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PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION
S.N. Aggarwal, President, Lt. Col. Darshan Singh and Piare Lal Garg, Members
NEW INDIA ASSURANCE COMPANY LTD. - Appellant
Versus
KIRAN AGNIHOTRI - Respondent
First Appeal No. 381 of 2003
Decided on : 11-12-2009
Insurance Claim - Accidental Death - 20.8.1998 to 19.8.2008 - Life Insurance Corporation of India v. Saroj Rani, 2008 CTJ 1075 (CP) (NCDRC)
Fact of the Case:
The insured had taken an insurance policy for Rs. 5 lacs which was valid until 19.8.2008. He suffered a head injury and died on the way to the hospital. The insurance claim was repudiated, leading to a complaint by the respondent.
Finding of the Court:
The court found that the death of the insured was due to an accidental fall, which was covered by the definition of accident. The court referred to a similar case where the proximate cause of death was considered to be a fall, and concluded that the respondent was entitled to the insurance claim.
Issues: Validity of insurance claim, proximate cause of death, interpretation of the word 'accident' in insurance policy
Ratio Decidendi: The court held that the fall from the bed was the proximate cause of death, covered by the definition of accident. It referred to legal provisions defining 'accident' and concluded that the respondent was entitled to the insurance claim.
Final Decision: The appeal was dismissed, and the appellants were directed to pay the insurance claim of Rs. 5 lacs to the respondent.
ORDER
S.N. Aggarwal, President - Rajinder Pal Agnihotri, husband of the respondent had taken insurance policy from the appellants on 20.8.1998 for an amount of Rs. 5 lacs which was valid upto 19.8.2008. He was suffering from Neurological Problem and remained admitted in D.M.C. Hospital, Ludhiana from 15.12.2000 to 23.1.2001.
2. It was further pleaded that after recovery from sickness, he had joined his duties. He was attending the office regularly and was performing his normal duties. He was declared fit to perform his duties.
3. It was further pleaded that on 14.2.2001, the insured fell from the stairs of his house and suffered the head injury. He was being taken to Tagore Hospital, Jalandhar but he died on the way. The insurance claim was lodged with the appellants which was repudiated. Alleging deficiency in service on the part of appellants, the respondent filed a complaint in the learned District Consumer Disputes Redressal Forum, Jalandhar (in short the District Forum ).
4. The appellants filed the written reply. It was admitted that Rajinder Pal Agnihotri had taken the Accident Insurance Policy on 20.8.1998 for an amount of Rs. 5 lacs from the appellants. It was denied if on 14.2.2001, the insured had a fall from the bed or if he had received the head injury or if he had died on the way to Hospital. It was denied if he was attended by Dr. Sant Kumar Gupta. The certificate given by Dr. Sant Kumar Gupta was manipulated by the respondent.
5. The matter was got investigated by the appellants from M/s. National Detective and Consultancy Services, Jalandhar who in the report dated 18.3.2001 reported that the insurance claim was not covered in the insurance policy. Hence the repudiation was legal and valid. Dismissal of the complaint was prayed.
6. The respondent proved documents Ex. C-1 to C-2 and also filed her affidavit Ex. C-3. She also proved documents Ex. C-4 to C-10. On the other hand, the appellants filed the affidavit of Kesar Dass, Senior Divisonal Manager as Ex. R-1 and the affidavit of B.S. Sharma as Ex. R-2. The appellants also filed documents Ex. R-3 to R-15.
7. After considering the pleadings of the parties and the affidavits/documents produced on file by them, the learned District Forum accepted the complaint vide impugned order dated 5.2.2003 and directed the appellants to pay the insurance claim of Rs. 5 lacs.
8. Hence the appeal.
9. The submission of the learned Counsel for the appellants was that appeal be accepted and the impugned order dated 5.2.2003 be set aside.
10. On the other hand, the submission of the learned Counsel for the respondent was that there was no merit in the present appeal and the same be dismissed.
11. Record has been perused. Submissions have been considered.
12. Admittedly Rajinder Pal Agnihotri, husband of Kiran Agnihotri, respondent was insured with the appellants for an amount of Rs. 5 lacs against death by accident and the insurance policy was valid for the period from 20.8.1998 to 19.8.2008. The Insurance Policy has been proved by the respondent as Ex. C-1. It has also been proved by the appellants as Ex. R-2. It is also not disputed that Rajinder Pal Agnihotri has died on 14.2.2001.
13. As per the version of the respondent, the life assured bad fallen from the bed of his house and had suffered the head injury by which he died on the way to Hospital but the appellants have filed the report of the National Detective and Consultancy Services, Jalandhar dated 20.3.2001 as Ex. R-5 who have held detailed investigation and reported that Rajinder Pal Agnihotri had fallen down from the bed and got injury on his head on 14.2.2001 at about 9.00 a.m. due to his illness (as he had been suffering since long). He was being shifted to the Hospital when he died on the way.
14. In any case even as per the version of the appellants, the assured had fallen down from the bed and died. Therefore, the only cause of his death was the accidental fall which caused him the head injury and which ultimately proved fatal
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