Unmarried Sister Can Receive ₹5 Lakh For Insured Breadwinner Brother’s Accidental Death As Legal Heir: Allahabad HC

The petitioner’s brother died in a road accident on 18 May 2019, during the currency of the group personal accident policy under the Mukhyamantri Kisan Evam Sarvahit Bima Yojana.

The petitioner claimed the ₹5,00,000 death benefit, asserting that her brother had been the family’s head and breadwinner after their parents’ deaths, and that she was dependent on him.

The insurer rejected the claim because a sister was not listed as a covered family member.

The District Committee, after considering the Sub-Divisional Magistrate’s report, found that the deceased was the head of the family and directed the insurer to pay; the insurer maintained its rejection.

The petitioner challenged the rejection dated 16 April 2021 by writ petition.

The insurance agreement, incorporated Scheme and policy govern the insurer’s liability; their words must be given effect without addition or substitution, and the provisions must be read together (Oriental Insurance Company Ltd. v. Smt. Uma Devi and others, Writ-C No. 21066 of 2020, decided 25 January 2021).

The Scheme distinguishes the persons covered for personal accident or medical benefits from the recipient of a death benefit: the family-composition clause identifies covered family members, while the death-payment clause requires payment of the insured amount to the nominee or legal heir when an insured head or breadwinner dies accidentally.

The Committee’s decision must be consistent with the Scheme and supported by reasons, and its authority cannot enlarge the insured risk.

The omission of a sister from the covered-family list does not, by itself, exclude her from receiving payment as a legal heir.

The Court found that the deceased’s accidental death occurred during the policy period and that the District Committee, relying on the revenue inquiry, had accepted him as the family’s head.

The petitioner claimed the death benefit as legal heir, not coverage for an accident or medical treatment suffered by her as a family member.

The agreement expressly provides for payment to a nominee or legal heir, without limiting that recipient to a person also listed as a covered family member.

The insurer’s interpretation would add such a restriction to the contract.

As no competing heir or other succession dispute was identified, the insurer’s categorical objection based solely on the petitioner’s status as a sister did not defeat her claim.

It allowed the writ petition, quashed the insurer’s rejection dated 16 April 2021, and directed the insurer to pay the petitioner ₹5,00,000 within four weeks of production of a certified copy of the judgment; the District Magistrate was directed to facilitate payment.