The central legal point established in the judgment is the requirement for bodily injury resulting solely and directly from an accident caused by outward, violent, and visible means for indemnification under the Janta Personal Accident Policy.

ORDER

Mrs. Rekha Gupta, Member. - The present revision petition has been filed against the judgment dated 27.6.2014 of the Maharashtra State Consumer Disputes Redressal Commission, Circuit Bench at Nagpur in Appeal No. 1020 of 2008.

2. The facts of the case as per the respondent/complainant are that the deceased husband of the respondent Chirukut Pande, was working as a Loader in the Underground Coal Mines at Pipla Western Coalfields. The Western Coalfields had drawn a Group Janta Personal Accident Policy of the workers working in their company. The deceased husband was a member of the said policy by paying premium of Rs. 484. The claim under the said insurance policy was Rs. 5,00,000 and its maturity date was 14.3.2009.

3. On 8.10.2006 the deceased husband of the respondent Shri Chirkut Pande fell down on the ground because of chest pain due to additional pressure and hard work. He was declared dead in the hospital. After conducting the post-mortem examination on his dead body at Indira Gandhi Government Medical College, Nagpur, the Government Doctor has opined that the deceased had died due to Coronary Artery Insufficiently. However, the deceased had not complained about pain in his chest earlier. After the death of her husband the respondent submitted the insurance claim along with all the required documents to the Western Coalfields for onward transmission to the petitioner.

4. The respondent filed tire consumer complaint bearing No. 18 of 2007 before the District Forum. The District Forum passed an order dated 10.5.2007, directing the WCL Company to submit the claim certificate of the deceased along with the required documents to the petitioner within a period of eight days and the petitioner should decide the said claim within a period of one month. On submission of the insurance claim and the required documents to the petitioner, as per the order passed by the District Forum on 23.7.2007, the petitioner rejected the claim of the respondent on the ground that the death of the deceased was a natural death outside the mine and when he was not on duty. However, the husband of the respondent died due to heavy hard work and pressure during the course of employment in the mine. The respondent had filed the complaint for compensation under the provisions of the Workmen's Compensation Act before the Labour Court. The Labour Court has accepted the said fact and passed the order declaring that the respondent was entitled for compensation. In view of these facts, the petitioner by rejecting the insurance claim of the respondent, failed to provide services to the respondent. Therefore, the respondent has filed the present complaint against the petitioner for compensation of Rs. 5,00,000 for mental and financial harassment and Rs. 20,000 for the expenses of this complaint.

5. The petitioner accepted that they had drawn Group Janta Personal Accident Policy in the name of WCL for the workers of WCL and Chirkut Pande was a member of the said policy. Other allegations made by the respondent were denied by the petitioner. As per the terms of the said policy, if the policy holder died due to accident, then his legal heirs were entitled to claim amount of the policy. The husband of the respondent Chirkut Pande died naturally due to heart attack during the course of employment therefore the claim made by his legal heirs was rejected. Post-mortem report revealed that the death of deceased Chirkut Pande was natural. So also the jurisdiction of the Labour Court came under the phrase of "worker". The decisions given by the Labour Court were not binding on this Forum. The petitioner rejected the insurance claim of the respondent in terms of the policy. In view of this, the petitioner was not liable to provide the services to the respondent. Therefore, the petitioner prayed before the District Forum that the present complaint filed by the respondent be rejected.

6. The Additional District Consumer Redressal Forum, Nagpur, vide its order dated 24.11.2008