Back
HARYANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CHANDIGARH
Hon’ble Mr. Justice S.S. Sandhawalia, President;
Smt. Basanti Devi, Member
RASHMI JALOTA—Complainant
versus
NEW INDIA ASSURANCE CO. LTD. AND ORS.—Opposite Parties
Complaint No. 19 of 1991—Decided on 4.2.1992
Counsel for the Parties :
For the Complainant :Mr. K.D. Sehgal, Advocate.
For the Opposite Party :Mr. Pradeep Bedi Advocate.
An insurance company is liable to pay the insurance amount and interest for delay in payment if the death of the insured person is covered by the policy, even if the insured person had a pre-existing heart condition.
Headnote:
GROUP PERSONAL ACCIDENT POLICY - INSURANCE COVERAGE - ACCIDENT RESULTING IN DEATH - PRE-EXISTING HEART CONDITION - LIABILITY OF INSURANCE COMPANY - INTERPRETATION OF POLICY TERMS - CAUSATION OF DEATH - DELAY IN SETTLEMENT OF CLAIM - COMPENSATION FOR LOSS AND INJURY.
Fact of the Case:
The case involved a claim under a Group Personal Accident Policy issued by the New India Assurance Company Limited (Opposite Party No. 1) to the employees of Yamuna Syndicate Limited (Opposite Party No. 3). The deceased, Shri Yogesh C. Jalota, an employee of Yamuna Syndicate Limited, suffered an accidental injury while on an official visit to Bangalore. He sustained a dislocation of the patella and acute pain in his knee. Despite medical attention, he died of cardiac arrest a few hours later. The widow of the deceased filed a complaint against the Insurance Company seeking payment of the insurance amount, interest for delay in payment, and compensation for suffering and mental torture.
Finding of the Court:
The court held that the death of the deceased was the direct result of the accidental injury suffered by him and was covered by the Group Personal Accident Policy. The court rejected the Insurance Company's contention that the deceased had a pre-existing heart condition and that his death was due to natural causes. The court also found that there was a deficiency in the services provided by the Insurance Company and that the delay in settling the claim was negligent.
Issues: 1. Whether the death of the deceased was caused by an accident or other wise? 2. Whether the Insurance Company was liable to pay the insurance amount and interest for delay in payment? 3. Whether the complainant was entitled to compensation for suffering and mental torture.
Ratio Decidendi: 1. The court held that the accidental injury suffered by the deceased was the proximate cause of his death, even though he had a pre-existing heart condition. The court relied on the principle that if death or disability is due to a heart attack resulting from the exertion of an employee in the performance of his duties, compensation should be awarded. 2. The court held that the Insurance Company was liable to pay the insurance amount and interest for delay in payment because the death of the deceased was covered by the Group Personal Accident Policy. The court found that the Insurance Company had failed to provide satisfactory reasons for repudiating the claim. 3. The court held that the complainant was entitled to compensation for suffering and mental torture caused by the delay in settling the claim.
Final Decision: The court allowed the complaint and directed the Insurance Company to pay the insurance amount, interest thereon, compensation for loss and injury, and costs to the complainant.
Mr. Justice S.S. Sandhawalia, President— The true import and scope of a Group Personal Accident Policy issued by the nationalized Insurance Companies is the larger significant question in this complaint. More pointedly at issue is the controversy whether the death of the widowed complainant’s husband was caused by an accident or other wise?
2. Learned Counsel for the parties are unreservedly agreed that herein there is no dispute whatsoever on facts. These may, therefore, be noticed with relative brevity. The Late Shri Yogesh C. Jalota, the husband of the complainant was an employee of the Yamuna Syndicate Limited (Opposite Party No. 3). The said concern through M/s. Escorts Dealers Development Association Ltd. (Opposite Party No. 2) had taken out a Group Personal Accident Insurance Policy for its employees with the New India Assurance Company Limited (Opposite Party No. 1). It is common ground that Shri Jalota was fully covered by the said policy.
3. Shri Y.C. Jalota (hereafter called the deceased) alongwith another co-employee Shri Sudhir Mohan had accompanied Shri Ramesh Malhar, the Managing Director of the Yamuna Syndicate Limited on an official visit to Bangalore in August 1990. Shri Sudhir Mohan and the deceased were staying in one room in a hotel in Bangalore and on the morning of the 12th of August, 1990 both of them left the hotel in the course of their official duties. While they were walking along a cinema hall called ‘Pallavi at about 11.30 a.m., the right knee of the deceased forcibly dashed against the panel of a cycle resulting in the dislocation of the patela and causing acute pain and agony to him. His companion Sudhir Mohan managed to put him in a motor vehicle (the deceased was unable to stand) and immediately took him to the well known St. Martha Hospital in Bangalore. Because the deceased complained of acute chest pain apart from the injury on the knee, the hospital staff carried out certain investigations including an E.C.G. of the heart of the deceased. Owing to the broken tissues of the knee and patela, the doctor thought it necessary to put the whole of his right leg and thigh in plaster. During this process the deceased complained about acute chest pain, but apparently because the E.C.G did not disclose any serious heart injury, he was given a sedative and after a bed rest of about two hours at the St. Martha Hospital was discharged there from around 2.30 p.m. The deceased on a stretcher was put in an ambulance and taken to his hotel, but before he could reach his room he started feeling very uneasy and started breathing hard and ultimately fainted. Noticing his serious condition Sudhir Mohan immediately rushed him back to the same hospital in the same ambulance van, where the deceased was attended to in the emergency ward. However, despite all medical aid the deceased could not survive and died of cardiac arrest around 3.30 P.M on that very day.
4. The necessary formalities after the death of the deceased were carried out by Sudhir Mohan under the’ instructions of the Managing Director and the body was sent to the Government hospital for a post-mortem which took place at 12 noon on the following day of 13th of August, 1990. The First Information Report was also lodged at Bangalore and the requisite certificates for carrying the dead body to Yamuna Nagar were secured and ultimately the same was cremated at the said place.
5. M/s Yamuna Syndicate Limited,, the employer of the deceased duly paid the compensation due to the widow and her two minor sons under the Workmen Compensation Act vide certificate C-1. They also lodged a claim for the payment of Rs. 65,000/- with the New India Assurance Company Limited (hereinafter called the Insurance Company) through Opposite Party No. by complying with the necessary formalities of forwarding the claim form with the statement of facts and enclosures thereto. The relevant documents are annexed as C-2 and C-3. The Insurance Company first sought some clarification
