State Consumer Disputes Redressal Commission
Lic Of India vs Ali Mohd. on 19 January, 2010
BEFORE
STATE C0NSUMER DISPUTES REDRESSAL COMMISSION, CIRCUIT BENCH,
RAJASTHAN, JAIPUR
Appeal No. 1808/2007
Life
Insurance Corporation of India Ltd., through its Divisional Office:
'Jeevan Prakash', B.S. Road, Jaipur- 302 005.
..Appellant-Opposite Party
VS
Ali
Mohd. S/o Shri Chiraguddin Maniyaar, R/o Bhartiya Hospital Road, Naya
Baas, Ward No. 11, Churu(Raj).
..Respondent-Complainant
Before:
Mr.
G.S. Hora, Presiding Member
Mr. Sikandar Punjabi, Member Present:
Mr.Vizzy Agarwal, counsel for the Appellant Mr. Prem Prakash on behalf of Mr. Asgar Khan, counsel for the Respondent.
ORDER Dated: 19.01.2010 PER Mr.H.S. HORA, PRESIDING MEMBER This
appeal arises out of the order dated 5.10.2007 passed by the District Consumer Forum (DCF), Churu whereby the Appellant Insurance Corporation was directed to give accidental benefits to the Complainant and to pay Rs. 2,000/- as compensation and litigation expenses.
The Complainant Ali Mohd. had taken a 15-years Jeevan Surabhi Policy with profits + accidental benefits on 12.11.1999 of sum assured of Rs. 50,000/-. The date of maturity was 28.10.2014. As per the Complainant, he had fever & jaundice together in 2001 because of which he went in coma and when he came out of coma, his body stopped working and that despite taking treatment from various Doctors, his condition did not improve and he was finally rendered total disabled on 11.7.2005 and became 100% blind. The Complainant sent an application to the Insurance Corporation for providing him disability benefits but the benefit was not extended to the Complainant on the ground that the Complainant could have been accorded disability benefit under the condition of the policy only if such disability had arisen out of accident. As the disability was not 2 due to an accident, the Complainant was not entitled to get any accidental benefit.
The learned DCF quoted dictionary meaning of the accident and relying upon certain rulings came to the conclusion that the disability suffered by the Complainant amounts to disability on account of accident and therefore passed an award in his favour.
Heard the learned counsels and gone through the file.
So far as the facts are concerned, both counsels agreed that the disability was because of fever & jaundice on account of which the Complainant went in coma and when he came out of coma, the body of the Complainant stopped working and he became blind thereafter. The question for consideration is whether such kind of ailments due to which the Complainant turned blind may be put in the category of accident.
In a matter where due to negligence of operating surgeon while performing cholestectomy, the insured died, the question for consideration before the National Commission was whether negligence in treatment would constitute accident within the definition of 'death due to accident'. It was held by the Hon'ble National Commission in Ashok Kumar Jain vs Unit Trust of India & Ors. 2006 (II) CPJ 191 (NC) that act of operation by Doctor could neither be said to be violent nor could be said to be caused be bodily injuries resulting solely from violent, external and visible mistake independent of any other causes. The definition of accident as per 'Black's Law Dictionary' was quotted as under:
"Accident:
An unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonably anticipated.
An unforeseen and injuries occurrence not attributable to mistake, neglect or misconduct."
Keeping in view the above observations of the Hon'ble National Commission, we feel that the disability on account of fever & jaundice cannot be categorised as disability due to accident. If such kind of disability or death due to ailment is taken as disability or death on account of accident then the all such deaths will further attract the accidental benefit also. This cannot be the intention of the 3 parties while entering into contract of insurance. In our view the learned DCF has gone wrong in allowing the complaint. This is not a case where the accidental benefit could be extended to the Complainant.
For the reasons as stated above, we allow this appeal and while setting aside the impugned order of the learned DCF dismiss the complaint leaving the parties to bear their own costs.
Member Presiding Member Hira Lal