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GUJARAT STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, AHMEDABAD
Hon‘ble Mr. Justice P.M. Chauhan, President; Dr. R.K. Shah, Member
PURIBEN RAMJIBHAI PATEL—Complainant
versus
NEW INDIA ASSURANCE CO. LTD.—Opp. Party
Complaint No. 29 of 1992—Decided on 9.11.1993
Counsel for the Parties :
For the Complainant:Mr. N.R. Patel, Advocate.
For the Opp. Party :Mr. R.R. Panchal, Advocate.
In a claim for accidental death under an insurance policy, the claimant bears the burden of proving that the death was caused by an accident.
Headnote:
ACCIDENT INSURANCE - MISCELLANEOUS ACCIDENT INSURANCE POLICY - CLAIM FOR ACCIDENTAL DEATH - CAUSE OF DEATH - BURNS - SEPTISEMIA - POST MORTEM - EVIDENCE - BURDEN OF PROOF - INSURANCE COMPANY'S LIABILITY.
Fact of the Case:
The complainant, widow of the insured, claimed Rs. 2 lakhs for the accidental death of her husband, who was covered under a miscellaneous accident insurance policy. The insurance company repudiated the claim, contending that the burns sustained by the insured were minor and that he had been completely cured. The complainant relied on medical evidence to establish that the insured had died of septisemia as a result of the burns.
Finding of the Court:
The court held that the complainant had failed to establish that the death of her husband was due to septisemia and that the septisemia, if at all, was caused by the electric burns. The court noted that the complainant had not obtained a post-mortem examination of the deceased's body, which would have been the most reliable evidence of the cause of death.
Issues: 1. Whether the insured's death was caused by septisemia resulting from electric burns sustained in an accident. 2. Whether the complainant had discharged the burden of proving the cause of death.
Ratio Decidendi: The court held that the complainant had failed to discharge the burden of proving that the insured's death was caused by septisemia resulting from electric burns. The court noted that the medical evidence was inconclusive and that the complainant had not obtained a post-mortem examination of the deceased's body, which would have been the most reliable evidence of the cause of death.
Final Decision: The court dismissed the complaint and held that the insurance company was not liable to pay the claim.
Mr. Justice P.M. Chauhan, President— The Complainant, widow of insured Ramjibhai who was covered under miscellaneous accident insurance policy, has claimed Rs. 2 lakhs for the accidental death of Ramjibhai on 2.10.89. Ramjibhai was an agriculturist and while operating the electric motor for the bore met with an accident by electric current on 20.4.89 and got burns on the hand and was thrown off. He was admitted in the hospital but discharged by the Doctor within three days after the accident. According to the complainant Ramjibhai was not completely cured and was subsequently affected by gangrene and died because of septisimia. The Opposite Party was requested to pay the insurance amount but repudiated and did not pay the insurance amount. The complainant has accordingly claimed Rs. 2 lakhs under the insurance policy.
2. The Opposite Party by written statement admitted that Ramjibhai was caused electric burns on the fingers of the hands but contended that they were minor injuries and he was treated by Dr. K.J. Parikh in the Valay Surgical Hospital from 20.4.89 to 22.4.89 and had subsequently examined and certified that all the burns were healed and no Neckirigidity was found. Dr. Parikh had found that Ramjibhai had deep burns of 10 mm diameter over pulps of 2, 3, 4, 5th fingers and over diagram of 1st and deep semel burns involving lid finger of right hand—fiesor aspect. No fracture was found. According to the Opposite Party, Ramjibhai was completely cured of the electric burn injuries and had not died of the accident. As the abovesaid injuries were caused, the Opposite Party offered Rs. 3750/- to the complainant but she refused to accept. The Opposite Party is still prepared to pay that amount.
3. The main dispute between the parties is the cause of death of Ramjibhai. According to the complainant the cause of death was the accidental burns which ultimately resulted into septisimia but according to the Opposite Party the burns were minor and Ramjibhai was completely cured and no septisimia was caused of any burns. It is also contended that post mortem was not got done and, therefore, cause of death could not also be ascertained.
4. Dr. Tribhuvanbhai N. Patel in his certificate dated 6.11.89 (Ex. 52) certified that Ramjibhai Motibhai Patel was admitted with electrical burns on both hands on 20.4.89 and at that time he was in shock but recovered from the burns caused to the fingers and was discharged on 22.4.89. with the treatment for backache and muscle pain on lower limbs. Ramjibhai was taking some treatment for server neurits. He had neuritic pain. He advised Ramjibhai to take rest upto December 1989. It is submitted that Ramjibhai was discharged from the hospital within two days and, therefore, the injuries must not be severe and he must have been cured.
5. The complainant relied on the certificates and evidence of Dr. C.A. Shah (Exh. 20). Dr. C.A. Shah has stated that he new Ramjibhai and was called for the treatment in 1989. As stated by him in his certificate he had examined Ramjibhai Motibhai on 15.10.89 and at that time Ramjibhai had severe neurits, gangrene of fingers and he was in septicimic shock. Subsequently he had examined him lastly on 19.10.89 and at that time he was in terminal stage due to septisimia and was in shock too. When he visited Ramjibhai on 15.10.89 he had told him that he had electric burns and previously had taken treatment of Dr. Tribhuvanbhai N. Patel. In the opinion of Dr. Shah because of the electric burns, the finger tissues had dried and that part had become black. In his opinion Ramjibhai was affected by gangrene and because of the pain he was in shock. He stated that if the circulation of blood is disturbed because of any reason that may result in the gangrene. He also opined that because of electric shocks there was possibility of such gangrene. But he could not say that gangrene must have been the result of electric shock. In his opinion gangrene may result, if the wound is caused becau
