BEFORE THE A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION

AT HYDERABAD

FA  122/2008  against C.C. 66/2007, Dist. Forum, Karimnagar         

Between:

Rondi Laxmi, @ Rondi Lachamma            

W/o. Rondi Sanjeev                  

Age: 50 years, Household       

R/o. Namilikonda (V)

Kodimiyal Mandal

Karimnagar Dist.                                         ***                        Appellant/

                                                                                                Complainant 

                                                                   And

1)  ICICI Lombard General Insurance

Rep. by its Office-in-charge

Road No. 1, Opp. Old HSBS Bank

Near Nagarjuna Circle

Banjarahills, Hyderbabad.

2)  ICICI Lombard General Insurance

Rep. by its Office-in-charge

Opp. Dist. Court Building

Karimnagar.                                                ****                       Respondents/

                                                                                                Ops.

Counsel for the Appellant:                          M/s. M. Ramgopal Reddy

Counsel for the Resps:                                M/s.  N. Mohana Krishna.

                                                                   M/s. D. Sri Jyothi Rao.

CORAM:

                         HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT     

     &

                                 SMT. M. SHREESHA, MEMBER

TUESDAY, THIS THE TWENTY THIRD DAY OF NOVEMBER TWO THOUSAND TEN

Oral Order: (Per Hon’ble Justice D. Appa Rao, President)

                                                          *****

1)                Appellant is unsuccessful complainant. 

2)                The case of the complainant in brief is that  she is the wife and nominee of  the deceased   Rondi Sanjeev  who had obtained  Pravasi  Bharathiya  Bheema Yojana-2006  policy for Rs. 5 lakhs  covering the  personal accident benefit.    While so on  27.7.2006  he died suddenly due to cardiac arrest at  Doha of Qutar State.    When claim was submitted  neither it was settled nor  repudiated.   After issuing registered notice  she filed the complaint  claiming Rs. 5 lakhs  towards personal accident  benefit,  and Rs. 30,000/- towards repatriation expenses with interest @ 18% p.a.,  and compensation of Rs. 10,000/-. 

3)                The insurance company  resisted the case,  however, it has  admitted issuance of policy.   The complainant was put to strict proof that she was the nominee  and legal heir  of the deceased.    The policy covers  only in case of death that took place due to accident.    He did not sustain  any bodily injury in an accident.   The death was due to cardiac arrest which cannot be termed as  death by accident.   There was no external bodily injury thus not attracting  conditions of the policy.    Therefore it prayed  for dismissal of the complaint  with costs.

4)                The complainant in proof of her  case filed  her affidavit evidence and got Exs. A1 to A7 marked, while the insurance company filed the affidavit evidence of its  Manager (Legal)  and got Ex. B1 & B2 marked.

5)                The Dist. Forum after considering the evidence placed on record opined that  the death was due to cardiac arrest,   and he did not sustain  any bodily injury and the policy does not cover such  a case, and therefore dismissed the complaint.

6)                Aggrieved by the said decision, the  complainant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective.      It ought  to have  seen that cardiac arrest  is undoubtedly  an accidental death.    The Hon’ble Supreme Court in 2007 (2) ALD 16 SC  opined that none of the events mentioned in  exclusion clause  included,   and in the absence of  any exclusion, repudiation of claim on such a clause  was unjust.    Therefore she prayed that the amount be directed to be paid. 

7)                The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact and law?

8)                It is an undisputed fact that the deceased husband of the complainant had taken  Janta Personal  Accident Policy  Ex. B1 for Rs. 5 lakhs covering the period from  19.7.2006 to 10.7.2008.  The assured died on  27.7.2006 due to cardiac arrest  vide death certificate Ex. A2 & A3 which was mentioned as  the cause of death.    No doubt there was slight change in the spelling of  nominee name  viz., in Ex. B1  it was mentioned as “LACHAMMA”  whereas in the complaint her name was shown as “Rondi Laxmi @ Rondi Lachamma”.   Whatever  be the nomenclature the fact remains that  personal accident (death  and permanent total disability) covers an amount of Rs. 5 lakhs,  Rs. 30,000/- towards repatriation expenses.   

Personal accident is defined  under benefit  1(a): 

scope of cover : 

          “The company hereby agrees subject to the terms, conditions and exclusions  herein contained or otherwise expressed herein, to pay to the insured a sum not exceeding the  sum insured, if the insured sustains  any bodily injury during the period of insurance, resulting in death  or permanent total disablement leading to  loss of employment, caused solely  and directly from any accident, arising from any external, violent and visible means  to the extent and in the manner provided, subject to the limit of  indemnity  as specified in part-I of the schedule. 

          In the event of death or permanent disability  during the period  of insurance due to any accident/physical  injury sustained, the company shall reimburse  the sum insured even after the expiry of the policy, provided  the accident occurred during the period  of insurance.”

          ‘Categories of benefits is defined as under :

          ‘Death’         “The capital sum assured as stated in part-I of the schedule will be paid if the death of the insured is within the period of 12 months from the date of bodily injury, and such bodily injury  be the sole and direct cause  of the death of the insured.”

9)                 A reading of above clauses  does  not in any way lead to the conclusion  that  natural cases of  death viz., death by  cardiac arrest could be included.    There should be undoubtedly bodily injury  and such bodily injury should be caused solely and directly from any accident. The words are explicit and that  it should be arising from any external, violent and visible means.      By no stretch  of imagination  cardiac arrest  could be termed as  accidental death, in the light of terms and conditions of the policy. 

10)               Learned counsel for the appellant relied a decision in  Rita Devi  @ Rita Gupta Vs. National Insurance Company Ltd. reported in IV (2007)  CPJ 355 (NC)  where  the National Commission  has considered  the case  where death was caused by cold wave.    Considering that the cold wave was  an untoward  event not expected  or designed  and an ordinary man  could not expect the occurrence and that the cold was sudden, it the circumstance  it was opined that  the death by accidental cold wave is not natural  and it would be accidental.  It is by nature external violent force, and therefore  the assured might have heart attack as a result of which he died, and therefore allowed  the claim. 

“Accident”. Back’s Law Dictionary, seventh edition defines accident to mean as follows:

“Accident”—1. An unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonable anticipated. 2. Enquity, practice. An unforeseen and injurious occurrence not attributable to mistake, neglect or misconduct-accident, adj.

 “The word accident”: In accident policies means an event which takes place without one’s foresight of expectation. A result, though unexpected, is not an accident; the means or cause must be accidental. Death resulting from voluntary physical exertions or from intentional acts of the insured is not accidental, nor is disease or death caused by the vicissitudes of climate or atmosphere the result of an accident; but where, in the act which precedes an injury, something unforeseen or unusual occurs which produces the injury, the injury results through accident.

“(1) A John Allan Appleman & Jean Appleman, Insurance Law and Practice: 360 at 455 (rev. vol. 1981).

After  exhaustively considering the meaning of the word   in Stroud’s  Judicial Dictionary of Words and Phrases, sixth edition  it defines accident as follows :

 “Accident; Accidental; Accidentall—The Courts have established a long line of cases which identify the essential characteristics of an accident as an event; which was neither expected nor intended and which causes hurt or loss [Hersey v. White, (1990) 1 Q B 481; Fenton v. Thorley, (1903) A C 433; Boyle v. Wright, (1969) V L R 699; R v. Pico, (1971) RTR 500].

“In deciding for the purposes of an insurance policy whether an event was ‘accidental’ a distinction has to be made whether the cause was the deliberate taking of an appreciated risk, and therefore, not accident, Gray v. Barr, (1971) 2 Q B 554, where a person intending to scare another with a gun shot him; held not accident), and cases where the cause (such as excessive drinking) although a deliberate act, led to the taking of a risk (such as dangerous driving) which was not deliberate and not appreciated but which was nevertheless the immediate cause of the event [Chief Constable of West Midlands Police v. Bellingham, (1979) 1 W L R 747].”

          Finally the National Commission observed :  

   “From the aforesaid law developed in other countries and in this country, it is clear that the injury or death caused by lightening, sun-stroke or earthquake has been held to be accidental. Further, where a man in the course of his work is exposed to excessive heat coming from a boiler and becomes exhausted and death occurs, it would be an accidental death. Similarly, a person working in a icy cold water and thereafter, sustains pneumonia which causes his death, such death is also considered to be an accidental death. Similarly, if the assured is seized by a fit and drowns or falls in front of a train and killed, death is due to external cause and is an accidental death. Death resulting from the threats by miscreants is also considered to be an accidental caused by external violence and visible means. In substance, death which does not occur in the usual course or natural course of events or events/causes which could not be reasonably anticipated is considered to be accidental one. Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect and it is by natural external violent force. Further, ‘cold wave’ is an untoward event which is not expected or designed, and an ordinary man could not expect the occurrence.”

11)              Evidently the complainant did not file any  evidence to show  any of the reasons as to sudden cardiac arrest of her husband.    Had  such an evidence been let in, we could have in a position to state that the death was accidental.  Sudden cardiac arrest  could not be termed as  accidental death.    We are in agreement with the  opinion expressed by the Dist. Forum.  We do not see any merits  in the appeal.

12)              In the result the appeal is dismissed. No costs.

1)      _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER           

   Dt.  23. 11. 2010.  

*pnr

UP LOAD – O.K.