Claim does not fall within the ambit of Certificate’s coverage

Background

The claim was made by the participant for hospitalisation and surgical benefit of the person covered due to the injuries suffered in an accident. It was noted that the person covered did not have a valid driving licence at the material time.  

 

Investigation and Findings

The participant’s claim was repudiated on the ground that the person covered did not possess a valid driving licence at the time of accident. The takaful operator contended that a person who drove a vehicle wihout a valid driving licence would fall within the meaning of ‘illegal activities’ in clause 9.1 (t) of the Certificate. Hence, the claim was not payable.  

Clause 9.1 (t) of the Certificate states as follows:   

 

9.  Risks not covered

9.1  We will not pay the benefit if any hospitalisation, surgery or charges resulted directly or indirectly, wholly or partly from or as a result of the following:

(t) Sickness or injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to sky dyving, wáter skiing, underwater activities requiring breathing apparatus, winter sports, profesional sports and illegal activities.”

 

The Case Manager had perused the supporting documents submitted and noted that based on the police report, the person covered had an accident in July, 2016 and thus, suffered multiple injuries. The Case Manager noted that the person covered did not possess a valid driving licence at the material time. The participant also admitted that the person covered did not possess a valid driving licence at the material time.

The question was whether ‘riding a motor cycle without a valid driving licence‘ belongs to the same genus and characteristics of “...racing of any kind (except foot racing), hazardous sports such as but not limited to sky dyving, wáter skiing, underwater activities requiring breathing apparatus, winter sports, profesional sports…”.  

The Case Manager opined that in intepreting clause 9.1 (t), regard must be had to the genus or common character of the preceding words before ‘illegal activities’ mentioned in the said clause and ought to be interpreted ‘Ejusdem Generis’.  

In this regard, the Case Manager drew the takaful operator’s attention to the principal rules of construction, i.e. ‘Ejusdem Generis Rule’, the meaning of a particular word may be limited by its context. The ‘Ejusdem Generis Rule’ is applied when a group of specific words or phrases are followed by a general word or phrase, e.g. “and other” or “etc”, then, in construing the general words, regard must be had to the genus or common character of the preceding words.

Applying the principle to the case, it was clear from the fact and circumstances of the case that ‘illegal activities’ referred in the clause should be construed as an illegal sports activities such as illegal match fixing, sports betting or gambling.  

Thus, the Case Manager opined that riding a motor cycle without a valid driving licence was not of the same genus or character of the other instances listed in the same clause.

 

Decision

The takaful operator revised its decision and settled the participant’s hospitalisation and surgical benefit claim.