The main legal point established in the judgment is that an accident, as defined in an insurance policy, may include rare, unexpected, and unforeseen events, and the requirement of external, violent, and visible means may be satisfied even if the means of the accident are noticeable but not necessarily seen by the person at the time of occurrence.

JUDGMENT :

Sanjeev Kumar, J.

CM No.5495/2019

1. This is an application by the National Insurance Company Limited [“the Insurance Company”] seeking condonation of delay of 61 days in preferring an appeal against the order of Jammu & Kashmir State Consumer Disputes Redressal Commission, Jammu dated 16.04.2019.

2. Despite notice, the respondent has chosen not to file any objections.

3. We have gone through the application for condonation of delay in which the Insurance Company has sought to explain the delay of 61 days on the ground that some time was taken to obtain sanction from the Competent Authority to file appeal and also that summer vacation in the High Court intervened in-between. It is submitted that after completing the requisite formalities and obtaining sanction from the Competent Authority, panel counsel was contacted and ultimately the appeal was filed.

4. Be that as it is, the explanation tendered by the appellant in the absence of any rebuttal thereto by the respondent, is required to be accepted. We are, thus, of the opinion that the appellant has shown sufficient cause for not preferring the appeal within time. The application is, therefore, allowed and delay in filing the appeal is condoned.

FAO(D) No.21/2019

5. This miscellaneous appeal arises out of an order dated 16.04.2019 passed by the Jammu & Kashmir State Consumer Disputes Redressal Commission, Jammu [“the Commission”], whereby a consumer complaint filed by the respondent has been allowed and the appellant directed to pay an amount of Rs.3.00 lakh along with interest @ 10% from the date of death till its realization along with litigation expenses of Rs.20,000/-.

6. Contextual facts, which are relevant for disposal of this appeal, are that the husband of the respondent was insured with the appellant through his employer Central Industrial Security Force (CISF) vide Group Personal Accidental Insurance Policy bearing No.251100/42/15/82000090 [“Insurance Policy”]. The Insurance Policy was valid for the period w.e.f. 04.01.2016 to 03.01.2017 and the respondent was nominee of her husband, namely, Balbir Singh (now deceased).

7. A complaint was filed by the respondent before the Commission alleging, inter alia, that her husband, a Constable in CISF, complained of vomiting and dizziness on account of which he was referred to NHPC Hospital, Surgani in Distirct Chamba. The deceased was discharged after treatment but during the night he again started vomiting and was taken to District Hospital, Chamba where a blood test was conducted upon him. It was found that the kidney of the deceased was infected. The deceased was referred to Amandeep Hospital, Amritsar where he remained under treatment from 06.04.2016 to 10.04.2016. He was diagnosed with acute infection of kidney and liver. On deterioration of his condition, he was shifted to DMC Ludhiana where he remained under treatment till he died on 16.04.2016. The death summary issued by the DMC Hospital, Ludhiana indicates that the deceased died of Scrub Typhus.

8. It was averred in the complaint that the deceased, while being posted at Chamba, was bitten by Chiggers (mite larvae) Mites Orientia tsutsugamushi, which resulted into Scrub Typhus, which is a rickettsial infection. It was pleaded that rickettsial infections are those type of infections which are caused by an unusual type of bacteria that lived only inside the cells of another organism. These infections are spread through ticks, mites fleas or lice. It was, thus, pleaded that the death of the deceased, which occurred due to Scrub Typhus caused by chiggers bite was purely accidental and, therefore, the respondent, the nominee of the deceased, was entitled to seek reimbursement of the amount for which her husband was insured under the Insurance Policy.

9. The complaint filed by the respondent was opposed by the appellant herein. In the reply, the case set up by the appellant was that the deceased Balbir Singh was insured under the Insurance Policy, which covered only accid