Life Insurance Corporation of India vs ANJU HUNJAN

NARESH Kumar (now deceased) husband of Smt. Anju Hunjan took Life Insurance Policy Nos. 160343003 dated 26.7.1990, 160437237 dated 30.3.1991, 160706202 dated 27.11.1993 for Rs. 25,000/-, 25,000/-, 50,000/- respectively. Smt. Anju Hunjan was his nominee under above said policies.

THE allegations made in the complaint are that Naresh Kumar husband of the complainant Smt. Anju Hunjan died on 5.5.1994 between 9.30 a.m. to 10 a.m. as he slipped in the bathroom. Nearby Dr. Ved Prakash Jindal was called immediately who referred him to the hospital but he died on the way. Dr. Hemant Wilson issued the certificate dated 6.12.1994 indicating that as per record patient Naresh Kumar was brought dead in the Causality at 10 a.m. on 5.5.1994 by his brother Santosh Kumar resident of Harpal Nagar, Ludhiana. It is further stated in the complaint that Naresh Kumar died due to accident while he fell in the bathroom and thus he was entitled to accident claim from the above said parties. THE accident claim made by Smt. Anju Hunjan widow of Naresh Kumar deceased has been repudiated by the opposite party on flimsy ground. A direction was sought by the complainant from the District Consumer Disputes Redressal Forum, Ludhiana (hereinafter called the District Forum), to pay her Rs. 1,00,000/- being insured amount towards accident benefit claim along with interest @ 18% p.a. from 5.5.1994 till the actual payment is made+Rs. 25,000/- as compensation for mental agony and suffering caused to the complainant. Another relief to which the complainant was found entitled to, was also asked for. After issuance of notice, the opposite party filed written statement. It was stated in the reply that there was no deficiency in rendering service. Complaint was not maintainable, as no accident had taken place. The claim of the complainant was denied on the ground that actually no accident had taken place and death by accident has not been established. Thus, the complainant is not entitled to accident benefit claim. All other claims, sum assured have been paid and accident benefit claim has been repudiated, as life insured did not receive any external injury after alleged slipping in the bathroom.

After hearing the Counsel for the parties and perusing the record, the District Forum allowed the complaint by holding that death took place due to an accident.

WE have heard learned Counsel for the parties and have perused the relevant record with their assistance. Only point which needs determination in this case is as to whether Naresh Kumar, insured with the opposite party i.e. Life Insurance Corporation of India, died on account of accident or his death was natural.

BEFORE proceeding further we would like to reproduce Clause 10(B) of the policy vide which the deceased was insured. Clause 10(B) reads as under : "10(B)-Death of the life assured : To pay additional sum equal to the sum assured under the policies if the life assured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means and such injury results in death within 90 days of its occurrence."

According to the above said provision, the opposite party is liable to pay additional sum equal to the sum assured under the policy, if the life insured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means and such injury results in death within 90 days of its occurrence. The case of the complainant-respondent is that Sh. Naresh Kumar, now deceased, slipped in the bath room on 5.5.1994 at about 9.30 a.m. Immediately after that, he was taken to the hospital. But he died in the way before be could reach the hospital.

IT is not proved on the record that the deceased suffered any injury on his body external or internal, which could be the cause of his death. Admittedly no FIR was lodged about the alleged accident. No post mortem was conducted on the dead body of the deceased, which could reveal the cause of death of the deceased. No external injury was found on the dead body. There could be other reasons for death of the deceased e.g. it could be heart attack. IT is not necessary that the heart attack could be the result of a fall in the bathroom. May be the deceased suffered heart attack before he fell in the bathroom. In these circumstances, it cannot even be presumed that the death of the deceased occurred due to accident. District Forum has erred in law and on facts in arriving at a conclusion that in this case the death of Naresh Kumar occurred due to an accident. At one place in its order, it has been mentioned as under : "Injury from the accidental slip was so severe that he slipped at 9.30 a.m. and died within half an hour and certificate issued by Dr. Jindal (Ex. C-8) and certificate of Dr. Hemant Wilson, wherein it has been stated that the patient, Naresh Kumar was brought dead in Casualty at 10 a.m. and this fact is also proved by the report submitted by the doctor. IT is admitted fact that death is due to accidental slip in the bathroom. IT is nowhere stated in the terms of the policy that it is necessary that injury, which resulted in death of the person, must be external only.... IT is established beyond doubt that inside injury was so severe which resulted into death within half an hour of the slip in the bathroom and when taken to C.M.C. Hospital Casualty, there he was declared dead."

FROM the readings of the order of the District Forum, it is evident that the District Forum has presumed that there was a severe injury on the body of the deceased due to accidental slip. This presumption by the District Forum is without any basis. We do not know as to from where it was found by the District Forum that the injury from the accident slip was so severe. Admittedly, no post mortem was conducted on the body of the deceased and there was no other visible sign from which it could be concluded that there was any injury at all internal or external on the body of the deceased. It is not even exactly known as to within how much time of the fall, Naresh Kumar had died; because when he was taken to the hospital, the doctor found him already dead. Absence of external injury on the dead body of Naresh Kumar becomes relevant when no internal injury on his dead body was proved on the record. It was incumbent on the complainant to produce some reliable evidence, which could reveal that the death of Naresh Kumar occurred due to some accident injury external or internal. In view of the factual position discussed above, we are firmly of the opinion that it is not proved on the record that the deceased Naresh Kumar died due to an accident. He could thus not avail of the benefit of Clause 10(B) of the policy and the Corporation was not liable to pay additional sum equal to the sum assured under the policy, when he did not sustain any bodily injury resulting solely or directly from accident caused by outward, violent and visible means. There was, thus, no deficiency on the part of the Insurance Company.

In view of our discussion made above, we set aside the order dated 19.12.1997 of the District Forum, Ludhiana and accept the appeal, however without any order as to costs. Appeal allowed.