The central legal point established in the judgment is that for an accident to be covered under a personal accident policy, it must be caused solely by external, visible, and violent means.

ORDER

V.K. Jain, Presiding Member(Oral) - Late Shri L.S. Chandrakar, husband of the complainant obtained two Janta Personal Accident Policies of Rs. 5,00,000/- each from the petitioner company. The aforesaid policy, to the extent it define the scope of the insurance cover reads as under:

"Death, loss of sight on both eyes, loss of both hands, loss of both feet, loss of one hand and one foot, loss of one eye and one hand, loss of one eye and one foot, loss of one limb or one eye. Other Total Permanent Disablement of Insured Person resulting solely and directly from accident caused by external visible and violent means, subject to terms, conditions, exclusions of personal accident insurance."

2. The insured late Shri L.S. Chandrakar died in Jawahar Lal Nehru Chikitsalya in Bhilai on 01-05-2000. The case of the complainant, as set out in the complaint is that the health of the deceased all of a sudden became bad and he started vomiting and was taken to Sector 9 Hospital, where he died during the course of his treatment. The post mortem report to the extent it disclosed the cause of death of the deceased reads as under:

"Asphyxia due to airway obstruction with pulmonary oedema caused by aspiration of blood with stomach contents."

3. It would, thus, be seen that the deceased died on account of asphyxia due to obstruction of the air way coupled with pulmonary oedema, which was caused by aspiration of blood with stomach contents. The learned counsel for the complainant/respondent submits that the deceased had accidentally consumed an external substance which led to his airways getting blocked and asphyxia being caused.

4. The complainant lodged a claim with the insurance company seeking payment in terms of the policy taken by the deceased. The claim, however, was repudiated by the insurance company on the ground that the death of the deceased was a natural death and not an accidental death.

5. Being aggrieved from the stand taken by the insurance company the complainant approached the concerned District Forum by way of a complaint. The insurance company resisted the complaint on the ground that the death of the deceased was not accidental and no amount in terms of the policy was payable to the complainant.

6. Vide its order dated 31-10-2008 the District Forum ruled in favour of the complainant. Being aggrieved from the order of the District Forum the insurance company approached the concerned State Commission by way of an appeal. Relying upon the decision of this Commission in Rita Devi v. National Insurance Co. Ltd. & Ors, IV (2007) CPJ 355 NC and Padma Ramanathan v. National Insurance Co. Ltd. 2008(3) CPR 172 NC the State Commission dismissed the appeal filed by the petitioner. Being dissatisfied with the view taken by the State Commission the insurance company is before us by way of this revision petition.

7. A careful analysis of the scope of cover stated in the insurance policy and as extracted hereinabove would show that the benefit in question was payable to the complainant only if the following conditions were fulfilled: (a) the deceased had died from an accident, (b) the accident had been caused solely by the means which were external, visible and violent and (c) the death was attributable solely and directly to the aforesaid accident. It is not every accident, but only an accident caused by means which are external visible and violent which qualify for payment under the policy.

8. If the deceased had consumed some substance which ultimately led to his death that in our opinion would certainly be a case of an accident. Therefore, the first condition envisaged in the policy stands fulfilled in this case. The substance consumer by him in such a case being an external mean, the second condition envisaged in the policy also stands fulfilled. However, it cannot be said that the consumption of an eatable would amount to an accident caused by visible and violent means. Neither the means i.e. food consumed by the deceased is visible on