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2009 Supreme(Mad) 1642

High Court of Judicature at Madras
THE HONOURABLE MR. JUSTICE M. VENUGOPAL
New India Assurance Company Limited, Gobichettipalayam
Versus
K. Thilagam
A.S.No.79 of 2002 & C.M.P.No.9963 of 2002
Decided on: 10-06-2009

Advocates Appeared:
For the Appellant:S. Manohar, Advocate.
For the Respondent:R.T. Doraisamy, Advocate.

The central legal point established in the judgment is the interpretation of the personal accident insurance policy clause, which required bodily injury resulting solely and directly from an accident caused by outward, violent, and visible means for the insurance company to pay the insured sum.

Headnote:

Insurance - Personal Accident Insurance - Janatha Personal Accident Insurance Policy - Clause of If the insured shall sustain any bodily injury resulting solely and directly from Accident caused by outward, violent and visible means - [Rs.5,00,000/-] - [Clause of If the insured shall sustain any bodily injury resulting solely and directly from Accident caused by outward, violent and visible means]

Fact of the Case:

The plaintiff's husband had a personal accident insurance policy with the defendant insurance company. The husband passed away due to a heart attack, and the plaintiff sought the insured sum from the insurance company. The insurance company refused to pay, citing policy conditions that excluded compensation for death due to other illnesses.

Finding of the Court:

The trial court directed the insurance company to pay the insured sum of Rs.5,00,000/- as per the policy but dismissed the claim for interest. The appellate court allowed the appeal, setting aside the trial court's judgment and decree, and dismissed the suit with no order as to costs.

Issues: The main issue was whether the insurance company was liable to pay the policy sum of Rs.5,00,000/- with interest at 12% from the date of death, as claimed by the plaintiff.

Ratio Decidendi: The court interpreted the policy clause that required bodily injury resulting solely and directly from an accident caused by outward, violent, and visible means for the insurance company to pay the insured sum. The court found that the death due to a heart attack did not fall within the scope of the policy's covenants, leading to the allowance of the appeal.

Final Decision: The appellate court allowed the appeal, set aside the trial court's judgment and decree, and dismissed the suit with no order as to costs.

Judgment :-

1. The appellant/New India Assurance Company Limited/defendant has preferred this appeal as against the Judgment and decree dated 211. 2001 made in O.S.No.239 of 2000 by the learned Principal Subordinate Judge, Gobichettipalaym, directing the appellant to pay the capital insured sum of Rs.5,00,000/-to the respondent/plaintiff and also directing the payment of court fee in a month, to be paid by the appellant.

2. The short summation of facts of the case are as follows:

The plaintiffs husband Karunanidhi insured with the defendant Company as per "Janatha Personal Accident Insurance Policy" for Rs.5,00,000/- and remitted a sum of Rs.250/-towards premium on 26. 1997. The appellant/Insurance Company/defendant issued the policy bearing No.4772080203638 and the date of issue of the policy was 26. 1997 and the same was to be in force till 26. 1998. The deceased Karunanidhi nominated his wife as nomiee to receive the capital sum insured in case of death. The respondent/plaintiff as nominee to receive the capital sum insured in case of death. The respondent/plaintiffs husband Karunanidhi, due to heart attack expired on 01.06.1998 at D.S.K.Hospital, Tiruppur. The appellant/ defendant was to pay the sum assured in the policy to the respondent/plaintiff because of fact that heart attack was also an accident. The respondent/plaintiff requested the appellant/defendant to pay the sum assured in the policy. But the appellant/defendant had not complied with. On 15. 2000, the respondent/plaintiff issued a lawyers notice on 25. 2000 but not paid the amount. Hence the suit was filed in directing the appellant/defendant company to pay a total sum of Rs.6,22,830/- (including policy sum and interest) along with future interest and costs.

3. The appellant/Insurance Company/defendant filed a written statement inter alia stating that the policy conditions were misconstrued by the respondent/plaintiff and that the she cannot claim compensation under "Janatha Personal Accident Insurance Policy" for the death of her husband due to heart attack inasmuch as the said policy enjoins that the insurer could not claim any compensation under the Policy, if the death was caused due to other illness of the deceased and that the suit was not maintainable and further the cause of action was not correct and the suit was to be dismissed with costs.

4. On the basis of the aforesaid pleadings, the trial Court framed three issues. On the side of the respondent/plaintiffs witness, P.W.1(Plaintiff) was examined and Exs P1 to P6 were marked and on the side of the appellant/defendant, D.W.1(Officer) was examined and no documents were marked.

5. On an appreciation of the oral and documentary evidence and taking note of the available material evidence on record, the trial Court came to the conclusion that the appellant/defendant should pay a sum of Rs.5,00,000/-as per policy and that the said sum was to be paid within a month and in regard to the claim of interest, the same was dismissed.

6. Dissatisfied with the Judgment and decree made in O.S.No.239 of 2000 by the trial Court viz., the Principal Sub Court, Gobichettipalayam, the appellant/Insurance Company/defendant has preferred this appeal.

7. The point that arises for determination is Whether the appellant/defendant company is liable to pay the policy sum of Rs.5,00,000/-with interest at 12% from 01.06.1998 to 18.06.2000 along with further interest at 12% etc. as claimed in the plaint?

8. The learned counsel appearing for the appellant/Insurance Company/defendant urges before this Court that the trial Court has not appreciated the Janatha Personal Accident Policy in a proper perspective and that the policy indicated that unless there was death due to an accident, the appellant was not liable to pay the amount and further the respondent/plaintiffs husband Karunanidhi was ailing from heart attack for few years prior to the accident and therefore, there was nothing accidental about the disease which caused the d
























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