A is a horse-owner and races his horses. He has been racing horses, all of which are insured comprehensively by a general insurance company. One of the insured horses which has won many races for A in the past, had of la

CS Professional · Insurance - Law and Practice · PYQS · June 2018
A is a horse-owner and races his horses. He has been racing horses, all of which are insured comprehensively by a general insurance company. One of the insured horses which has won many races for A in the past, had of late, due to various factors including age, been on a losing streak and had lost at the recent three races and A had lost large amount of money because of this. Suddenly, this horse, which was insured for ₹25 lakhs, fell sick and died soon thereafter, the cause of death was indicated to be colic, a common killer disease of horses. A made a claim on the insurance company for ₹25 lakhs and incidental expenses. The insurer after due enquiry passed the claim and paid to A the amount of ₹25 lakhs as claim. One year after such payment was made, due to persistent newspapers reporting and on the basis of police investigation conducted in similar cases, it was noticed that some race horses which had become old and were losing races, were systematically killed by the owners through the help of a syndicate which had been retained by the owners. Y was arrested by the police in this regard as the main culprit who had poisoned the horses and enabled the owners to collect the insurance money. On examination, Y revealed the names of the horses that he had killed through poisoning and their respective owners. A was also included in the list. It was ascertained that death by electrocution could be disguised as death caused by colic. On the basis of this investigation and report, the insurer who had paid ₹25 lakhs to A wants to reopen the claim. Arising out of the above move, the following issues arise for consideration which you are required to deal: Can the insurance company which had already taken due measures to ensure the acceptance of the claim, go back on its settlement and recall the case.

Answer & Explanation:

The Insurance company has relied upon the facts and documents submitted by A and made the payment of the claim for death of the horse. Insurance is a contract of utmost good faith and the company relied on all the facts as given by the claimant. However on getting further information about the actual facts as reported in the press and police investigation in the matter the insurance company is entitled to go back to its settlement and recall the case. The insurance company can only recall the case by taking A in the court putting proper evidences against A then only the company gets back the payment given to A. Moreover A owns many horses and out of so many horses only one of those horses dies due to colic also puts a question mark on the intents. Besides the statement given by Y also indicates towards death of horses of other horse owners who planned the electrocution with Y and made claims to their insurance companies for such horses that were old and losing in the horse races. All these facts point towards the malafide intentions of the insured and thus insurance company can now reopen the case.

Topics: Insurance Claims

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