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This week I would like to write about two orders of the apex consumer court pertaining to accident insurance policy. While in one, the court held that death from cold wave constitutes an accidental death, in the other it made it clear that while interpreting the terms and conditions of an insurance contract, companies have to keep in mind the ground realities. Both are extremely important orders. The first case pertains to the death of 37-year-old Parshuram Singh from cold wave in Bihar. When his wife sent in the claim papers and asked the insurance company to pay the insured amount on the Janata accident insurance policy taken by him, the company pointed out that the policy pertained to accidental death. Since he died from cold wave, her claim was liable to be rejected. The apex court in this case examined two important decisions of the Patna High court on a similar issue and also Halsbury's laws of England, and concluded that death from exposure to natural elements such as cold wave constituted accidental death. In a well-reasoned order, Justice M.B.Shah, president, and Ms Rajyalakshmi Rao, member, National Consumer Disputes Redressal Commission, pointed out that the word accident meant something unexpected or an untoward event. But the test of what is unexpected is whether an ordinary reasonable man could have expected such an occurrence. Said the commission: "From the law developed in other countries and in this country, it is clear that injury or death caused by lightening, sun-stroke or earthquake has been held to be accidental. Further, where a man in the course of his work is exposed to excessive heat coming from a boiler and becomes exhausted and death occurs, it would be an accidental death. Similarly, a person working in icy conditions gets pneumonia, which causes his death. Such a death is also considered to be accidental. Similarly, if the insured is seized by a fit and drowns or falls in front of a train and is killed, the death is due to an external cause and is accidental. Death resulting from threats by miscreants is also considered to be accidental caused by external, violent and visible means." "In substance, death which does not occur in the usual course, or natural course of events, or events/causes which could not be reasonably anticipated, is considered to be an accidental one. Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect, and it is by natural external violent force. Further, cold wave is an untoward event which is not expected or designed, and an ordinary man could not expect its occurrence. It is to be stated that in the present case, the cold wave was sudden and due to that a number of persons, including the husband of the petitioner, suffered a massive heart attack, as a result of which he died." Thus the death of Parshuram Singh, the husband of the petitioner, will be covered by the policy, the apex court said, and asked the insurance company concerned to pay Rs 3 lakh along with 12 per cent interest calculated six months from the date of the accidental death. It also asked the company to pay Rs 10,000 towards costs of litigation. The second case pertains to death by snake bite. Here, the police officer, the village administrative officer and a local doctor certified that the insured had died of snake bite. Yet, the insurance company was unwilling to pay the insured amount on the ground that a postmortem was not conducted, as required under the terms of the policy. Dismissing this contention, the apex court pointed out that when a person dies of a snake bite in a small village, it would be impractical to expect the family to take the body to a far-away civil hospital for a postmortem.
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