Sri Shyamal Gupta, Member

Present Appeal is directed against the Order dated 13-12-2013 passed by the Ld. District Forum, Howrah in CC No. 88/2013, whereof the complaint has been allowed.

Complainant’s case, in short, is that, at the time of purchasing a flat with the financial assistance rendered by the OP No. 1, her husband took a life insurance policy from the OP No. 2.  Initially the OP No. 1 issued a cheque worth Rs. 6,40,000/- on 11-06-2011 in favour of the vendor of the flat and a sum of Rs. 34,000/-  was taken from Complainant’s husband as premium of the Insurance policy.  Complainant’s husband died on 10-09-2011 due to acute cardiac arrest.  The insurance claim lodged in this respect being repudiated by the OP Insurance Company, the instant complaint was filed.

By filing a WV, the OP No. 2 stated that the claim was repudiated as per policy terms and conditions.  This OP claimed that it received the claim amount of Rs. 7,195/- vide a cheque dated 04-08-2011 only on 11-08-2011.  Based on the membership form, the insurance coverage was granted w.e.f. 11-08-2011.  As per Clause 22 of the policy, during the waiting period of 45 days, death benefit was payable only on account of accidental death of the Life Assured (LA).  Since the LA died within 30 days of inception of the policy and such death was not accidental in nature, the instant claim was not payable.

Decision with reasons

Heard the Ld. Advocates of the parties and gone through the documents on record. 

According to policy terms and conditions, during the initial waiting period of 45 days, only accidental death was eligible for indemnification, otherwise not. In this case, the LA died of heart attack.  The burning issue, therefore is, whether such death falls under the category of accidental death or not. 

Be it mentioned here that the policy wordings contained in the policy schedule does not define the term ‘accidental’.  Therefore, we deem it fit and proper to go by the literal meaning of the word.  According to Cambridge dictionary, the term ‘accidental’ means happening by chance.  Oxford Living dictionary defines ‘accidental’ as happening by chance, unintentionally or unexpectedly. 

Going by the above literal meaning, accidental death not necessarily mean death caused due to external injury; any death that occurs suddenly/unexpectedly can be treated as accidental death.  No document is placed on record by the Appellant to show that the LA was suffering from any kind of previous ailment.  At the time of death, the LA was only 44 years old and at this age, if one suffers heart attack, that sounds indeed unusual.  Notwithstanding the death certificate attributes the cause of death to Cardiac arrest with Type-II diabetes, unlike Type-I diabetes in which symptoms usually start in childhood, in case of Type-II diabetes, the person may not have symptoms before diagnosis.

Accordingly, we find no justification whatsoever behind repudiation of the instant claim of the Respondent No. 1 by the Appellant citing exclusion period as stipulated under clause 22 of the policy in question. Thus, we are of opinion that the Ld. District Forum rightly allowed the complaint. 

The Appeal, accordingly, fails.

Hence,

O R D E R E D

The Appeal stands dismissed against the Respondent No. 1, but without any cost.  The impugned order is hereby affirmed. 

Let the LCR be sent to the Ld. District Forum along with a copy of this order forthwith.