IMPORTANT POINTS
(1) Since the insured while sitting on the chair fell down on the ground, got head injury and surface undoubtedly a hard surface, injury is accidental.
(2) Respondent’s husband is covered under clause 10(b) to get the accidental benefit which is additional benefit to the policy.

JUDGMENT

Dr. D.P. Choudhury, President.—Heard learned counsel for both sides on V.C.

2. Here is an appeal filed u/s 15 of the erstwhile Consumer Protection Act, 1986 (hereinafter called the ‘Act’). Parties to this appeal shall be referred to with reference to their respective status before the District Forum.

3. The factual matrix leading to the case of the complainant is that her husband Jitendriya Senapati had purchased “Janasurakhya policy with accident benefit” vide policy No. 586249840 commencing on 28.11.2005 for sum assured of Rs.50,000/-. Complainant alleged inter alia while life assured was sitting on the chair, he fell down on the ground and he became unconscious. Thereafter, he was shifted to District Headquarters Hospital, Bhadrak, then to Aditya CARE Hospital, Bhubaneswar and Kalinga Hospital Ltd., Bhubaneswar but succumbed to injury on 17.4.2013. where after the complainant made claim. OP after scrutiny of documents debited a sum of Rs. 63,141/- to the account of the complainant through RTGS. Complainant alleged that as the accident benefit required under the policy has not been given to the complainant, and he was forced to write letters on 17.9.2013 and 20.12.2013 for disbursement of such amount but the respondent rejected the request for which the complaint was filed.

4. OPS filed written version admitting that the husband of the complainant is a beneficiary under the policy and after the complainant filed the documents, they have considered the same and made payment of Rs.63,141/- to the account of the complainant who is admittedly the nominee of the deceased. It is further stated in the written version that the accidental benefit of the deceased is not payable as the deceased has not died due to accident. Therefore, there is no deficiency of service on their part.

5. Learned District Forum after hearing both parties passed the following impugned order:-

“xxx xxx xxx

In the result, complaint is allowed on contest against the OPs. The OPs are directed to disburse the accidental benefit of Rs.50,000/- along with interest @9% per annum till its realization from the date of disbursement of death claim of the life assured i.e. 06.09.2013 within a period of 30 days of receipt of this order to the complainant. We further direct the OPs to pay litigation cost of Rs.1,000/- to the complainant within the aforesaid stipulated period.”

6. Learned counsel for the appellants submitted that the learned District Forum has committed error in law by not considering the written version filed by the OPs with proper perspective. According to him the life assured although insured for the accidental benefit, but the death of the assured did not come within the purview of ‘accident’. He submitted that learned District Forum has not followed the policy bond where it is specifically addressed that such type of cases are not covered under “accidental injury”. Therefore, he submitted that the learned District Forum ought to have followed the policy condition to peruse the definition of ‘accident’ so that the complainant is only entitled the amount which is already paid through RTGS mode. He further submitted that the impugned order being illegal and improper to be set aside by allowing the appeal.

7. Learned counsel for the respondent submitted that the life assured while sitting on the chair suddenly fell down on the ground and as such got head injury and became unconscious. He was shifted to Hospital at various places and finally succumbed to injury. Therefore, the death was fully covered under the “accident” because of head injury. He submitted that the learned District Forum appropriately passed the impugned order. He also drew attention to the policy bond where the policy bond does not deny such type of case. So he supports the impugned order.

8. Considered the submission of learned counsel for both sides and perused the DFR including the impugned order.

9. It is well settled in law that the complainant is to prove the deficien