issue raised in this case.
When the owner is armed with personal accident policy, whether the owner is entitled to claim compensation (based on that policy) before the
claims tribunal or his remedy lies before some other forum?
Whether the owner of the vehicle can be non-suited if the injury suffered by the owner does not match the scheduled item of injuries enumerated
in the insurance policy?
Brief facts:
The petitioner Subramanian, aged 42, an auto driver-cum-owner, earning a sum of Rs.3,000/- per month filed a petition claiming a sum of
Rs.3,00,000/- as compensation, in respect of injury sustained by him, in an accident that took place on 22.05.2007. On that date, the injured
petitioner took passengers in his auto bearing registration TN-67-K-0074 from Rajapalayam to Cholapuram. Due to unanticipated crossing of two
dogs, the petitioner could not control his vehicle and it capsized. The petitioner suffered fracture in the left tail bone, apart from other injuries on the
left hand and face. He underwent a surgery and despite best treatment, he suffered permanent disablement. Ex.P.2-wound certificate, Ex.P-6-
discharge summary, Ex.P.12-disablility certificate and Ex.P.13-X-ray have been filed to support the claim of the petitioner. Because of the mal-
union of bones, there had been shortening of left leg to the extent of 3 c.m. and there had been stiffening of left leg leading to restriction of
movement.
3.1. The tribunal has awarded compensation of Rs.1,28,674/- under the following break up details and directed the insurance company to pay the
same.
Head Amount in Rs.
Permanent disability 60,000
Medical Expenses (Exs.P.7, 8 and 9) 43,674
Pain and suffering 15,000
Extra nourishment 5,000
Cost of attendant 5,000
Total 1,28,674
Challenging the liability to pay the compensation, the insurance company has filed the appeal under the following contentions.
The petition by a tort-feasor is not maintainable under the provision of the Motor Vehicles Act.
The Claims Tribunal has no jurisdiction to decide the claim arising out of personal accident claim of the owner/injured.
Personal accident policy covers only the cases of death and injuries of specified nature and it will not applicable in respect of any other injuries.
In view of the contentions raised, the issue regarding jurisdiction of motor accidents claims tribunal has to be decided first;
Whether a tort-feasor can make the claim for compensation against himself and the insurance company under the provisions of Motor Vehicles
Act; and Whether the tort-feasor can make a claim based upon personal accident policy under the provisions of Motor Vehicles Act are the
remaining issues to be considered.
5.1. It is an admitted fact that, it is the petitioner-owner-driver of the auto met with an accident. It is also an admitted fact that, during the accident,
the petitioner himself was driving the auto. The question is when the owner of the vehicle himself, drives the vehicle and when there is an accident,
not involving any other vehicle, On whom does the fault lie? Who could be faulted with for the accident? Against whom does the claim lie? When
the driver is at fault, the owner becomes vicariously liable and the insurer become statutorily liable to answer the claim of the 3rd parties /injured /
legal representatives of the deceased ( in case of death). In other words the liability to pay compensation is based on ''fault'' theory except where
the claim itself is made under ""no fault liability theory"". Now, the question is when the driver/owner himself is at fault and the driver/owner himself
suffers as a victim due to invited/imposed/unanticipated/unwanted consequences, who will be answerable and who can be made answerable
legally?
5.2. Answers to these questions can be found in New India Assurance Co. Ltd. Vs. Meenal and Others, where under the contention raised was
that, the claim petition itself is not maintainable on the very plea raised in the claim petition itself, as there is no allegation regarding negligence on the
part of the driver/owner and therefore, in the absence of any pleadings/proof regarding fault on the part of the driver(deceased himself)/owner, the
insurance company will not be legally liable and that plea was upheld. In other words, when there is no vicarious liability which could be fastened
on the part of the owner, the insurance company cannot be made liable. Thus, when there is no foundation for liability, the insurance company
cannot be called upon to answer the claim of such owner cum driver.
5.3. It is relevant to quote the decision reported in National Insurance Company Ltd. Vs. Sinitha and Others, where a motorcyclist hit a large stone
lying on the road and sustained fatal injuries and succumbed to the same later. Claimant filed the petition u/s 166 of the Motor Vehicles Act and
later got it converted into a petition u/s 163 (A) of the Motor Vehicles Act. The Tribunal found that the deceased himself was responsible for the
accident and dismissed the petition for compensation. A contention was raised by the Insurance Company that the deceased being the driver of the
motorcycle would step in to the shoes of the owner and as he cannot be treated as 3rd party and claim under 163(A) of Motor Vehicle Act is not
maintainable. In other words the contention was that as section 163(A) is based on ''''fault liability'''' principle and as the deceased himself was
responsible for the accident, the claim petition was not maintainable.
The Hon''ble Supreme Court answered the contention by laying down the dictum that the claim made u/s 163(A) can be defeated either by the
owner or by the insurance company by pleading and establishing that the accident was based on the wrongful act, neglect or default on the part of
the victim of the accident.
5.4 But at the same time the Honourable Supreme Court quoting the decision reported in Oriental Insurance Co. Ltd. Vs. Smt. Jhuma Saha and
Others, stated that, ""The deceased was the owner of the vehicle. For the reasons stated in the claim petition or otherwise, he himself was to be
blamed for the accident. The accident did not involve motor vehicle other than the one, which he was driving. The question which arises for
consideration is that the deceased himself being negligent, whether the claim petition u/s 166 of Motor Vehicle Act would be maintainable?
The dictum laid down by the Honourable Supreme Court in Oriental Insurance Co. Ltd. Vs. Smt. Jhuma Saha and Others, is that when the owner
himself is at fault petition u/s 163 (A) is not maintainable.
The learned counsel for the Insurance Company contended that when the claim is not covered by the provisions of Motor Accident Act and the
claim is covered by personal accident policy then the claims tribunal has no jurisdiction. The issue regarding jurisdiction is answered in the decision,
reported in 2012 (1) ACJ 23 (Oriental insurance company vs. Manorama Devi) and this decision is based on the decision of Honourable Supreme
Court reported in National Insurance Co. Ltd. Vs. Mastan and Another, , wherein it has been held as follows:-
(22) Section 167 of the 1988 Act statutorily provides for an option to the claimant stating that where the death of or bodily injury to any person
gives rise to a claim for compensation under the 1988 Act as also the 1923 Act, the person entitled to compensation may without prejudice to the
provisions of Chapter X claim such compensation under either of those Acts but not under both. Section 167 contains a non obstante clause
providing for such an option notwithstanding anything contained in 1923 Ac
6.1. In the reported case contention was raised that the policy was restricted only to claim made under Workmen''s Compensation Act and
therefore the claimants are entitled to file their claim only under the Workmen Compensation Act and not under Motor Vehicles Act. Repelling the
contention the Honourable Supreme Court ruled that as section 167 of the Motor Vehicles Act,1988 contains a non-obstinate clause and it
provides for an option to the claimant, not withstanding anything contained in 1923 Act claimants are entitled to file the petition before the claims
tribunal.
6.2. Moreover, it was also held that the clause in the insurance policy cannot over-ride the provisions of the Motor Vehicles Act.
I am of the considered opinion that this clause of the policy cannot override the statutory provisions of section 167 of the Motor Vehicles Act
which starts with non obstante clause that ""notwithstanding anything contained in the Workmen''s Compensation Act, 1923 (8 of 1923) in case of
death or bodily injury, the claimants shall be entitled to file claim petition under the Motor Vehicles Act or under the Workmen''s Compensation
Act, 1923
6.3. The learned counsel for the Respondent relied upon a judgment of the Supreme Court reported in Union of India Vs. Bhagwati Prasad and
Others, where under it has been held that,
Where an application is filed before a Claims Tribunal for compensation in respect of accidents involving the death or bodily injury to persons
arising out of the use of Motor Vehicle and the claims is made both against the insurer, owner and driver of the motor vehicle as well as the other
joint tort-feasors, if a finding on hearing is reached that it is solely the negligence of the joint tort-feasor and not the driver of the motor vehicle the
Tribunal would not lose the jurisdiction to award compensation against the joint tort-feasor. The reason being as follows:-...
Factually this decision has additional set of facts but the basic principle underlying this case is that when an accident had taken place arising out of
use of motor vehicle"" then the claim petition is maintainable before the tribunal. It has been held that the jurisdiction of tribunal to entertain an
application for compensation in respect of an accident arising out of use of motor vehicle depends essentially on the fact, whether there had been
any use of motor vehicle and once that is established the tribunal''s jurisdiction cannot be held to be ousted, on a finding being arrived at a later
point of time, that is negligence of the other joint tort-feasor and not the negligence of motor vehicle in question. Based on the two decisions court
held that the tribunal has jurisdiction to try the issue. Just because there is an ultimate finding that the accident arose out of the negligence of
deceased himself and that he is not entitled to get any compensation will not shut out the jurisdiction of the court for the initial entry of the claimant.
Therefore, the contention that the claims tribunal has no jurisdiction is not acceptable.
6.4. It is also relevant to point out the clause in the insurance policy which reads as follows:-
Nothing in this policy or any endorsement hereon shall affect the right of any person indemnified by this policy or any other person recovers an
amount under or by virtue of the provision of motor vehicles act.
According to learned counsel for the claimant, the claim of the petitioner is based on personal accident cover as well as the claim under no fault
liability principle under the Motor Vehicles Act and therefore, the claim before tribunal is maintainable.
It is also an admitted fact that the claim of the injured is covered by personal accident cover. It is necessary to extract the relevant portion of
personal accident cover in view of the serious contention raised on both sides with regard the liability of the insurance company as well as the
liability with specific reference to injuries enumerated as mentioned in the policy and also with regard to the interpretation of the terms and
conditions of the policy:-
SECTION IV - PERSONAL ACCIDENT COVER FOR OWNER - DRIVER:-
Subject otherwise to the terms, exceptions, conditions and limitations of this policy, the Company undertakes to pay compensation as per the
following scale for bodily injury/death sustained by the owner-driver of the vehicle in direct connection with the vehicle insured or whilst mounting
into / dismounting from or travelling in the insured vehicle as a co-driver, caused by violent, accidental external and visible means which
independent of any other cause shall within calendar months of such injury result in:
Nature of Injury Scale of Compensation
i) Death 100%
ii) Loss of two limbs or sight of two eyes or 100%
one limb and sight of one eye
iii) Loss of one limb or sight of one eye 50%
iv) Permanent total disablement from injuries100%
other than named above
The learned counsel for the appellant contended that the injuries sustained by the claimant are not covered under any of the injuries specified
under the policy and therefore he is not entitled to make any claim for compensation; and in support of their contention the following decisions are
relied upon:-
i) Rakesh kumar vs. United India Insurance Company (FAO 3469 of 2008)
The contention raised was that the claimant himself was the owner-cum-driver of the vehicle and as such, as he is not a 3rd party, the insurance
company is not liable.
The injury suffered resulted in physical disability only to the extent of 10.7 % whereas, he did not suffer any injury to the extent of (ii) loss of two
limbs or sight of two eyes or one limb and sight of one eye; (iii) loss of one limb or sight of one eye; (iv) permanent total disablement from injuries
other than named above. Thus the claimant is not covered by any of the categories of injuries as mentioned in the conditions of the policy i.e. under
the Private car package policy in which the claimant had paid premium of Rs.100/- for compulsory personal accident cover to the owner /driver up
to the amount of Rs.2,00,000/-.
ii) United India Insurance vs. J.K. Raju @ Sakthi 2009 STPL (CL) 3747 NC
In this case, the complainant had been covered by Janatha Personal Accident Insurance Policy. His knee was fractured resulting in shortening of
lower limb by 0.7 inches. The contention was that the disability alleged was not permanent, total and absolute disability. The state commission held
that the disability can be termed as 100% with reference to his employment opportunity but the national commission did not agree with the state
commission. The national commission held that the claimant had not proved that he had been rendered permanently disabled from carrying out any
other profession. It was further held that policy condition was not proved.
iii) 2010 STPL (CL) 1399 NC-Mahendra Agarwal vs. Oriental Insurance Company Ltd.,
Consumer Protection Act, 1986 - Section 2(I)(g), 14(I)(d) and 21(b) - Insurance - Compensation - personal Accident Insurance Policy -
Suffered from total hyphema and permanent disablement - Vision lost - Claim Settled on basis of proportionate disability of 30% loss of vision -
District Forum directed insurer to pay balance amount with 12% interest per annum - In appeal order of Forum set aside - Revision - Wrong to
interpret loss of vision only by 30% - No provision in policy with regard to payment of compensation in proportion to percentage of
injury/disablement - Either insurer pay 50% of sum assured in case convinced of total permanent vision loss of one eye or pay nothing if loss of
eyesight not total - Complainant entitled to 50% of capital sum assured as per policy - Impugned order set aside - Revision Petition allowed.
8.1. These contentions are answered in the Judgment of Allahabad High Court in Udai Shankar Singh v. Branch Manager, LIC, Bharwari, in
which the petitioner had taken two insurance policies from LIC. While travelling on a two-wheeler, he met with an accident with a truck due to
which his right leg had to be amputated above the knee and his right hand was also paralysed. LIC repudiated its liability on the ground that the
disability sustained by the petitioner was not a ""permanent disability"" as defined in the policy and, therefore, the petitioner was not entitled to the
payment for permanent disability. The definition of ""permanent disability"" in para 10 of the policy of insurance inter alia declared:
... or in the amputation of both hands at or above the wrist, or in the amputation of both feet at or above ankles, or in the amputation of one hand
at or above the wrist and one foot at or above the ankle shall also be deemed to constitute such disability
Thus, while an accidental injury resulting in amputation of one hand and one foot was contractually defined to be a permanent disability, and since
the victim had suffered the amputation of only one leg and paralysis of the hand, it did not strictly fall within the definition of ""permanent disability
as defined in para 10 of the policy. After referring to several judgments on purposive construction, deduced that in the present case ""amputation of
hand"" should be construed to mean ""the hand becoming useless"" (whether by amputation, paralysis or otherwise) and that amputation of the hand
was only illustrative, and not exhaustive, of the intent. On this reasoning, a writ of mandamus was issued to LIC to pay the claim of the petitioner.
8.2. In the light of the interpretation made above, that is
a. Amputation of the hand was only illustrative, and not exhaustive, of the intent.
b. ""amputation of hand"" should be construed to mean ""the hand becoming useless"" (whether by amputation, paralysis or otherwise), and by
applying the principles of interpretation to the terms and conditions of the policy and applying the same interpretation to the facts of this Case, the
Court has to find out whether the Claimant would be entitled to compensation as per the terms and conditions of the policy-
1.The Claimant is a driver
He has suffered fracture of the Femur, the thigh bone which has resulted in 50% disability according to the evidence of the doctor.
The strength of the thigh bone is quintessential for driving. With 50% disability due to the fracture of femur it is impossible to drive. Though
physically the bone exists, the fractured bone has no significance to the claimant as it has become useless i.e., ''the leg becoming useless'' should be
construed as equivalent to ''amputated leg.
Finding that the disabled /useless leg is an injury, equivalent to loss of limb that is matching/fitting into one of the scheduled injury in the policy, this
Court is of the view that the Claimant is entitled to 50% of the assured amount, (as per the terms and conditions of the policy) that is the claimant is
entitled to Rs.1,00,000/- as compensation. In the result, the Civil Miscellaneous Appeal is dismissed. However, the award by the Claims Tribunal
is modified in terms of the quantum and basis of the liability to pay compensation. The Insurance Company shall pay a sum of Rs.1,00,000/- with
interest at the rate of 7.5% p.a. from the date of petition till the date of deposit, less the amount already deposited if any, within a period of 8
weeks from the date of receipt of copy of this judgment. On such deposit being made, the claimant will be entitled to withdraw the same, less the
amount already withdrawn, if any. No costs. Consequently, connected miscellaneous petition is closed.