State Consumer Disputes Redressal Commission
New India Assurance Co.Ltd vs Smt.Kiran Agnihotri Widow Of Shri ... on 11 December, 2009
1
Appeal 381/2003
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SCO NO.3009-10, SECTOR 22-D, CHANDIGARH
First Appeal No.381 of 2003
Date of Institution : 26.3.2003
Date of Decision : 11.12.2009
New India Assurance Co.Ltd. having its Regional Office at SCO No.36-37,
Sector 17-A, Chandigarh, through Shri Anil Chawla, Legal Officer, duly
Constituted Attorney.
.........Appellant
Versus
Smt.Kiran Agnihotri widow of Shri Rajinder Pal Agnihotri, resident of EG-
903, Mohalla Gobindgarh, Jalandhar.
.........Respondent
Appeal against the order dated 5.2.2003
of District Consumer Forum, Jalandhar.
BEFORE
Hon'ble Mr.Justice S.N.Aggarwal, President
Lt.Col.Darshan Singh (Retd.), Member
Mr.Piare Lal Garg, Member PRESENT For the appellant : Sh.P.S.Saini, Advocate and Sh.Parminder Singh, Advocate with him For the respondent : Sh.Sanjay Nagpal, Advocate JUSTICE S.N.AGGARWAL, PRESIDENT Rajinder Pal Agnihotri, husband of the respondent had taken insurance policy from the appellants on 20.8.1998 for an amount of Rs.5 lacs which was valid upto 19.8.2008. He was suffering from Neurological Problem and remained admitted in D.M.C. and Hospital, Ludhiana from 15.12.2000 to 23.1.2001.
2. It was further pleaded that after recovery from sickness, he had joined his duties. He was attending the office regularly and was performing his normal duties. He was declared fit to perform his duties.
3. It was further pleaded that on 14.2.2001, the insured fell from the stairs of his house and suffered the head injury. He was being taken to 2 Appeal 381/2003 Tagore Hospital, Jalandhar but he died on the way. The insurance claim was lodged with the appellants which was repudiated. Alleging deficiency in service on the part of appellants, the respondent filed a complaint in the learned District Consumer Disputes Redressal Forum, Jalandhar (in short the 'District Forum').
4. The appellants filed the written reply. It was admitted that Rajinder Pal Agnihotri had taken the Accident Insurance Policy on 20.8.1998 for an amount of Rs.5 lacs from the appellants. It was denied if on 14.2.2001, the insured had a fall from the bed or if he had received the head injury or if he had died on the way to Hospital. It was denied if he was attended by Dr.Sant Kumar Gupta. The certificate given by Dr.Sant Kumar Gupta was manipulated by the respondent.
5. The matter was got investigated by the appellants from M/s National Detective & Consultancy Services, Jalandhar who in the report dated 18.3.2001 reported that the insurance claim was not covered in the insurance policy. Hence the repudiation was legal and valid. Dismissal of the complaint was prayed.
6. The respondent proved documents Ex.C-1 to C-2 and also filed her affidavit Ex.C-3. She also proved documents Ex.C-4 to C-10. On the other hand, the appellants filed the affidavit of Kesar Dass, Senior Divisonal Manager as Ex.R-1 and the affidavit of B.S.Sharma as Ex.R-2. The appellants also filed documents Ex.R-3 to R-15.
7. After considering the pleadings of the parties and the affidavits/documents produced on file by them, the learned District Forum accepted the complaint vide impugned order dated 5.2.2003 and directed the appellants to pay the insurance claim of Rs.5 lacs.
8. Hence the appeal.
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9. The submission of the learned counsel for the appellants was that appeal be accepted and the impugned order dated 5.2.2003 be set aside.
10. On the other hand, the submission of the learned counsel for the respondent was that there was no merit in the present appeal and the same be dismissed.
11. Record has been perused. Submissions have been considered.
12. Admittedly Rajinder Pal Agnihotri, husband of Kiran Agnihotri, respondent was insured with the appellants for an amount of Rs.5 lacs against death by accident and the insurance policy was valid for the period from 20.8.1998 to 19.8.2008. The Insurance Policy has been proved by the respondent as Ex.C-1. It has also been proved by the appellants as Ex.R-2. It is also not disputed that Rajinder Pal Agnihotri has died on 14.2.2001.
13. As per the version of the respondent, the life assured had fallen from the bed of his house and had suffered the head injury by which he died on the way to Hospital but the appellants have filed the report of the National Detective and Consultancy Services, Jalandhar dated 20.3.2001 as Ex.R-5 who have held detailed investigation and reported that Rajinder Pal Agnihotri had fallen down from the bed and got injury on his head on 14.2.2001 at about 9.00 a.m. due to his illness (as he had been suffering since long). He was being shifted to the Hospital when he died on the way.
14. In any case even as per the version of the appellants, the assured had fallen down from the bed and died. Therefore, the only cause of his death was the accidental fall which caused him the head injury and which ultimately proved fatal.
15. It may be that the life assured was suffering from a Neurological Problem which had not been concealed by the respondent from the appellants. Rather in the complaint, the respondent has pleaded that the life assured was suffering from Neurological Problem for which he remained 4 Appeal 381/2003 admitted in the hospital and had got the medical treatment. The treatment was taken by the life assured upto 23.1.2001. He was serving from 23.1.2001 till 14.2.2001. He died not because of his illness but because of his accidental fall. Therefore, the fall was the proximate cause of death of life assured. By the fall from the bed, the life assured suffered the injury on his head even as per the version of the appellants.
16. If the life assured did not have any fall, he could have continued living and would not have died on 14.2.2001. Therefore, the casue of death of life assured was the fall from his bed.
17. Similar preposition had come up for consideration before this Commission in First Appeal No.795 of 2007 titled as 'Life Insurance Corporation of India Versus Saroj Rani' decided by this Commission on 9.11.2009. As per the facts of that case, the life assured had ulcer in the body which burst only when he had a fall on the road by footslip. It was held that the proximate cause of death of the life assured was the fall which precipitated his death.
18. In the present case also, the cause of death of life assured was fall from the bed and it was covered by the definition of accident. The word accident has been defined in the judgment of Hon'ble National Commission reported as "Maya Devi v. Life Insurance Corporation of India" 2008 CTJ 1075 (CP) (NCDRC) as under:-
"Further, in England law on the subject is settled. In Halsbury's Laws of England Vol. 25 Pg.307 Para 569, 4th Edition (2003 reissue), as to the meaning of the word 'accident', it is stated as under :
"569. Meaning of 'accident'. The event insured against may be indicated in the 5 Appeal 381/2003 policy solely by reference to the phrase 'injury by accident' or the equivalent phrase 'accidental injury', or it may be indicated as 'injury caused by or resulting from an accident'. The word 'accident', or its adjective 'accidental', is no doubt used with the intention of excluding the operation of natural causes such as old age, congenital or insidious disease or the natural progression of some constitutional physical or mental defect; but the ambit of what is included by the word is not entirely clear. It has been said that what is postulated is the intervention of some cause which is brought into operation by chance so as to be fairly describable as fortuitous. The idea of something haphazard is not necessarily inherent in the word; it covers any unlooked for mishap or an untoward event which is not expected or designed, or any unexpected personal injury resulting from any unlooked for mishap or occurrence. The test of what is unexpected is whether the ordinary reasonable man would not have expected the occurrence, it being relevant that a person with expert knowledge, for example of medicine, would have regarded it as inevitable. The stand point is that of the 6 Appeal 381/2003 victim, so that even willful murder may be accidental as far as the victim is concerned."
19. Since the death has taken place due to accidental fall from the bed (as per the version of the appellants) and from the staircase (as per the version of the respondent), therefore, the respondent was entitled to insurance claim.
20. This appeal is, therefore, dismissed with cost of Rs.5,000/-
21. The appellants have deposited an amount of Rs.25,000/- with this Commission at the time of filing of appeal on 28.3.2003. This amount of Rs.25,000/- with interest accrued thereon, if any, be remitted by the registry to the respondent by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellants.
22. Remaining amount shall be paid by the appellants to the respondent immediately.
23. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
( JUSTICE S.N.AGGARWAL ) PRESIDENT ( LT.COL.DARSHAN SINGH RETD. ) MEMBER ( PIARE LAL GARG ) MEMBER December 11, 2009 vr/-
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