State Consumer Disputes Redressal Commission
Reeta Sharma vs Lic Of India on 11 August, 2009
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION, RAJASTHAN, JAIPUR APPEAL NO: 514/2006 Smt.Reeta Sharma w/o Lt.Sh.Anil Sharma r/o 1/8, MIG Parijat Housing Board, Nehru Nagar, Sainti, Chittorgarh. Complainant-appellant Vs. Life Insurance Corporation of India through Br.Manager Br.office, Kila Road, Chittorgarh Opposite party-respondent Date of judgment 11.8.09 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member Mr.Umesh Nagpal counsel for the appellant Mr.Ramkalyan Sharma counsel for the respondent JUDGMENT
BY THE STATE COMMISSION ( PER HON. MR.JUSTICE SUNIL KUMAR GARG, PRESIDENT ) 2 This appeal has been filed by the complainant appellant against order dated 14.2.06 passed by the District Forum, Chittorgarh in complaint no. 322/2005 by which the complaint of the complainant appellant was dismissed.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum,Chittorgarh on 30.7.05 inter alia stating that her husband Anil Kumar Sharma, now deceased was a General Manager in the Saifco Cement Pvt. Ltd. at Srinagar in the State of Jammu & Kashmir. It was further stated in the complaint that the deceased had taken two LIC policies from the respondent bearing policy no.181946251 on 29.11.96 for a sum of Rs. 1 lac and another policy bearing no. 182623527 on 10.2.99 for a sum of Rs.1 lac and both policies were taken with accidental benefit. It was further stated in the complaint that the deceased was a Foreman in the cement factory and in the night of 12/13.1.04 after performing his duties, he came to his quarter and since there was very cold in the State of Jammu and Kashmir, people of that State were in habit of sleeping in the room after putting fire on Angithy. It was further stated in the complaint that on that night the deceased as well as his associate Qadir Wali Khan both had slept after lightening the Angithy and because of that fire a poisonous gas known as Carbon Mono Oxide came outside through the smoke that was coming from 3 Angithy and thereafter because of Carbon Mono Oxide gas there was suffocation in the room, and since the room was not found opened on 13.1.04 in the morning by both of them , the same was opened on 13.1.04 after breaking the door and the associate Qadir Wali Khan was found dead on the spot while the deceased was found unconscious and he was taken to the SMHS Hospital,Srinagar where he was declared dead. It was further stated in the complaint that thereafter the matter was investigated by SHO Pathan chowk, Srinagar and since the police had come to the conclusion that the death of the deceased was accidental one and death had taken place due to suffocation of poisonous gas and thereafter claim was preferred by the complainant respondent being the wife and nominee of the deceased before the office of the respondent in respect of both policies and only the insured amount had been paid by the respondent LIC to the complainant but the accidental benefit was not given by the respondent LIC and the claim was repudiated by the respondent through letter dated 14.12.04 in respect of accidental benefit on the ground that since the death of the deceased was due to inhalation of carbon mono oxide and that death was not covered under the definition of accident, therefore accidental benefit was not payable .Thereafter the present complaint was filed.
A reply was filed by the respondent LIC on 5.10.05 and in the reply they have taken the same pleas 4 which were taken by them in the repudiation letter dated 14.12.04 and the respondent had admitted the fact that the deceased had taken two LIC policies alongwith accidental benefit as mentioned above and since the death of the deceased had taken place due to inhalation of poisonous gas, therefore, it was not a case of accidental death and reliance has been placed on clause 10 (b) of the policy and it was prayed that complaint of the complainant be dismissed as claim of the complainant was rightly repudiated by the respondent.
After hearing the parties, the District Forum, Chittorgarh through impugned order dated 14.2.06 had dismissed the complaint enumerating the reasons in para 7 of the impugned order.
Aggrieved from the said order dated 14.2.06 passed by the District Forum, Chittorgarh, this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the appellant complainant is that a bare perusal of the proceedings taken by the police of Pathan chowk u/s. 174 CRPC and from the report dated 13.1.04 of the SHO Pathanchowk clearly reveals that the death of the deceased had taken place because of inhalation of the gas coming from Angithy and that report of SHO was submitted to the Sub-divisional Police Officer, Nehru Park who had forwarded the report to the S.P. City East through letter dated 1.7.04 in 5 which he had also come to the conclusion that it was found established that the death of the deceased had taken place due to inhalation hard cook gas and therefore, the death of the deceased should be treated as accidental one and hence, repudiation of claim of the complainant appellant by the respondent was wholly illegal and arbitrary and in view of this the findings of the District Forum as mentioned in para 7 of the impugned order dismissing the complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity and it was prayed that appeal be allowed.
4. On the other hand, the learned counsel appearing for the respondent has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondent and gone through the entire materials available on record.
6. There is no dispute on the point that the deceased had taken two LIC policies from the respondent bearing policy no.181946251 on 29.11.96 for a sum of Rs. 1 lac and another policy bearing no. 182623527 on 10.2.99 for a sum of Rs.1 lac and both policies were taken with accidental benefit.
7. There is also no dispute on the point that deceased had died on 13.1.04 while he was sleeping alongwith his associate in his room after lightening Angithy to save themselves from 6 cold and after the death of the deceased the matter was investigated by the police of Pathan chowk,Srinagar u/s. 174 CRPC and the report dated 13.1.04 of the SHO Pathanchowk was submitted to the Sub-divisional Police Officer, Nehru Park who had forwarded the report to the S.P. City East through letter dated 1.7.04 in which he had also come to the conclusion that it was found established that the death of the deceased had taken place due to inhalation hard cook gas.
8. There is no dispute on the point that after the death of the deceased postmortem of the dead body of the deceased was got conducted in which the cause of death of the deceased was assigned by the doctors of the hospital in the following manner-
" Opinion as to cause of death Died because of Carbon Monoxide poisining as confirmed by Forensic Science Laboratory vide their report no. FSL/237-C47/Sgr. Dated 28.8.2004"
9. There is no dispute on the point that the claim in respect of accidental benefit of the above mentioned two policies was repudiated by the respondent through letter dated 14.12.04 on the grounds mentioned therein.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded 7 by the District Forum by which complaint was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondent in respect of accidental benefit was justified or not or whether the death of the deceased in the pesent case could be treated as accidental one or not.
11. Before proceeding further it may be stated here that clause 10 (b) on the basis of which claim of the complainant appellant was repudiated by the respondent is reproduced here-
"10 (b) Death of the Life Assured: to pay an additional sum equal to the sum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 120 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. However, such additional sum payable in respect of this policy together with any such additional sums payable under other policies on the life of the life assured shall not exceed Rs.5,00,000/-."
12. It may further be stated here that the death of the deceased in the present case could not be treated as suicidal one, could not be treated as homicidal one and could not be trated as natural one but on the contrary the death of the deceased had taken place because of 8 inhalation of hard cook gas while he was in the room and the question is whether the said death could be treated as accidental one or not.
13. Before proceeding further something should be said about the word "
accident".
14. The word " accident" is constantly used in ordinary English and therefore, in law, in two senses, one much wider than the other. Strictly an occurrence only be said to be accidental when it is due neither to design nor to negligence. For, if an act be intentional it is clearly no accident; if it be result of culpable negligence, then by due care it could have been avoided and the negligent person could not be allowed to excuse himself by declaring it an accident. In this narrower sense of the word, an accident must be " nobody's fault ".
15. The word " accident " generally denotes an event that takes place without one's foresight or expectation ; an event which proceeds from an unknown cause, or is an unusual effect of a known cause and therefore, not expected; chance, causality, contingency ; an event happening without the occurrence of the will of the person by whose agency it was caused.
16. The word " accident" is derived from the Latin verb "
accidere " signifying " fall upon, befall, happen, chance ". In an etymological sense anything that happens may be said to be an accident and in this sense, the word has been defined as 9 befalling a chance; a happening; an accident; an occurrence or event.
17. The ordinary meaning of the word "accident " is an unintended occurrence which had an adverse physical result.
18. The expression "accident " has been defined as an unlooked for mishap, an untoward event which is not expected or designed. It is used in the popular and ordinary sense and mens a mishap or an untoward event not expected or designed.
19. An accident is not the same as an occurrence but something that happens out of normal or ordinary course of things.
20. It may be stated here that the Hon'ble National Commission in a historical judgment under the name and style of Rita Devi @ Rita Gyota Vs. National Insurance Co. Ltd. & ors. reported in IV ( 2007) CPJ 355 (NC) has held as follows-
" Death due to cold wave not natural, it is by natural external violent force, cold wave an untoward event not expected or designed, an ordinary man could not expect occurrence, cold wave was sudden, number of persons including insured suffered massive heart attack as a result of which he died, death accidental proved, Insurance Company liable under the policy."10
The Hon'ble National Commission in para no. 49 has further held in the following manner-
" 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 fails 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."
21. A bare perusal of the law laid down by the Hon'ble National Commission in the case of Rita Devi (supra) clearly 11 covers the present issue of this appeal and when a death due to cold wave could be treated as an accidental death , therefore, the death which had taken place due to inhalation of hard cook gas would certainly amount to accidental death especially when the death of the deceased is neither suicidal nor homicidal and nor natural one and further the incident in the present case where the death had taken place due to inhalation of hard cook gas would certainly amount as an untoward event or unintended occurence which was not expected or designed and further an ordinary man could not expect such occurence and further since that unintended occurence had resulted an adverse physical result in the shape of death of the deceased due to suffocation, therefore, it would certainly amount to accidental death.
22. For the reasons stated above, it is held that the death of the deceased in the present case was accidental one and thus repudiation of claim of the complainant appellant by the respondent in respect of accidental benefit on the ground of clause 10 (b) could not be justified and the respondents were not justified in repudiating the claim of the complainant appellant and the findings of the District Forum dismissing the claim of the complainant appellant as enumerated in para 7 of the impugned order could not be sustained as they are not based on correct appreciation of entire materials and evidence available on record and they suffer from basic infirmity or illegality or perversity and the same are liable to quashed and set aside and the appeal deserves to be allowed.
12Accordingly, the appeal filed by the appellant is allowed and the impugned order dated 14.2.06 passed by the District Forum, Chittorgarh is quashed and set aside and the complaint of the complainant appellant stands allowed in the manner that the respondents are directed to pay to the complainant appellant a sum of Rs. 1 lac as amount of accidental benefit in respect of policy no.181946251 and similarly a sum of Rs. 1 lac as amount of accidental benefit in respect of policy bearing no. 182623527, totalling Rs. 2 lacs alongwith interest @ 9% p.a. from the date of filing of the complaint i.e. 30.7.05 till the payment is made and the respondents would further pay a sum of Rs. 5000/- as costs of litigation to the complainant appellant.
(Vimla Sethia) (Justice Sunil Kumar Garg) Member President