NATIONAL INSURANCE COMPANY LIMITED Vs. RAJAMANI

JUDGEMENT

(1.) 1. This appeal coming before us for hearing finally on 30.11.2012 Upon hearing the arguments of the Counsel for both sides, perusing the documents, lower Court records, and the order passed by the District Forum, this Commission made the following order: The second opposite party is the appellant.

(2.) THE complainant's husband Manoharan employed under the first opposite party as a Driller availed Group Personal Accident Policy from the second opposite party through the first opposite party for a sum of Rs. 50,000 and while he was on duty on 24.5.2003 at 2.00 p.m. near Bori, Maharashtra State the vehicle was stopped near Bori for drilling and at the time of drilling the driver Manoharan got severe chest pain due to gas and strain on duty and immediately he was taken to the nearby Government Hospital but he died in the hospital. Hence claim was made on the basis of policy, the second opposite party repudiated the same on the ground that the cause of death was not due to accident to grant the relief as per the terms and conditions of the policy. Hence, the complainant was compelled to file the consumer complaint before the District Forum and the District Forum after an inquiry allowed the complaint by directing the opposite party to pay a sum of Rs. 50,000 towards policy amount and to pay Rs. 10,000 towards compensation for mental agoay to pay Rs. 5,000 as costs.

(3.) AGGRIEVED by the impugned order the second opposite party filing this appeal contending that the complainant's husband even though died in the course of employment but cause of death was not due to accident and it was due to natural cause of death because of severe chest pain and died in the hospital. Chest pain does not come under the scope of Accident and at the most it would fall under the Workmen's Compensation Act and thereby the District Forum erroneously allowed the complaint by wrongly considered the meaning for Accident. Further the Counsel for the appellant relied the ruling reported in the case of New India Assurance Company Limited, Gobichettipalayam by its Branch Manager, 112 New Hospital Street, Gobichettipalayam v. K. Thilagam, in which it was held that death due to heart attack not within the scope and ambit of policy covenants. The deceased Manoharan taken the insurance policy and when the policy was in force subsequently he died in the course of employment. But the complainant side stated that he got stress and strain due to the employment and having chest pain and died in the hospital and thereby it was meant an accident. The District Forum ruled upon a decision reported mMadras Metropolitan Water Supply v. Tmt. Karmal in which it was held as follows, "Workmen's Compensation Act, 1923, Section 3(1) -Words and phrases -Accident -What is an accident by itself implied that it may happen at any point of time with or without knowledge of the person who suffers by it and it cannot be proved always by direct evidence" and stated that the deceased would have died because of breathing problem due to heavy gas produced at the time of drilling in the rig which can be termed as an accident. But on perusal of Ex. A5 Accidental Death Report issued by the P.S. Bori, Maharashtra State in which the reason for the death is mentioned as due to heart attack filed by Head Constable and the gist of the complaint given information in which by stating that on that date of occurrence, "the complainant and two others including deceased Manoharan were working in connection with drilling of bore well at that time the deceased was suffering from severe chest pain due to which he was admitted in the Hospital at Bori for medical treatment at about 14.30 hours and in the course of treatment he died clue to heart attack. There is no any doubt about his death due to heart attack." No other document was filed by the complainants to prove the cause of the death to show that during the drilling of bore well and gas was produced, which made him to suffer severe chest pain. Since the other two employees accompanied with him at that time have not suffered any such thing they have taken Manoharan to the hospital and one of them had given the complaint to the police under Ex. A5 as stated above.