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MADHYA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
N.K. Jain, President and Pramila S. Kumar, Member
NEW INDIA ASSURANCE CO. LTD. - Appellant
Versus
BHAGWATIBAI AND ANR. - Respondents
Appeal No. 2394 of 2007
Decided on : 20-02-2008
Mr. Pradeep Nighoskar, Advocate, for the Appellant; Ms. Usha Malviya, Advocate, Mr. Santosh Dhote, Advocate, for the Respondent
A sudden heart attack does not qualify as an accident under an insurance policy.
Headnote:
Accidental Death - Insurance Policy - The court held that a sudden heart attack does not qualify as an accident under the insurance policy, citing legal provisions and previous court decisions. The appeal was allowed, and the complaint of the respondent was dismissed.
Fact of the Case:
The Forum awarded the sum assured to the respondent for the death of her husband, who died of a heart attack while being covered under an insurance policy. The appellant argued that a heart attack does not qualify as an accident under the policy.
Finding of the Court:
The court found that the death due to a heart ailment could not be termed as an accident, and the Forum erred in allowing the respondent's claim for the sum assured. The appeal was allowed, and the complaint of the respondent was dismissed.
Issues: Interpretation of 'accident' under the insurance policy, whether a sudden heart attack qualifies as an accident, and the correctness of the Forum's decision in allowing the respondent's claim.
Ratio Decidendi: The court relied on legal provisions and previous court decisions to define 'accident' as an untoward mishap which is not expected or designed, and concluded that a sudden heart attack does not qualify as an accident under the insurance policy.
Final Decision: The appeal was allowed, the impugned order was set aside, and the complaint of the respondent was dismissed. No order as to costs.
ORDER
N.K. Jain, President - Heard.
By the order impugned the Forum below has awarded the sum assured Rs. 5 lacs to respondent No. 1/complainant, for the death of her late husband Kunjilal Sahu, who was an employee of respondent No. 2/Western Coal Fields Ltd. and was covered against any accidental death during his employment, under a policy issued by the appellant/the New India Assurance Co. Ltd.
2. As per complainant's own showing the deceased died of heart attack. Such a natural death was not covered by the policy. The Forum below even while holding that the death was the result of heart attack, concluded that such a sudden heart attack is also an accident. We are afraid, the approach of the Forum below was wholly incorrect. Any such attack, though sudden in nature, cannot be termed as an accident. As held by the Supreme Court in the case of Jyothi Ademma v. Plant Engineer, Nellore and Anr., 2006 ACJ 2165 (SC) and reiterated in a later decision in the case of Shakuntala Chandrakant Shreshti v. Prabhakar Maruti Garvali and Anr., 2007 ACJ 1 (SC):
"The expression accident means an untoward mishap which is not expected or designed. Injury means physiological injury. In Fenton v. J. Thorley and Co. Ltd., (1903) AC 443, it was observed that the expression accident is used in the popular and ordinary sense of the word as denoting an unlooked for mishap or an untoward event which is not expected or designed."
In the instant case there was no such untoward mishap. The death occurred due to some heart ailment which could certainly not be termed as accident. Claim of respondent was rightly repudiated and the Forum below, in our opinion, erred in allowing respondent's claim for the sum assured.
3. We thus, allow the appeal, set aside the impugned order and dismiss the complaint of respondent. No order as to costs.
