# Oriental Insurance Co. Ltd v. Smt. Kuntesh & Ors

- **Citation:** (2022) 4 ILRA 801
- **Court:** High Court of Judicature at Allahabad
- **Decided:** 2022-04-06
- **Case number:** Writ-C No. 5317 of 2022
- **Bench:** Saumitra Dayal Singh
- **Source:** https://unisonlegal.in/judgment/allahabad-high-court/oriental-insurance-co-ltd-v-smt-kuntesh-ors-48347
- **Pages:** 15

## Headnote

A. Civil Law - Insurance - Interpretation -
if the words used in the Insurance Policy
give
rise
to
two
alternative
interpretations, one in favour of the
petitioner-insurer and the other in favour
of
the
insured,
the
rule
of
Contra
Proferentum
would
apply
&
the
interpretation,
which
is
against
the
person/insurer, drafting the words or
expressions, applies - Insurance Policy is a
contract
entered
into
between
the
petitioner-insurer & the State Government
-
Though
it
has
been
reached
in
furtherance of the Government Policy yet,
its terms were drafted by the petitionerinsurer - It is those terms that bind it.
(Para 46)

B. Civil Law - Insurance - Group Personal
Accident Insurance Policy - Mukhyamantri
Kisan Evam Sarvhit Bima Yojna - Issue -
Whether all and/or any bread winner (of
an eligible family) were insured under the
Insurance Policy, or the 'Mukhiya'/head of
the family or the sole bread winner of the
eligible family alone was insured - Held - it
is the risk/contingency of loss of life of
either the 'Mukhiya / head of the family'
or a bread winner (described as 'Roti
Arjak / bread earner') that is insured -
intent of the Government Policy was to
insure all adult active members of an
eligible family who may have had an
earning - coverage clause under the
Insurance
Policy
read
with
the
Government
Policy
is
to
allow
for
coverage of each adult earning hand of an
eligible family (below 70 years of age),
including its 'Mukhiya / head of the family'
- fact that he may or may not be the sole
bread winner, to a lesser or greater
extent, would not be relevant. - in the
unfortunate occurrence of more than one
death during the policy period, the insurer
may be exposed to honour only the first
claim per eligible family (Para 47, 50, 52,
53)

In a road accident one Rahul Kumar, aged
above 18 years, died - father of the Rahul
Kumar namely Rajkumar was the 'Mukhiya /
head of his family' & was alive on the date of
the accident and he had an earning - At the
time of death Rahul Kumar was engaged in
agricultural activity, though along with his father
- His mother made a claim for payment of Rs. 5
lacs under the Insurance Policy - It was
repudiated by the petitioner-insurer for the
reason the 'Mukhiya / head of the family' (of the
deceased), i.e. father of the deceased Rahul
Kumar, was alive on the date of death of Rahul
Kumar - Claimant Preferred claim petition before
the Permanent Lok Adalat - petitioner-insurer
directed to pay Rs. 5 lacs to the claimant -
Argument of insurer was that coverage was
singular & It was extended only to the 'Mukhiya
/ head of the family' who would have been the
bread winner of his family - Held - Rahul was a
802 INDIAN LAW REPORTS ALLAHABAD SERIES
person covered under the Insurance Policy as a
bread winner of his family - Since Rahul Kumar
died during his father's lifetime and the claim
there from arose first, the Permanent Lok Adalat
has not committed any error in allowing the
same - challenge raised in the writ petition is
found lacking in merit.

Disposed Off. (E-5)

List of Cases cited:-

## Text

_Characters 0–39,964 of 48,568. This is a partial read: ask again with offset=39964 for what follows._

4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
801
that any leaseholder having suffered lapse,
would be dis-entitled to any benefit of the
amended provisions of the 1957 Act
because
of
the
express
exclusion
contemplated in Section 8-A (9) of the
1957 Act.

6. For the reasons mentioned above,
we do not find any merit in the present writ
petition.

7. The writ petition is, accordingly,
dismissed.
----------
(2022)04ILR A801
ORIGINAL JURISDICTION
CIVIL SIDE
DATED: ALLAHABAD 06.04.2022

BEFORE

THE HON'BLE SAUMITRA DAYAL SINGH, J.

Writ-C No. 5317 of 2022

Oriental Insurance Co. Ltd. ...Petitioner
Versus
Smt. Kuntesh & Ors. ...Respondents

Counsel for the Petitioner:
Sri Parv Agarwal

Counsel for the Respondents:
C.S.C., Sri Satya Deo Ojha

A. Civil Law - Insurance - Interpretation -
if the words used in the Insurance Policy
give
rise
to
two
alternative
interpretations, one in favour of the
petitioner-insurer and the other in favour
of
the
insured,
the
rule
of
Contra
Proferentum
would
apply
&
the
interpretation,
which
is
against
the
person/insurer, drafting the words or
expressions, applies - Insurance Policy is a
contract
entered
into
between
the
petitioner-insurer & the State Government
-
Though
it
has
been
reached
in
furtherance of the Government Policy yet,
its terms were drafted by the petitionerinsurer - It is those terms that bind it.
(Para 46)

B. Civil Law - Insurance - Group Personal
Accident Insurance Policy - Mukhyamantri
Kisan Evam Sarvhit Bima Yojna - Issue -
Whether all and/or any bread winner (of
an eligible family) were insured under the
Insurance Policy, or the 'Mukhiya'/head of
the family or the sole bread winner of the
eligible family alone was insured - Held - it
is the risk/contingency of loss of life of
either the 'Mukhiya / head of the family'
or a bread winner (described as 'Roti
Arjak / bread earner') that is insured -
intent of the Government Policy was to
insure all adult active members of an
eligible family who may have had an
earning - coverage clause under the
Insurance
Policy
read
with
the
Government
Policy
is
to
allow
for
coverage of each adult earning hand of an
eligible family (below 70 years of age),
including its 'Mukhiya / head of the family'
- fact that he may or may not be the sole
bread winner, to a lesser or greater
extent, would not be relevant. - in the
unfortunate occurrence of more than one
death during the policy period, the insurer
may be exposed to honour only the first
claim per eligible family (Para 47, 50, 52,
53)

In a road accident one Rahul Kumar, aged
above 18 years, died - father of the Rahul
Kumar namely Rajkumar was the 'Mukhiya /
head of his family' & was alive on the date of
the accident and he had an earning - At the
time of death Rahul Kumar was engaged in
agricultural activity, though along with his father
- His mother made a claim for payment of Rs. 5
lacs under the Insurance Policy - It was
repudiated by the petitioner-insurer for the
reason the 'Mukhiya / head of the family' (of the
deceased), i.e. father of the deceased Rahul
Kumar, was alive on the date of death of Rahul
Kumar - Claimant Preferred claim petition before
the Permanent Lok Adalat - petitioner-insurer
directed to pay Rs. 5 lacs to the claimant -
Argument of insurer was that coverage was
singular & It was extended only to the 'Mukhiya
/ head of the family' who would have been the
bread winner of his family - Held - Rahul was a
802 INDIAN LAW REPORTS ALLAHABAD SERIES
person covered under the Insurance Policy as a
bread winner of his family - Since Rahul Kumar
died during his father's lifetime and the claim
there from arose first, the Permanent Lok Adalat
has not committed any error in allowing the
same - challenge raised in the writ petition is
found lacking in merit.

Disposed Off. (E-5)

List of Cases cited:-

1. The Oriental Insurance Company Ltd Vs St. of
U.P. & ors. Writ - C No. 6995 of 2022

2. Vania Silk Mills Ltd. Vs CIT, AIR 1991 SC
2104

3. Glynn Vs Margetson, (1893) A.C. 351

4. Investors Compensation Scheme Ltd. Vs West
Bromwich Building Society, (1998) 1 WLR 896

5. South East Asia Marine Engineering &
Constructions Ltd. Vs Oil India Ltd., AIR 2020
SC 2323

6. M.O.H. Uduman & ors. Vs M.O.H. Aslum, AIR
1991 SC 1020

7. M/S Sha Moolchand Kesarimull Vs. M/S
Associated Agencies, AIR 1942 Mad 139

8.
General
Assurance
Society
Ltd.
Vs.
Chandumull Jain & Anr., AIR 1966 SC 1644

9. Manmohan Nanda Vs. United India Assurance
Co. Ltd. & anr., 2021 SCC Online SC 1181

(Delivered by Hon'ble Saumitra Dayal
Singh, J.)

1. The present and the connected
matters involve a common question of law.
The facts are not in dispute. Accordingly,
these petitions have been heard together.
Upon hearing, other petitions have been detagged owing to other issues found
involved
in
those
cases,
requiring
affidavits. However, all counsel (for the
respective parties), were heard, on the
following common question of law.

"Whether all and/or any bread winner
(of an eligible family) were insured under
the Insurance Policy, or the 'Mukhiya'/head
of the family or the sole bread winner of the
eligible family alone was insured?"

2. Heard Sri Parv Agarwal, Sri Pawan
Kumar Singh, Sri Komal Mehrotra and Sri
Ajay Singh, learned counsel for the
petitioner - insurance company (appearing
in different petitions); Sri Satya Deo Ojha
and Sri Vidya Kant Shukla, learned counsel
for the respondent-claimant (appearing in
different
petitions),
on
the
common
question of law, noted above.

3. Present writ petition has been filed
by the insurance company against the order
dated 24.08.2021, passed by the Permanent
Lok Adalat, Muzaffarnagar, in Claim
Petition - Case No. 191 of 2020 (Smt.
Kuntesh Vs. Oriental Insurance Co. Ltd. &
Ors.). Earlier, the petitioner-insurer had
repudiated
the
claim
made
by
the
respondent-claimant. Presently, the claim
petition instituted with respect to the tailormade Group Personal Accident Insurance
Policy (hereinafter referred to as the
Insurance Policy) has been allowed. The
Insurance Policy was taken out by the State
of
U.P.,
with
the
petitioner-insurer,
pursuant
to
a
Memorandum
of
Understanding (M.O.U. in short) dated
14.09.2016 (as amended), entered into
between the State Government and the
petitioner insurer (hereinafter referred to as
the Agreement), to implement the State
Government's welfare policy measure - the
'Mukhyamantri Kisan Evam Sarvhit Bima
Yojna' (hereinafter referred to as the
Government Policy). Earlier, it was known
as the 'Samajvadi Kisan Evam Sarvhit
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
803
Bima Yojna', for the term 14.09.2018 to
13.09.2019.

4. Further, the answer to the question
of law noted above involves interpretation
of
the
Insurance
Policy
and
the
Government Policy, already on record. The
parties do not intend to file counter
affidavits
(to
this
writ
petition).
Accordingly, with the consent of parties,
this case has been heard finally, at fresh
stage. In other matters, affidavits have been
called, owing to other issues involved.

5. Briefly, on 14.10.2018, a road
accident took place. Therein, Rahul Kumar
S/o Smt. Kuntesh/respondent no.1 suffered
grievous
injuries.
He
died.
His
mother/respondent no.1 made a claim for
payment of Rs. 5 lacs under the Insurance
Policy. It was repudiated by the petitionerinsurer, on 28.11.2019 on account of delay
and also for the reason the 'Mukhiya / head
of the family' (of the deceased), i.e. father
of the deceased Rahul Kumar, namely, Raj
Kumar was alive on the date of death of
Rahul Kumar.

6. Being aggrieved, respondent no.1
preferred the claim petition before the
Permanent Lok Adalat being PLA Case
No. 191 of 2020. After efforts to
conciliate failed, the Permanent Lok
Adalat
proceeded
to
adjudicate
the
dispute. Accordingly, it has framed the
impugned
award
dated
24.08.2021.
Thereby, the petitioner-insurer has been
directed to pay Rs. 5 lacs to the claimantrespondent under the Insurance Policy,
within a period of three months from the
date of award. Failing that, interest @ 6%
(from the date of presentation of the
claim petition to the date of actual
payment),
has
been
awarded.
The
objection as to delay was decided against
the petitioner-insurer since the claim was
made within 30 days from the end of the
policy term. No challenge has been
pressed to that finding reached (by the
Permanent Lok Adalat), in this writ
petition.

7. Learned counsel for the petitioner
have vehemently urged - the coverage
under the Insurance Policy was to a preidentified, single family member. The
risk covered was accidental loss of life of
the 'Mukhiya / head of the eligible family'
who would have been the 'Roti Arjak' -
bread earner (winner), of such family. On
him, his family would have been wholly
dependent, for its economic needs. No
other risk - of accidental loss of life (of
any other member of such family), was
insured. Even if such other member may
have had an income, he was not insured
against accidental loss of life. Any other
interpretation would violate the single
person coverage (against accidental loss
of life) offered by the Insurance Policy
taken out by the State Government and
the Agreement reached between the
insurer and the State Government. The
only contingencies involving other family
members of the eligible family could
arise in case(s) of accidental injury
suffered or complete dependency of
'Mukhiya / head of the family' on his son.
In those contingencies, the petitionerinsurer would be liable to the extent
agreed.

8. In support of their submissions,
learned counsel for the petitioner have
extensively referred to the Insurance Policy
and the Agreement/MOU dated 14.09.2016
(as amended from time to time) entered
between the Oriental Insurance Company
and the Governor of U.P. Those documents
have been annexed to Writ - C No. 6995 of
804 INDIAN LAW REPORTS ALLAHABAD SERIES
2022 (The Oriental Insurance Company
Ltd vs. State of U.P. & 2 Ors.). The same
have been read in this proceeding.

9. Thus, reference has been made to
the gross premium - Rs. 54,03,58,132.00
paid by the State Government to cover the
risk of accidental loss of life - of an
estimated
29,39,000
citizens
(of
the
districts included in and collectively
described as Meerut Cluster of the State of
Uttar Pradesh), for the policy term
14.09.2018 to 13.09.2019. Relying on
Clause 4 of the Insurance Policy, it has
been urged, the total number of eligible
families in Meerut Cluster was first
estimated at 29,39,000. Therefore, exactly
that many lives/risk to life were insured,
assuming one 'Mukhiya'/ 'Roti Arjak' i.e.
head-of-family/bread winner, per eligible
family. Clause 5 of the Insurance Policy
clearly makes applicable the terms of the
MOU dated 14.09.2016, entered between
the Governor and the Oriental Insurance
Company.

10. Referring to the Agreement as last
amended on 13.09.2018, it has been
submitted, different premium amounts were
worked out for different Clusters (of
districts) of the State, depending upon
estimated number of eligible families
residing in each Cluster. Thus, Clause 1 of
the Agreement reads as below:

"1. Insurance Company i.e. The
Oriental
Insurance
Company
Limited
undertakes that it shall provide services for
the implementation of Mukhyamantri Kisan
and Sarvhit Bima Yojna as per the
conditions laid in para (e & f) as
mentioned above for below cluster(s)

S No
Cluster
Annual
Premium
Amount Inclusive of all
taxes, applicable duties
and other charges (in
INR)
1
Agra
Rs. 105,93,81,344 (One
Hundred
Five
crores
Ninety Three lacs Eighty
One
Thousand
Three
hundred
fourty
Four)
Only
2
Meerut
Rs. 54,03,58,132 (Fifty
four crores Three lacs
Fifty
Eight
Thousand
One hundred Thirty two)
Only
3
Bareilly Rs.
74,22,45,091
(Seventy
Four
crores
Twenty Two lacs Forty
Five Thousand Ninety
One) Only
4
Kanpur
Rs.
76,09,84,705
(Seventy Six crores Nine
lacs
Eighty
Four
Thousand Seven hundred
Five) Only
5
Basti
Rs.
25,74,05,500
(Twenty
Five
crores
Seventy
Four
lacs
FiveForty
Five
Thousand Ninety One)
Only
Thousand
Five
hundred) Only

11. Also, reference was made to
Clause 3 of the Agreement. It contains the
text of the 'Mukhyamantri Kisan Evam
Sarvhit Bima Yojna' (as amended) /
Government Policy. The opening clause of
the Government Policy recites its object. It
reads:

"योजना का उद्देश् सवसिन्न प्रकार क़ी
असनसित दुिााग्यपूणा घिनायें सजससे पररवार के
मुण्डिया क़ी मृत्यु िो सकत़ी िै/ सवकलांग बना
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
805
सकत़ी िै जो पूरे पररवार के सलये असुरक्षा
/सवपसत्तयां ला सकत़ी िै, क़ी सिायता िेतु।"

 (emphasis supplied)

12. Next, Clause 1 of the Insurance
Policy taken out pursuant to the aforesaid
Government Policy reads:

"Personal Accident Insurance benefit
up to a maximum of INR 5 lakhs to the
Head of the Family/Bread Earner (Policy
holder) of the covered family."

(emphasis supplied)

13. Also, Clause 4 of the Insurance
Policy reads:

"Estimated number of families for this
cluster are 29,39,000 for Meerut, Gautam
Budh Nagar, Baghpat, Ghaziabad, Hapur,
Moradabad-Amroha,
Rampur,
Bijnour,
Saharanpur,-Muzaffarnagar,
Shamli,
Sambhal."

 (emphasis supplied)

14. Thus, it has been submitted, the
insurance cover provided to the State
Government under the Insurance Policy
was to cover the risk of accidental loss of
life of 29,39,000 'Mukhiya' / respective
heads of families of the most vulnerable
and therefore eligible families, in Meerut
cluster, against payment of premium, Rs.
54,03,58,132/-. That is clear from the
object clause of the Government Policy. It
covered the risk of accidental death of the
''Mukhiya / head of the eligible family',
alone.

15. Learned counsel for the petitioner
would further submit, the word 'Roti Arjak
/ bread winner' (in English), appears only
by way of clarification made i.e. 'Mukhiya /
head of the family' would be the bread
winner for the purpose of coverage offered
under the Insurance Policy. Only, in case of
such person being aged more than 70 years
on the date of commencement of the
Insurance Policy, his son (unmarried or
married), on whom he may be wholly
dependent, would become the person
insured under the Insurance Policy, to the
exclusion of the 'Mukhiya / head of the
family', himself. As to the other persons or
family members, coverage of accidental
injury was provided, under Clause 2 of the
Insurance Policy, only. It reads:

"Post accidental medical treatment
benefits on floater basis shall be provided
to Head of the Family/ Bread Earner/
family members as follow:

a) Primary medical treatment benefit
(on need basis) up to a maximum of INR
25,000/- (INR Twenty Five Thousand). b)
Medical treatment benefit up to a maximum
of INR 2,50,000/- (Two Lakh Fifty,
Thousand) (inclusive of primary medical
treatment benefits of INR 25,000, wherever
applicable).

c) On need basis, artificial limb
replacement up to a maximum of INR
1,00,000 (One Lakh).

The aforementioned amount of INR
2.5
Lakhs
for
Maximum
Accidental
Medical treatment cover is inclusive of
primary medical treatment benefits of INR
25,000, wherever applicable and exclusive
of maximum of INR 1 Lakh for artificial
limb, as the case may be."

(emphasis supplied)

16. Also, the clauses pertaining to
''Parivar Aachhadan' i.e. Eligible Family
and ''Bima Aavran Ki Avadhi' i.e. Period of
Insurance Cover, of the Government Policy
read as below:

"पररवार आच्छादन - आच्छासदत पररवार
का मुण्डिया / रोि़ी अजाक (ब़ीमा धारक) रू0
806 INDIAN LAW REPORTS ALLAHABAD SERIES
5.00 लाि तक का व्यण्डक्तगत दुघािना ब़ीमा
लाि एवं मुण्डिया/ रोि़ी अजाक / पररवार के
सदस्य दुघािना के उपरान्त रू० 25,000 तक
प्रार्थसमक सचसकत्सा एवं रू0 2.25 लाि तक
वृिद्ध सचसकत्सा लाि तर्था आवश्कतानुसार
असधकतम रू० 1.00 लाि तक का कृसत्रम अंग
प्राि कर सकेंगे।

बीमा आवरर् की अवतध - ब़ीमा आवरण
क़ी अवसध संस्र्थागत सवत्त, ब़ीमा एवं वाह्य
सिायसतत पररयोजना मिासनदेशालय, उ0प्र0
एवं ब़ीमा कम्पऩी के मध्य मेमोरेिम आफ
अिरस्ट्ैंसडंग (एम0ओ०यू०) िस्ताक्षररत िोने
क़ी सतसर्थ से एक वषा के सलए मान्य िोग़ी
तदोपरान्तु इसे वषावार बढाया जायेगा। यि
योजना 03 वषा + 03 वषा से असधक नि़ीं िोग़ी।"

 (emphasis supplied)

17. Sub-clause (2) of the Clause -
''Yojana Ki Visheshtaayein' i.e. Special
Features of the Policy, reads as below:

"व्यण्डक्तगत दुघािना ब़ीमा - पररवार के
मुण्डिया / रोि़ी अजाक क़ी दुघािना में मृत्यु /
स्र्थाई पूणा सवकलांगता / स्र्थाय़ी और लाईलाज
पागलपन / कुल दो अंगों के स्र्थाय़ी नुकसान /
दोनों आंिों में स्र्थाय़ी दृसष्ट का नुकसान / एक
अंग और एक आंि क़ी दृसष्ट का स्र्थाय़ी
नुकसान / वाकु् का स्र्थाय़ी नुकसान / सनचले
जबडे क़ी पूऱी िासन/ चबाने क़ी ण्डस्र्थसत का
स्र्थाय़ी नुकसान पर ब़ीसमत रासश रू0 5.00
लाि, दोनों कानों से बिरेपन क़ी ण्डस्र्थसत में
ब़ीसमत रासश रू0 5.00 लाि का 75 प्रसतशत
तर्था एक अंग का स्र्थाय़ी नुकसान या एक आंि
क़ी दृसष्ट िासन के स्र्थाय़ी नुकसान पर ब़ीसमत
रासश रू0 5.00 लाि का 50 प्रसतशत लाि
सदया जायेगा ।"

18. It is undisputed - the father of the
Rahul Kumar namely Rajkumar was the
''Mukhiya / head of his family'. He had an
earning. He was alive on the date of the
road accident suffered by Rahul Kumar, on
14.10.2018.
Therefore,
the
petitionerinsurer claims, insurance claim made, on
the death of Rahul Kumar, was ineligible
(under the Insurance Policy read with the
Government Policy). The fact - later,
during the term of the Insurance Policy,
Rajkumar also suffered an accidental death,
would
make
no
difference
to
the
ineligibility of the claim arising on the prior
death of Rahul Kumar.

19. In short, the petitioner-insurer has
invoked the principle - a stipulation in the
Insurance Policy may be interpreted upon a
complete reading of that contract. A
contract is not to be read as a statute but as
a whole document, in the context of the
general object for which it was executed.
Therefore, laying heavy emphasis on the
'Object' clause of the Government Policy
and the 'Coverage' clause of the Insurance
Policy, it has been vehemently urged, the
coverage was singular. It was extended
only to the ''Mukhiya / head of the family'
who would have been the bread winner of
his family.

20. Sri Parv Agarwal has placed
reliance on a decision of the Supreme Court
in Vania Silk Mills Ltd. Vs CIT, AIR
1991 SC 2104, to suggest, ordinary,
popular and natural meaning is to be given
to the word 'Mukhiya', used both under the
Insurance Policy and the Government
Policy.

21. Sri Pawan Kumar Singh has
referred to Glynn Vs. Margetson, (1893)
A.C. 351, to submit, all provisions of a
contract should be read together. The intent
of the parties to the contract must be clearly
understood, therefrom. Only then a clear
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
807
picture may emerge as to the true
interpretation of the contract. Contrary to
the
purpose
of
the
contract
(thus
determined), an inconsistent word or
provision may be rejected, in entirety.
Relying
on
Investors
Compensation
Scheme
Ltd.
Vs.
West
Bromwich
Building Society, (1998) 1 WLR 896, he
would submit (as per his written note) - the
following five principles are useful to
interpret contracts, exist :

"1.
Contextual
approach
to
interpretation

(i) Interpretation is the ascertainment
of the meaning of the document to the
reasonable
person
having
all
the
background knowledge which would be
reasonably available to the parties in the
circumstances

2.
Wide
scope
of
background
knowledge

(i) Relevant background knowledge of
the includes "absolutely anything" which
would have affected the understanding of
the reasonable man

3. Pre-contractual negotiations are
inadmissible

(i) Previous negotiations of the parties
and their declarations of subjective intent
are inadmissible as background

(ii) The only exception is in an action
for rectification

This distinction is made for practical
policy of reducing litigation time and costs

4. Substitution of words and syntax

(i) The background circumstances
"may not merely enable the reasonable
man to choose between the possible
meanings of words which are ambiguous
but even (as occasionally happens in
ordinary life) to conclude that the parties
must, for whatever reason, have used the
wrong words or syntax."

(ii) Meaning is contextual not literal

5. Business common sense

(i) The natural and ordinary meaning
must yield to business common sense if it
flouts it

(ii) However, there is the presumption
that people do not easily make linguistic
mistakes

(iii)
The
natural
and
ordinary
meaning is not unhelpful when words have
not been used in a natural and ordinary
way"

22. Then, reliance has been placed on
the following two decisions of the Supreme
Court and a decision of the Madras High
Court to submit, the coverage granted to
the 'Mukhiya' may not be enlarged as it
would conflict with the policy terms:

(i)
South
East
Asia
Marine
Engineering & Constructions Ltd. Vs.
Oil India Ltd., AIR 2020 SC 2323

(ii) M.O.H. Uduman & Ors. Vs.
M.O.H. Aslum, AIR 1991 SC 1020

(iii) M/S Sha Moolchand Kesarimull
Vs. M/S Associated Agencies, AIR 1942
Mad 139

23. Contesting the above, learned
counsel
for
the
claimant-respondents
submits, the Insurance Policy was taken out
by the State Government, to fulfil welfare
objective. It covers both, the head of every
eligible family as also every bread earner of
every eligible family. Thus, they have
relied on the eligibility-clause under the
Insurance Policy and also the eligibility /
'Patrata' clause under the Government
Policy (with reference to the other
stipulations contained therein). It has been
submitted, there is no exclusion made and
there is no intent emerging from the
reading of any of the clauses of the
Insurance Policy or the Government Policy
as may restrict the coverage under the
808 INDIAN LAW REPORTS ALLAHABAD SERIES
Insurance Policy to a single person,
namely, the ''Mukhiya' who may or may not
be the sole bread winner of the eligible
family. For ready reference, Eligibility
clause of the Insurance Policy reads as
below:

"ELIGIBILITY CLAUSE - All farmers
of Uttar Pradesh (without any Income
limit), Landless farmers, those related to
Agriculture related activities, (Fishery,
milk producing, pig farming, goat farming,
Bee keeping etc.) nomadic/ roaming
families, businessmen (who are not covered
under any other Governmental Scheme),
forest workers, retailers, Rickshaw pullers,
porters and those engaged in other
activities who are residents of rural or
urban areas whose annual income is less
than INR 75,000/- and age limit in between
18 to 70 years shall be eligible for this
Scheme. During the currency of the
Scheme, If a person attains the age of 18
years or a person crosses the age of 70
years, that person shall also be covered."

 (emphasis supplied)

24. Also, the Eligibility clause of the
Government Policy reads as below:

"पात्रता- उत्तर प्रदेश राि के समस्त
कृषक (अस़ीसमत आय स़ीमा) िूसमि़ीन कृषक,
कृसष से संबंसधत सियाकलाप करने वाले, (मत्स्य
पालक, दुग्ध उत्पादक, सूकर पालक, चकऱी
पालक मधुमक्ख़ी पालक इत्यासद)घुमन्तू पररवार,
व्यापाऱी (जो सक सकस़ी शासन योजना से
आच्छासदत नि़ी 8). पन श्रसमक, दुकानदार,
फुिकर काया करने वाले, ररक्शा चालक. कुल़ी
एवं अन्य काया करने वाले ग्राम़ीण क्षेत्रों अर्थवा
शिऱी क्षेत्रों के सनवास़ी सजनक़ी पाररवाररक आय
रू० 75.000/- प्रसत वषा से कम िो एवं सजनक़ी
आयु 18 वषा से 76 वषा के मध्य िै पात्र िोंगे।
इसमें राि सरकार एवं िारत सरकार तर्था
राि एवं केन्द्र सरकार के प़ी०एस०यू० के
सवत्त़ीय सिायता प्राि संस्र्थानों के सनज़ी क्षेत्र के
तर्था स्वशास़ी सनकायों / सावाजसनक उपिमों /
सनगमों / बोडा एवं प्रासधकरणों के कमाचाऱी जो
सकस़ी ब़ीमा कम्पऩी क़ी ब़ीमा योजना से
लािाण्डन्वत िो रिे िैं, शासमल नि़ीं िोंगे। ब़ीमा
आवरण क़ी अवसध में 18 वषा क़ी आयु पूणा करने
वाले उक्त सि़ी योजना के अन्तगात पात्रता क़ी
पररसध में आयेगे। इस़ी प्रकार ब़ीमा आवरण
अवसध में 70 वषा पूणा िो जाने पर उक्त सि़ी
पात्रता श्रेण़ी में माने जायेगें।

कृषक - कृषक का तात्पया राजस्व
असिलेिों अर्थाात ितौऩी में दजा िातेदार /
सििातेदार से िै, सजसक़ी आयु न्यूनतम 18 वषा
तर्था असधकतम 70 वषा िो ।
.
िूसमि़ीन कृषक एवं कृसष से संबंसधत
सकयाकलाप - ऐसे ग्राम़ीण िूसमि़ीन पररवार जो
प्रत्यक्ष या अप्रत्यक्ष रूप से कृसष काया से जुडे हुए
िों।

अन्य - कृषकों के असतररक्त सजनक़ी आयु
18 वषा से 70 वषा के मध्य िै तर्था पाररवाररक
आय रू० 75,000/- प्रसत वषा से कम िो
योजनान्तगात पात्र िोंगे। इसमें राि सरकार एवं
िारत सरकार तर्था राि एवं केन्द्र सरकार के
प़ी०एस०यू० के, सवत्त़ीय सिायता प्राि संस्र्थानों
के सनज़ी क्षेत्र के तर्था स्वशास़ी सनकायों /
सावाजसनक
उपिमों/सनगमों/
बोडा
एवं
प्रासधकरणों के कमाचाऱी जो सकस़ी ब़ीमा कम्पऩी
क़ी ब़ीमा योजना से लािाण्डन्वत िो रिे िैं, शासमल
नि़ीं िोंगे। प्रदेश सरकार के सकस़ी ि़ी सविाग
द्वारा संचासलत सकस़ी ि़ी दुघािना ब़ीमा योजना में
आच्छासदत
लािार्थी
मुख्यमंत्ऱीसकसान
एवं
सवासित ब़ीमा योजना के सलए पात्र नि़ीं िोंगें।"

 (emphasis supplied)

25. Thus, it has been submitted, the
insurance company had taken a heavy
premium to cover the risk of accidental loss
of life - to the most vulnerable and the
weakest in the economic ladder of our
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
809
society. Each 'Roti Arjak / bread earner' of
an eligible family, stood insured under the
Insurance
Policy,
read
with
the
Government Policy. The petitioner insurer
has repudiated its liability on a fallacious
ground of single risk coverage, that too to a
''Mukhiya / head of the family'. The
coverage was, clearly plural.

26. Having heard learned counsel for
the parties and perused the record, there
can be no dispute to the fact that the
occurrence (of accidental death of Rahul
Kumar on 14.10.2018), fell within the
contingencies covered by the Insurance
Policy. It is also not in dispute that the total
family income (of the family to which
Rahul Kumar belonged), did not exceed Rs.
75,000/- per annum and that he was more
than 18 years, but less than 70 years of age
on the date of occurrence of his accidental
death. To that extent, there is no dispute.

27. In absence of person identification
or
name
specification
made
while
providing for the risk cover under the
Insurance Policy, a dispute exists - which
lives of an eligible family or contingencies
faced by an eligible family would be
covered and which would be not ?

28. Since the Insurance Policy and the
Government Policy do not offer a direct
answer to that issue, the terms and
conditions of the Insurance Policy, the
Government Policy (that has been made
part of the Insurance Policy), and the
Agreement would have to be examined in
entirety to determine the same. To that
extent, the principle being invoked by
learned counsel for the petitioner is true
and correct.

29. Examined in that light, first, under
Clause 1 of the Insurance Policy, coverage
of personal accidental death insurance
benefit, Rs. 5,00,000/- was provided to the
'Mukhiya / head of the family / bread
winner of an eligible family'. The person/s
covered has/have been described as "Policy
holder". It also cannot be denied, in that
policy document, a clear reference exists -
to the number of estimated persons
covered, being 29,39,000, in the Meerut
Cluster.

30. Then, in the eligibility clause of
the Insurance Policy, persons engaged in
various
activities/vocations,
whether
residing in urban or rural areas were
covered. First, all farmers (without income
ceiling) were covered. Second, all landless
labourers; all types of nomadic families;
businessmen (not covered under any other
government schemes); forest workers;
retailers; rickshaw pullers; porters; etc.
were covered, subject to their annual family
income being less than Rs. 75,000/-.

31. Then, by way of general
exceptions, that eligibility was made
subject to age limit 18 to 70 years (of the
insured person), provided further, if the
insured person attained the age of 18 years
or crossed the age of 70 years during the
currency of the insurance term, he would
still be covered thereunder. Further, by way
of specific exclusion, the Insurance Policy
provided as below:

EXCLUSIONS- Employees of Central
Government, State Government, Public
Sector Units (PSU) of Central Government
or State Government, Financially aided
Organizations, Private Sector, Autonomous
Bodies/ Public Undertakings/ Corporations
Boards and Authorities who are covered
under any insurance scheme shall not be
covered under the Samajwadi Kisan &
Sarvhit Bima Yojna Scheme.
810 INDIAN LAW REPORTS ALLAHABAD SERIES

EXCLUSIONS- Any beneficiary who is
covered under any accidental Insurance
scheme operated by any of the department
of State Government shall not be eligible
under the Samajwadi Kisan & Sarvhit
Bima Yojna Scheme.

 (emphasis supplied)

32. Similar clauses existed under the
Government Policy, as well. Thus, it
appears, the two documents are not
conflicted. The Government Policy was
framed earlier. Against that, the petitioner
insurer was selected, through open tender
process. The agreed premium was paid by
the State Government and Insurance Policy
taken out, by it. In such facts, the above
two documents do not attempt to cover two
different risks or contingencies. In fact,
largely, one is the reflection of the other.
The choice of exact words and elaborations
made apart, per se, no clause has been
shown to exist in either document that may
conflict with any clause contained in the
other. Then, Clause 5 of the Insurance
Policy makes the Agreement (of which the
Government Policy is a part), a part of the
Insurance Policy.

33. Undisputedly, the risk of an
accidental injury, was insured to the "head
of the family" or "bread winner" and other
members of an eligible family. While
providing for that contingency and cover
against accidental injury, the Insurance
Policy did not specifically or by direct
reference made, provide for coverage of
risk to life against accidental death, of all or
any
other
family
member/s.
Thus,
exclusion is claimed to arise on a
comparative reading of the relevant Clauses
of the Insurance Policy. Yet, no contrary
intention is expressed in the Government
Policy or the Agreement.

34. Then, the opening Clause of the
Government Policy discloses its object. It
was to provide financial assistance to the
eligible
families
against
''Asuraksha/Vippatti'
i.e.
insecurity/
calamity arising from the sudden accidental
death of the ''Mukhiya' i.e. the head of an
eligible family.

35. At the same time, in the very
next
Clause,
while
providing
for
eligibility,
that
Government
Policy
includes
within
the
sweep
of
the
Insurance Policy, all members of eligible
families. It includes citizens from all
walks of life, subject to specific general
exclusions, noted above.

36. The term ''Mukhiya / head of the
family' is not a term defined, either under
the Government Policy or under the
Insurance Policy. It is also not a term
defined by legislature. Primarily, it is a
social construct. Commonly, the eldest
member of any family is described as its
''Mukhiya'. The Government Policy is
progressive inasmuch as it has used the
term ''Mukhiya / head of the family', in a
more gender plural sense by using the
words male/female.

37. If the intent of the Government
Policy and, therefore, if the coverage under
the Insurance Policy were to be confined to
the 'Mukhiya' only, there would have arisen
no need to mention ''Roti Arjak / bread
earner'. The fact that such terms had been
used by adding ''/' (stroke) after the word
''Mukhiya', indicates the intent to cover
either the head of the family, or its bread
winner, during the term of the Insurance
Policy - from 14.09.2018 to 13.09.2019.
Clause 3 of the Insurance Policy reads as
under :
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
811

"3.
Below
individuals
shall
be
considered as family members under the
Samajwadi Kisan & Sarvhit Bima Yojna
Scheme:

a) Head of the Family/Bread earner
(Male/Female)

b) Husband/Wife of Head of the
Family/Bread earner

c) Unmarried daughter

d) Dependent son

e) Dependent parents of unmarried
son (where unmarried person is Head of
the Family/Bread Earner)

f) Dependent parents of Head of the
Family/Bread Earner (only in cases where
husband is the Head of the Family)

Note: Parents of wife shall not be
covered."

 (emphasis supplied)

38. Then, the clause pertaining to
''Parivar
Nirdharan'
contained
in
the
Government Policy reads as below:

"पररवार तनधानरर् -पररवार के अन्तगात
पररवार का मुण्डिया/रोि़ी अजाक (पुरुष /स्त्ऱी)
उसक़ी पत्ऩी/पसत, असववासित पुत्ऱी, आसश्रत पुत्र,
मुण्डिया पसत एवं असववासित पुरुष के आसश्रत
माता-सपता ब़ीमा का लाि प्राि करने िेतु आवृत्त
िोगें।"

 (emphasis supplied)

39. Thus, for the purpose of
determining the family members/persons
insured under the Insurance Policy, the
'Mukhiya / head of the family' could be
both - the person insured as also a
beneficiary. As 'Mukhiya / bread winner',
such person was included as family
member under Clause 3(a) of the Insurance
Policy. He would be the 'policy holder'. At
the same time if such person's unmarried or
married son was a bread earner, such
person though 'Mukhiya' would be a
beneficiary, in case of occurrence of death
of such married son [under Clause 3(e) &
3(f) of the Insurance Policy], subject to him
being dependent on his son, now described
as 'Head of the family / Bread Earner'.

40. Therefore, the Insurance Policy
does seek to insure the risk to life of a
person other than a 'Mukhiya / head of the
family' also, in certain situations. In
absence of the words "Ek Matra"/ sole
prefixed to the phrase ''Roti Arjak / bread
earner' and in absence of any exclusion
clause to oust a claim of a partly dependent
'Mukhiya', in the case of death of his
married or unmarried son, it is to be seen if
by use of word 'dependent' under Clause
3(e) and 3(f) of the Insurance Policy, only
non-earning 'Mukhiya / head of the family',
may become a beneficiary in the event of
death of their earning son (married or
unmarried).

41. While the Insurance Policy is
silent in that regard, the object clause of the
Government Policy makes it plain that the
object was to take out an Insurance Policy
to provide for vital aid to the financially
most vulnerable and exposed families who
may be faced with 'Asuraksha / Vippati' i.e.
insecurity / calamity upon occurrence of
accidental death of its 'Mukhiya' or 'Bread
Earner'. A minimum amount of money as
may help them avoid destitution, upon the
loss of vital minimum earning was sought
to be provided, to an eligible family, to
address the insecurity or extreme hardship
arising upon being faced with the calamity
of death taking away the hope of minimum
means to survive.

42. The Eligibility clause under the
Government Policy, includes all citizens
from different walks of life engaged in
different
professions
and
vocations,
812 INDIAN LAW REPORTS ALLAHABAD SERIES
residing in different parts of the State. It
includes all farmers (irrespective of their
annual earning) and, others having family
income less than Rs. 206/- per day (Rs.
75,000 / 365 days). Also, the insured
''Mukhiya / head of the family / Roti Arjak
/ bread earner' could be a person in the age
bracket of 18 years to 70 years. It is
apparent that the intent of the Government
Policy was to insure all adult active
members of an eligible family who may
have had an earning.

43. Thus, a person below 18 years of
age was treated to be ineligible. He would
remain not - insured on deemed basis,
though such person (in a given unfortunate
situation), may have been the sole bread
winner of his family. Correspondingly, any
person above 70 years of age was treated to
be the person not insured as he was deemed
to be not contributing economically to his
family.

44. Therefore, there may be no
dispute to rejection of a claim made on
occurrence of death of a person below 18
years of age or above 70 years of age.
There, upon fiction introduced, the dead
would not be of a person insured. Yet, a
conflict would arise if interpretation made
by learned counsel for the insurer is
accepted with respect to a person aged
below 70 years of age who may be the
eldest member of an eligible family and
who may (speaking hypothetically), be
earning a frugal sum of say Rs. 24,000/-
per annum. In that case, such a person
would be included under the cover of the
Insurance Policy in his capacity as
''Mukhiya'. Yet, as a beneficiary he would
be ineligible to claim insurance money if
his unmarried son (who may have been
earning Rs. 50,000/- per annum), died an
accidental death. It would be so because
according to learned counsel for the
petitioner-insurer, the claimant would not
be wholly dependent on his son. At the
same he would be eligible if his earning
were nil.

45. The test of full dependency
neither appears to exist under the Insurance
Policy or the Government Policy or the
Agreement nor it may be practicable to
satisfy. Also, if strictly applied it may allow
any and every such claim to be defeated
upon the insurer being able to satisfy that
the 'Mukhiya' / parent of the head of the
family had earned, say Rs. 100/- per month,
through any manual labour performed. That
result would be plainly absurd. The
Insurance Policy may not be interpreted to
include and exclude the same person from
the
scope
of
insurance/beneficiary,
simultaneously. Clearly, an ambiguity
exists.

46. Undeniably, the Insurance Policy
is a contract entered into between the
petitioner-insurer & the State Government.
Though it has been reached in furtherance
of the Government Policy yet, its terms
were drafted by the petitioner-insurer. It is
those terms that bind it. Therefore, if the
words used in the Insurance Policy give
rise to two alternative interpretations, one
in favour of the petitioner-insurer and the
other in favour of the insured, the rule of
Contra Preferentum would apply. It thus
commends to the Court to read the words
'Roti Arjak / bread earner', used in the
coverage Clause (1) of the Insurance Policy
to include all bread winners of an eligible
family. Similarly the word 'dependent' used
in 'Family Composition' - clause (3) of that
policy includes partial dependency and/or
inter-dependency. To that extent, those
words have to be read against the
petitioner-insurer as it was itself the
4 All. Oriental Insurance Co. Ltd. Vs. Smt. Kuntesh & Ors.
813
draftsman of the Insurance Policy. Unless
read in that manner, the core objective of
the Insurance Policy - to preserve the most
vulnerable lives of our society, would fail.
In General Assurance Society Ltd. Vs.
Chandumull Jain & Anr., AIR 1966 SC
1644 a Constitution Bench of the Supreme
Court noted the applicability of rule Contra
Preferentum, to insurance contracts. The
said rule has been applied by the Supreme
Court, recently, in Manmohan Nanda Vs.
United India Assurance Co. Ltd. & Anr.,
2021 SCC Online SC 1181.

47. Clearly, it is the risk/contingency
of loss of life of either the ''Mukhiya / head
of the family' or a bread winner (described
as ''Roti Arjak / bread earner') that is
insured. The object of that coverage is not
simple life insurance, but, to prevent
extreme destitution described under the
Government
Policy
as
'Asuraksha
/
Vippati'. It would be unreasonable to
conclude that the coverage is to be confined
to the ''Mukhiya / head of the family who is
the sole ''Roti Arjak / bread winner of the
family'. A parent who may be dependent
either, wholly or in part. In that case his
earning son/s may also stand insured
against risk of loss of life to the extent they
would both be contributing to the minimal
earnings of their family.

48. In absence of any specific
exclusion under the Insurance Policy, there
is no inherent logic to exclude the
unfortunate occurrence of accidental death
of any bread winner i.e. ''Roti Arjak / bread
earner' (as described under Insurance
Policy) from the cover of insurance. Here,
the underlying object of the policy must be
given primacy.