S. B. I. General Insurance Co. Ltd. v. Kuldeep S/o Lala Ram
2024-11-14
MUNNURI LAXMAN
body2024
DigiLaw.ai
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.
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 arising out of Accident Policy fell for consideration before Hon’ble Supreme Court in the case of Smt. Alka Shukla Vs. Life Insurance Corporation of India, reported in 2910(6) SCC 64, which has a similar term, which is used in the present policy. In para 9 of the judgment, the Court observed as under:- “9.
Life Insurance Corporation of India, reported in 2910(6) SCC 64, which has a similar term, which is used in the present policy. In para 9 of the judgment, the Court observed as under:- “9. ……...There exists a divergence of opinion on whether ‘accidental means’ and ‘accidental death’ are to be read as similar or whether in order for an accidental insurance claim to succeed, the means causing the injury or death also have to be accidental in nature. For the purposes of this case, it is not necessary to conclusively decide this question. In order to sustain a claim under the accident benefit cover, it must be established that the assured has sustained a bodily injury which resulted solely and directly from the accident. There must, in other words exist a proximate causal relationship between the accident and the bodily injury. Moreover, the accident must be caused by outward violent and visible means. The expression “outward violent and visible” signifies that the cause of the accident must be external. Moreover, the injury must be the cause of the death within the period of 180 days. There has to be proximate relationship between the injury and the death to the exclusion of all other causes. The outcome of the present case involves interpretation of the accident benefit cover. Breaking down the clause into its components, what it postulates is that: (i) The assured must sustain a bodily injury; (ii) The injury must solely and directly result from an accident; (iii) The accident must be caused by outward, violent and visible means; (iv) The injury must solely, directly and independently of all other causes result in the death of the assured; and (v) Death must ensue within a period of 180 days from the injury caused in the accident.” 10) In the light of the above decision of Hon’ble Supreme Court in order to cover the Policy to the deceased in the present case, the claimant must establish that the death was on account of accident, which must be a sudden, unforeseen and involuntary event caused by external, visible and violent means. The claimant’s case is that the death of the deceased was on account of fall while he was walking on the road.
The claimant’s case is that the death of the deceased was on account of fall while he was walking on the road. In order to support his case, the claimant relied upon the documents like First Information Report, which was given by Nathu Ram (the nephew of the deceased), inquest report, postmortem report and statements of two sons & wife of the deceased as well as Final Report of the police under Section 174 of Cr.P.C. There is no dispute that the postmortem report simply says that the death was due to intracerebral hemorrhage, which is suggestive of subarachnoid Hemorrhage. Subarachnoid hemorrhage (SAH) is most often caused by head trauma, such as from a serious fall or vehicle accident. Another common cause is a brain aneurysm bursting (bulging or ballooning in a blood vessel in the brain) resulting in SAH, which is a medical condition. 11) The column 2 of the postmortem report are dealing with the injuries of Cranium and Spinal Cord and it is not suggestive of any injury to the Scalp, skull & brain and it is recorded as ‘Healthy’. The inquest report also suggests that there is no external visible injury. The cerebral hemorrhage may be on account of medical condition or serious injury to the cranium. The Permanent Lok Adalat has simply relied upon the statements of interested witnesses recorded by the Police Officer during the proceedings under Section 174 of Cr.P.C. as well as the report of the Investigating Officer. The Investing Officer’s report shows that on account of internal injury to the head, there was a hemorrhage. These findings of Investigating Officer are not getting support from the postmortem report. 12) The incident had occurred on 14.10.2019 at 11 a.m. and the victim was admitted in hospital on the same day. He was taken back to the home from the hospital and on 16.10.2019 at 4 a.m., he died at the house. The manner in which the treatment was given would suggest that if the hemorrhage was on account of a serious forcible injury to the cranium, which resulted hemorrhage, it would be highly improbable that the victim would be taken to the house immediately after giving short medication. The examination of the scalp and skull by doctor in the postmortem report and its findings suggest that they were healthy. There is no reference of any injury to scalp and skull.
The examination of the scalp and skull by doctor in the postmortem report and its findings suggest that they were healthy. There is no reference of any injury to scalp and skull. The internal hemorrhage would only possible, if there was serious injury to the skull, which is absent. If the deceased had fallen, the probable injury was on the forehead or on the back portion of the head or on the parietal regions. If such a fall has an impact on the head, definitely there would have been some kind of external or internal injury on the scalp leading to hemorrhage, which is not the case of the Medical Doctor, who conducted the postmortem. 13) The Permanent Lok Adalat simply relied upon the statements of interested witnesses and the Investigating Officer’s report, which is also based on statements of interested witnesses. The Investigating Officer’s report is contrary to the medical evidence. Such reliance was placed even without giving opportunity to the Insurance Company to test the veracity of interested witnesses in the summary proceedings. Therefore, the award impugned suffers from patent illegality and also perversity, which is liable to be quashed. 14) In the result, the present writ petition is allowed and the award dated 31.10.2023 passed by Permanent Lok Adalat, Pali is set aside. 15) Pending interlocutory applications, if any, shall stand disposed of.