The central legal point established in the judgment is the interpretation and application of Clause 10(B) of the insurance policy, emphasizing the requirement of sustaining bodily injury resulting solely and directly from an accident caused by outward, violent, and visible means.

Mr. Justice H.S. Brar, President—Naresh Kumar (now deceased), husband of Smt. Anju Hunjan took Life Insurance Policy Nos. 160343003 dated 26.7.1990, 160437237 dated 30.3.1991, 160706202 dated 27.11.1993 for Rs. 25,000/-, Rs. 25,000/- and Rs. 50,000/- respectively. Smt. Anju Hunjan was his nominee under above said policies.

2. The allegations made in the complaint are that Naresh Kumar, husband of the complainant Smt. Anju Hunjan died on 5.5.1994 between 9.30 a.m. and 10 a.m. as he slipped in the bathroom. Nearby Dr. Ved Prakash Jindal was called immediately who referred him to the Hospital but he died on the way. Dr. Hemant Wilson issued the certificate dated 6.12.1994 indicating that as per record patient Naresh Kumar was brought dead in the Causalty at 10 a.m. on 5.5.1994 by his brother Santosh Kumar, resident of Harpal Nagar, Ludhiana. It is further stated in the complaint that Naresh Kumar died due to accident while he fell in the bathroom and thus he was entitled to accident claim (sic).

3. The claim made by Smt. Anju Hunjan, widow of Naresh Kumar deceased has been repudiated by the opposite party on flimsy ground. A direction was sought by the complainant from the District Consumer Disputes Redressal Forum, Ludhiana, (hereinafter called the District Forum), to pay her Rs. 1,00,000/- being insured amount towards accident benefit claim alongwith interest at the rate of 18% per annum from 5.5.1994 till the actual payment is made plus Rs. 25,000/- as compensation for mental agony and suffering caused to the complainant. Another relief to which the complainant was found entitled to, was also asked for.

4. After issuance of notice, the opposite party filed written statement. It was stated in the reply that there was no deficiency in rendering service. Complaint was not maintainable, as no accident had taken place. The claim of the complainant was denied on the ground that actually no accident had taken place and death by accident has not been established. Thus, the complainant is not entitled to accident benefit claim. All other claims, sum assured have been paid and accident benefit claim has been repudiated, as life insured did not receive any external injury after alleged slipping in the bathroom.

5. After hearing the Counsels for the parties and perusing the record, the District Forum allowed the complaint by holding that death took place due to an accident.

6. We have heard learned Counsels for the parties and have perused the relevant record with their assistance.

7. Only point which needs determination in this case is as to whether Naresh Kumar, insured with the opposite party, i.e., Life Insurance Corporation of India, died on account of accident or his death was natural.

8. Before proceeding further we would like to reproduce Clause 10(B) of the policy vide which the deceased was insured. Clause 10(B) reads as under :

“10(B) Death of the life assured : to pay additional sum equal to the sum assured under the policies if the life assured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means and such injury results in death within 90 days of its occurrence.”

According to the above said provision, the opposite party is liable to pay additional sum equal to the sum assured under the policy, if the life insured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means and such injury results in death within 90 days of its occurrence.

9. The case of the complainant-respondent is that Sh. Naresh Kumar, now deceased, slipped in the bathroom on 5.5.1994 at about 9.30 a.m. Immediately after that, he was taken to the hospital. But he died in the way before he could reach the hospital.

10. It is not proved on the record that the deceased suffered any injury on his body external or internal, which could be the cause of his death. Admittedly no FIR was lodged about the alleged accident. No post-mortem was cond