Additional Secretary... v. Bajaj Allianz Genera...

which, while allowing appeal, the order dated 15.09.2010, passed by the District Consumer Disputes Redressal Forum, Raipur in consumer complaint no. CC/08/25, allowing the said complaint, was set aside.

2. Brief facts of the case are that the petitioner/complainant Chhattisgarh State Power Holding Company Limited obtained a group personal accident insurance policy from the OP for the benefit of its employees for the period 10.09.05 to 09.09.2006, according to which a sum of ` 4 lakh was payable in case of accidental death of any employee of the petitioner/complainant. The Policy No. OG-06-2303-9902- 00000029 was issued by the insurance company on payment of ` 49,03,900/- as premium. It has been stated that an employee of the complainant, Maniram Sahoo aged 49 years, employed as Attendant Class-2 (Line) was doing some construction work for the Chhattisgarh State Electricity Board on 10.07.2006 and he climbed on an electric pole 36' in height for the purpose. The said Maniram Sahoo fell down from the electrical pole and died. The report of the incident was lodged with the Police. The body of the deceased was taken to the hospital and post-mortem was conducted, the report of which is on record. The petitioner/complainant company paid a sum of ` 4 lakh to the legal representatives of the deceased and claimed that amount from the insurance company by sending the claim form alongwith the required documents on 1.08.2006. The Insurance Company repudiated the claim on 18.09.2007, saying that the said employee died due to cardiac arrest. The present consumer complaint was, thereupon filed, claiming a sum of ` 4 lakh from the Insurance Company alongwith ` 50,000/- as compensation for mental harassment etc.

3. In the written statement to the complaint filed by the Insurance Company, it was denied that Maniram Sahoo died due to injuries on account of falling from electric pole. They stated that according to the post-mortem report, he died due to heart failure, as he had been suffering from diabetes and heart disease. The Insurance Company maintained that the claim had been rightly repudiated by them.

4. The District Forum vide their order dated 15.09.2010 allowed the complaint, saying that a sum of ` 4 lakh should be paid to the heirs of the deceased, alongwith an interest of 6% p.a. from the date of complaint and also a sum of `5,000/- as compensation for mental harassment and ` 1,000/- as cost of litigation. An appeal was filed against this order before the State Commission which accepted the same and set aside the order of the District Forum, saying that it was a case of natural death and hence, under the terms of Group Janta Personal Accident Policy, the Insurance Company was not liable to pay any amount. It is against this order that the present revision petition has come up.

5. At the time of arguments before us, the learned counsel for the petitioner stated that the death of their

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employee Maniram Sahoo occurred due to his sudden fall from an electric pole, 36' high and hence, this was death due to accident. He has drawn our attention to a letter No. 033-12-Gen./Accident/760 dated 10.08.2006, sent by the Superintendent Engineer (S.E.) Construction circular of the petitioner at Bilaspur, addressed to the Chief Engineer Bilaspur, in which it has been stated that Maniram Sahoo, Line Attendant met with a fatal non-electrical accident on 10.07.2006 at 3:30 PM, while shifting the high tension wire of Railway over-bridge, Korba. Based on various statements submitted before the S.E., it was concluded that the accident was absolutely non-electrical and the supply was completely switched off, i.e., he was working on a dead line and hence, their Department was not responsible for the accident. The learned counsel has drawn our attention to clause 3.4 and 3.5 of the Personal Accident Policy document, issued by the respondent Insurance Company, which states as follows:-

"3.4 "Accident" or "Accidental" means a sudden, unintended and fortuitous external and visible event.

3.5 "Bodily Injury" means physical bodily harm or injury, but does not include any mental sickness, disease or illness."

6. It has also been stated that the Company will pay the sum assured in the event of Accidental Bodily Injury, causing the Insured's death within 12 months of the Accidental Bodily Injury being sustained. The learned counsel argued that the insured was working on an electric pole and repairing the electric supply line. As a result of severe shock due to falling down from the pole, 36' in height, he got heart-attack, as a result of which, he died. The Insurance Company was, therefore, liable to pay the amount in question to the petitioner. The petitioner had already paid this amount to the legal representatives of the deceased.

7. In reply, the learned counsel for the respondent Insurance Company has drawn our attention to judgement of the Hon'ble Supreme Court in 'Rubi (Chandra) Dutta versus United India Insurance Company Limited' [as reported in (2011) 11 SCC 269], saying that the scope of revision petition under section 21(b) of the Consumer Protection Act, 1986 was limited to cases where some prima-facie or patent error appears in the impugned order. A different interpretation of the same facts on record was not permissible and hence, this petition is liable to be dismissed. Learned counsel also invited our attention in this regard to the orders passed by the National Commission in "New India Assurance Co. Ltd. versus Lakhwinder Kaur" [as reported in II (2007) CPJ 36 (NC)] and "Oriental Insurance Company Ltd. versus Shri Kant Pandharinath Yeole" [as reported in II (1994) CPJ 106 (NC)] in support of the arguments that the scope of revision petition was limited. The learned counsel stated that the version of the petitioner that the employee died due to shock, had not been taken by them earlier. In fact, while working on the pole, the

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deceased suffered heart attack, died there and then fell down. The learned counsel has drawn our attention to the Post-Mortem report, saying that the death was stated to have taken place due to cardiac arrest and no external injury was seen on his body and hence, it is natural death only.

8. We have examined the entire material on record and given a thoughtful consideration to the arguments advanced before us. The admitted facts are that the petitioner/complainant had obtained a Group Personal Accident Insurance Policy for the benefit of its employees from the respondent/OP Insurance Company, under which a sum of ` 4 lakh was payable in case of accidental death of any employee of the petitioner/complainant. It is also admitted that the deceased employee Maniram Sahoo was doing some construction work on an electric pole at 36' height and that he fell down from the said pole, after which he was declared dead by the medical authorities. The version of the complainant that at that time, the power was switched off has also not been denied by the other party. The basic issue to be decided in the present case is whether in this case, the death occurred due to accident and whether the Insurance Company is liable to pay the claim in accordance with the terms and conditions of the Insurance Policy in question.

9. The report of the post mortem about the cause of death says as follows:-

"The cause of death is Cardiorespiratory failure which may be due to associated Cardiac Pathology. Time passed since death is within 12 hours from commencement of Post mortem examination."

10. As per the above report, the cause of death is cardiorespiratory failure. The cause of cardiac arrest could be the existence of a pre-cardiac disease or even in the absence of such a disease, the cardiac arrest could take place due to shock upon falling from a pole 36' in height. In the event of death by any means, the cardiac arrest or cardiac failure has to take place and only after that, a person is usually declared as dead. The cause of death stated in the post mortem report, therefore, does not support the version of the respondent that it was a death not due to accident. Further, it has been stated in the post mortem report that no external injury was found on the body of the deceased. During fall from a pole, it is not necessary that bodily injury should always take place. The basic point is that there has been a fall from a pole and there has been the death of the employee. The argument taken by the respondent that the employee suffered heart attack while working on the pole, he died then and there, and then fell down, is not substantiated by any medical evidence. Rather, the version that because of his fall from the pole, he got a shock, due to which he suffered a heart-attack and died, seems to be a more plausible explanation. Even if it is believed that heart-attack occurred while he was working on pole, the factum of falling from the pole and his death does not exclude the incident from the nomenclature of 'accident', based on the test of any prudent

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thinking and common sense.

11. It is made out very clearly from the facts on record, therefore, that this is a case where death has occurred because of an accident, involving fall from an electric pole 36' in height and under the terms and conditions of the Insurance Policy, the respondent is liable to pay compensation to the legal heirs of the deceased employee. Since in this case, the amount of ` 4 lakh has already been paid to the legal heirs of the deceased employee, the OP has to pay the said amount to the petitioner/complainant and also a compensation of `_5,000/- for mental agony and ` 1,000/- as litigation cost as ordered by the District Forum.

12. Based on the above discussion, this revision petition is allowed, impugned order passed by the State Commission is set aside and the order dated 15.09.2010 passed by the District Forum upheld. There shall be no order as to costs.

......................J

K.S. CHAUDHARI

PRESIDING MEMBER

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DR. B.C. GUPTA

MEMBER

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