BEFORE THE ADDITIONAL BENCH OF A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
FA.No.1824/2007 AGAINST C.C.NO.13/2007 DISTRICT FORUM, KADAPA
Between:
The Branch Manager
M/s.Oriental Insurance Company Limited
D.No.7/43`, Korrepadu Road,
Proddatur Mandal, Kadapa. Appellant/
Opposite party
A N D
Miduthuri Parvathi W/o.late Suresh
Aged about 38 years, R/o.Goppavaram
Village, Proddatur Mandal,
Kadapa District. Respondent/
Complainant
Counsel for the Appellant:M/s.Bhaskar Poluri
Counsel for the Respondent:Mr.V.Gourisankara Rao.
QUORUM: SMT.M.SHREESHA, PRESIDING MEMBER
&
SRI SYED ABDULLAH, MEMBER
THURSDAY, THE FIFTEENTH DAY OF OCTOBER,
TWO THOUSAND NINE
Oral Order( Per SYED ABDULLAH,Hon’ble Member)
***
Aggrieved by the order of the file of District Forum, Kadapa, in C.C.No.13/2007 directing payment of insurance claim pertaining to the Janata Personal Accident Policy, this appeal is preferred by the opposite party contending that the District Forum has passed an erroneous order contrary to the terms and conditions of the policy.
The facts of the case are that the complainant’s husband, namely, Miduthuri Suresh, had taken Janata Personal Accident Policy for an assured amount of Rs.1,00,000/- i.e. policy bearing No.1806/1999 for the period from 31-3-1999 to 30-3-2000 and that the complainant was the nominee under the said policy issued by the opposite party. While the matter stood thus on 30-4-2004, the insured, Suresh, complained of chest pain and was taken to the nursing home at Proddatur where he became unconscious and died. He died due to cardiac arrest. The complainant informed the same to the opposite parties and requested to issue claim forms and settlement of the insurance claim but the opposite party neither supplied the claim forms nor settled the claim. Hence she alleged that the act or omission on the part of the opposite party amounts to deficiency in service and thereby sought for a direction to pay the insurance claim of Rs.1,00,000/- with interest at 18% p.a. from 30-4-2004 till realization together with compensation of Rs.25,000/- for mental agony and costs of Rs.1,000/-.
The opposite party filed a counter admitting that Janata Personal Accident Policy was issued in favour of the complainant’s husband but denied that the complainant informed about the death of the insured or requested for sending claim forms. However, the deceased died due to heart attack which is not an accidental death. The policy in question covers accidental deaths only. The certificate was obtained from the Nursing home my manipulation and no post mortem was done to find out the cause of death.
During the enquiry, the complainant had filed Exs.A1 to A5 along with the affidavit evidence in support of her claim. The opposite party has not filed any documents.
After going through the evidence on record, the District Forum gave a finding that death on account of cardiac arrest is an unexpected and unforeseen event which one cannot foresee and so it amounts to accidental death and thereby granted the relief as prayed for.
Aggrieved by the said order, the opposite party filed the present appeal contending that the impugned order suffers from factual and legal infirmity for the reason that the terms and conditions of the Janata Personal Accident Policy covers only bodily injuries resulting death caused by such injuries, other violent or by visible means. It is also contended that in the absence of any accidental injury, the cardiac arrest cannot be considered as accidental death.
The point for consideration is whether the impugned order is sustainable taking into consideration that the death due to cardiac arrest is an accidental death or natural death
Perused the record and on reappraisal of it we are of the considered opinion that as per the terms and conditions of the Janata Personal Accident Policy, it covers only accidental deaths but not death that has taken place otherwise due to cardiac arrest. On perusal of the terms and conditions of the policy which discloses that the insured should sustain any bodily injury resulting solely or directly from an accident by outward, violent and visible means then only the company shall be liable to pay the assured amount. In view of the clear terms and conditions of the policy under no stretch of imagination, it can be said that the cardiac arrest was due to any accidental injury and the order of the District Forum suffers from this infirmity since the death was on account of cardiac arrest. The finding of the District Forum that it is an unexpected and unforeseen event which cannot be foreseen and as such it is accident is not at all sustainable. The aforesaid reasoning given by the District Forum is contrary to the terms and conditions of the policy and is not sustainable. Hence we allow the appeal and set aside the order of the District Forum by dismissing the complaint.
In the result, this appeal is allowed setting aside the impugned order of the District Forum in C.C.No.13/2007 and consequently dismissing the complaint. Each party to bear their own costs in the circumstances of the case.
Sd/
MEMBER.
Sd/-
MEMBER.
.
JM 15-10-2009
