IMPORTANT POINT
The claimant must establish a direct causal link between the accident and the injury for compensation under the accident policy.

ORDER :

1) The present writ petition assails the award dated 31.10.2023 passed by the Permanent Lok Adalat, Pali on the file of Case No.07/2021, wherein and whereby the claim made by the respondent No.1 herein for grant of compensation for the personal accident was allowed and assured sum of Rs.10,000/- was granted with interest.

2) The petitioners herein are the Insurance Company, which is the respondent Nos. 1 & 2 before the Permanent Lok Adalat. For convenience, the claimant is referred to as the claimant and non-claimant Nos.1 & 2 as the Insurance Company.

3) The sum and substance of the case of the claimant is that on 14.10.2019 at about 11:00 a.m., Lala Ram (deceased) while on foot on the road, fell down and sustained fatal injury and immediately, he was shifted to hospital. On account of injury resulting in Hemorrhage, the deceased succumbed to the injury on 16.10.2019 at 4:00 a.m. Thereafter, a report under Section 174 of Cr.P.C. was filed. Basing on the said report, an enquiry was conducted by the police and the statements of nephew, two sons and wife of the deceased were recorded. The scene of offence, inquest and postmortem was also conducted on the body of the deceased. The report of the police under Section 174 Cr.P.C. indicates that the deceased suffered internal head injury on account of fall resulting brain Hemorrhage and death. The deceased was covered by Personal Accident Policy issued by the Insurance Company, which was valid from 12.12.2018 to 11.12.2019. As such, the claim for assured sum was made.

4) Heard learned counsel for the Insurance Company as well as learned counsel appearing for the claimant.

5) The case of the Insurance Company is that they have issued Group Personal Accident Insurance Policy and customer covered to the Account Holders of SBI Bank. The Policy indicates definition part of “accident”, which shows that claim is allowable only on sudden, unforeseen and involuntary event caused by external, visible and violent means. According to the Insurance Company, the postmortem report indicates that the death was on account of Hemorrhage and such Hemorrhage was on account of internal or external injury. The police report under Section 174 of Cr.P.C. indicates that the internal head injury was sustained by the deceased, which is causative factor for the brain hemorrhage. In fact, such conclusion is contrary to the medical evidence but based on the statements of interested witnesses. Such report and statements were relied by the Permanent Lok Adalat to come to the conclusion that the death was on account of fall. Such findings of Permanent Lok Adalat suffer from patent illegality and perversity, which require interference.

6) Per contra, the learned counsel appearing for the claimant has supported the award impugned and contended that the Permanent Lok Adalat after considering the material available on record has rightly held that the claimant is entitled to the assured sum and therefore, the impugned award does not require any interference.

7) I have considered the rival submissions of both the parties and carefully perused the material available on record.

8) The Policy issued by the Insurance Company was a Master Policy and it was valid from 12.12.2018 to 11.12.2019. The alleged incident occurred within the said period. The terms of Policy indicate that coverage is limited to death on account of “accident” only. The terms and conditions of Group Personal Accident Insurance Policy defines what constitute an accident, which reads as under:-

“Part A: Interpretations & Definitions:

The terms defined below have the meanings ascribed to them wherever they appear in this Policy Document and, where appropriate, references to the singular include references to the plural; references to the male include the female and references to any statutory enactment include subsequent changes to the same:

1) Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.”

9) The claim