National Consumer Disputes Redressal
Krishna Wati vs Lic Of India on 22 November, 2005
Equivalent citations: I(2006)CPJ21(NC)
ORDER
P.D. Shenoy, Member
1. The question for consideration is whether the accidental injuries which resulted in death of the insured during the treatment within three days of the accident, finally due to heart-attack, can it be termed as an 'accidental death' or a 'natural death'. Admittedly, the insured was struck down by a cow while he was on the way to his office, as a result, he had fallen down, suffered chest pain and died within three days. In our view, it was not a natural death but was a death due to accident.
The facts in brief are as under:
Case of the complainant:
The complainant's husband late Shri Bhagat Ram (hereinafter called the deceased) had taken four double accident insurance policy Nos. 23244953, 23835197,170270663 and 170835166 for Rs. 5,000, Rs. 10,000, Rs. 15,000 and Rs. 25,000 respectively.
2. While the deceased was going to his hospital on his bicycle, he was struck down by a stray-cow, due to which he fell down and suffered severe chest pain. He was then taken to a hospital, whereat first aid was given to him and later on he was referred to the heart specialist who gave medical aid. As his condition became serious, on the next day, he was referred to another heart specialist, Dr. S.C. Garg, of Kurukshetra Nursing Home. As he could not get proper medical aid, he expired in same Nursing Home on 30.6.1996. Despite repeated correspondence, the Insurance Company released only the single benefit, treating it as the case of natural death and double accident benefit claim was refused. Hence, the, complainant had to approach the District Forum, Kurukshetra by filing Complaint No. 309/96.
3. The District Forum held that it was not proved on record that the death of Bhagat Ram was due to the injury caused to him in the accident on 27.6.1994. Accordingly, the District Forum did not find any merit in the complaint filed by her. Therefore, dismissed the same without any order as to costs.
4. Aggrieved by the order of the District Forum, Smt. Krishna Wati filed an appeal, First Appeal No. 1567 of 2000 before the State Commission, Haryana. The State Commission held that it was brought to their notice that the complainant had filed her Complaint No. 757 of 1995 against the Oriental Insurance Company before the District Forum, Chandigarh, which was decided on 13.10.1998 with a direction to opposite party-Oriental Insurance Company, to pay a compensation of Rs. 74,000 to the complainant-Smt. Krishna Wati, in full and final settlement of the claim as the matter was mutually settled between Smt. Krishna Wati and the Oriental Insurance Company. During the pendency of this complaint, the complainant filed another Complaint Case No. 309 of 1996 against the LIC before the District Forum, Kurukshetra. Accordingly, the State Commission ordered that they were not inclined to interfere with the impugned order of the District Forum and dismissed the appeal. Hence this revision.
Submissions of the learned Counsel for the revision petitioner:
5. It is submitted that the Oriental Insurance Company along with the learned Counsel for the complainant filed a compromise petition and accordingly the Oriental Insurance Company was directed to make payment of Rs. 74,000 to the complainant in full and final settlement of the claim, whereas the case before this Commission is about four insurance policies taken from the LIC for the assured sum of Rs. 55,000 as the claimant's husband died due to an accident but the double benefit due to the accident cover has not been paid to the complainant. The learned Counsel for the petitioner prayed that this Commission may Kindly award the same.
Submissions of the learned Counsel for the respondent:
6. The learned Counsel for the LIC submitted that both the Fora below have rightly dismissed the complaint. He brought to our notice the claim form submitted by the complainant, wherein the immediate cause of death is mentioned as heart attack as per the version of the doctor. Hence, he submitted that the claimant has not mentioned accident as the immediate cause of death. Therefore, the revision petition should be dismissed in limine. He further stated that the Strategic Security Consociates made an enquiry from Dr. S.C. Garg of Kurukshetra Nursing Home. The inquiry revealed that there were no apparent injuries on the body of Shri Bhagat Ram, when he was brought to him on 28.6.1994 and he was treated for heart attack. He also revealed that after the demise of Shri Bhagat Ram in the Nursing Home, he had advised the deceased's relatives for getting the post-mortem done in a Civil Hospital. He also counselled that it was very difficult, rather impossible, to say that the heart attack could be caused due to the type of the accident described by him to us (collision of the insured and a stray cow when the insured was cycling; resulting in the insured's fall from his bicycle), unless the port mortem as done. He has also submitted that the complainant has concealed the fact of having taken the insurance policy from the Oriental Insurance Company and got the claim settled therefrom while submitting the complaint before the District Forum, Chandigarh. There is no nexus between the alleged accident and the death due to heart attack. For the aforesaid reasons, the Fora below after going through the records as well as the evidence produced before them have rightly rejected the claim of the complainant.
7. Findings:
(a) Our attention was drawn to the claimant's statement, wherein immediate cause of death has been referred to as "heart attack as per version of doctor." It is relevant to look into some other columns as well. Against duration of last illness it was mentioned "four days" that means late Shri Bhagat Ram was ill for four days after injuries caused due to the accident while he was riding a bicycle and was attacked by a cow. Secondly, in the column against nature of illness it was mentioned "pain in chest." Thirdly, against the column, when did the deceased first complain of being not in usual god health, the reply is 27.6.1994, "just soon after the accident".
(b) It is useful to go through the report of the investigator of Strategic Security Consociates, the detective and investigators. During some supplementary investigation, it is mentioned that his inquiry from Dr. S.C. Garg revealed that there was no injury on the body and after the death of the injured, he advised the deceased's relatives for getting the postmortem done in a Civil Hospital. He also advised that to prove that heart attack could be caused due to this accident (collision of the insu red and a stray cow when the insured was cycling; resulting into the insured's fell from his bicycle), post mortem report is necessary. We do not have any affidavit filed by Dr. S.C. Garg to support this contention.
(c) The aforesaid investigating agency also submitted as follows:
Our independent and secret inquiries from various employees of the Block Dev. and Panchayat Samiti Officer, Ladwa, revealed that Shri Bhagat Ram, who was employed there, had never suffered from any heart trouble and he was also never seen or said to be taking any medicine for that. In fact he was said to be a very active and energetic man, who used to do lot of cycling every day.
During our further inquiries from the Agarwal Nursing Home, Dr. V.P. Agarwal, confirmed that Shri Bhagat Ram Aggarwal (the insured) was not having any cardiac problem previously (i.e., before the accident and the heart attack). He wrote this fact, in form of a letter to the Insurance Company (placed as Annexure-2 with this report).
Our further inquiries about the insured's accident, from the various shop-keepers around the spot/site of the accident, revealed the same, which had been gathered by vis earlier during our first investigation on the case. Some of the shop-keepers (who are having shops very near to the shop of the accident), in their joint statement, placed as Annexure-3 with this report, have confirmed about the accident and subsequent pain in Shri Bhagat Ram's chest.
During the course of our further independent inquiries, it was learnt that Shri Bhagat Ram Aggarwal (the insured) was brought to the Agarwal Nursing Home, upon being referred by Dr. P.R. Pruthi, Medical Officer of the Civil Hospital, Ladwa. Subsequently, Dr. P.R. Pruthi was contacted and cross-examined by us in the Civil Hospital. He said that Shri Bhagat Ram, accompanied by some other persons, had walked upto him in the Hospital and had told him that he was having pain in his legs and all around the chest area, including his ribs, because of a fall from his bicycle, after being struck by a stray cow near the Hospital, Chowk Ladwa. He examined him and referred him to Dr, V.P. Aggarwal of the Agarwal Nursing Home, Ladwa. He also said that he did not notice any skin injuries on the body of Shri Bhagat Ram. As regards the previous health history, he said that Shri Bhagat Ram, sometimes used to be checked by him for high blood pressure but never for any heart trouble. Dr. Pruthi, however, refused to give any statement in writing.
As for the deceased's Post Mortem not having been got conducted by the family of the insured, it was disclosed by the wife and sons of the deceased (the insured) that they did not get the Post Mortem carried out because they did not want any dissection/mutilation of his dead body and also because the death was not caused due to any fight with any person or accident against any vehicle. Their point statement is placed as Annexure-5 with this report.
Our further inquiries from the residents of the neighbouring houses to the insured's confirmed the fact that the insured was enjoying healthy life and that he was not suffering from any heart trouble before the accident. A joint statement to this effect, by some of the neighbouring residents to the insured's, is placed as Annexure-6 with this report.
8. After analysing all the evidence, he gave an opinion that the death of the insured was caused because of the accident, which resulted into injuries (not visible) to the insured and his subsequent death.
(d) This report is signed by ShriS.C. Mehta, Managing Director, Strategic Security Consociates and is dated 20th November, 1994. This report dispels any iota of doubt about the health of the insured and the proximate ard the ultimate cause of death of the insured. Though this agency was engaged by Oriental Insurance Company, the investigation conducted by this agency pertains to the same accident which caused the demise of Shri Bhagat Ram, the complainant in this case. Further, the learned Counsel for the Life Insurance Corporation, the respondent in this case, has also quoted the extracts from the report of this agency particularly relating to the inquiry made from Dr. S.C. Garg of Kurukshetra Nursing Home. Hence this report is reliable. In our view, from the record as it is, it is apparent that first the accident took place, resulted in injuries and chest pain which ultimately resulted in 'death'. May be, the death in the medical terms be described as 'due to heart-attack, but the main cause for leading to heart-attack was injury caused due to accident. Accident is the basis for Causing chest pain and thereafter heart-attack. Therefore, the orders passed by the lower Fora deserve to be set aside.
9. Accordingly, while allowing the revision petition, we set aside the order passed by the Fora below and direct the respondent LIC to pay the balance amount of Rs. 55,000 with 9% interest from the date of the complaint. It is also ordered that Rs. 5,000 be paid as cost by the respondent to the petitioner.