Injury Must Be Direct Cause Of Death To Claim Insurance Under Accidental Death: Telangana State Commission Dismisses Appeal Against United India Insurance

Brief Facts of the Case

The complainant' husband, an advocate, had an insurance policy with United India Insurance/insurer making the complainant as the nominee. Subsequently the deceased suffered a heart attack while undergoing surgery and passed away. The complainant filed a claim under a Group Personal Accident policy obtained from the insurer, with a sum assured of Rs. 10,00,000. The complainant stated that the death should be treated as accidental according to the policy. But the insurer denied the claim, stating that a heart attack is not an accidental death. The complainant then approached the District Commission, but the complaint was dismissed. Consequently, the complainant appealed to the State Commission of Telangana.

Contentions of Insurer

The insurer argued that the policy covers only deaths caused by accidents, which are sudden, unexpected, and due to external, visible, and violent forces. Since a heart attack is a medical issue, it does not count as an accidental death. The insurer claimed the policy did not cover the insured's death and asked for the complaint to be dismissed with costs.

Observations by the State Commission

The State Commission highlighted that the complainant's husband, while being taken to the operation theatre for a spinal fusion surgery, suffered a sudden heart attack and died. The complainant argued that a “sudden heart attack” should be considered an accidental death under the policy. The complainant cited the case Rita Devi @ Rita Gupta vs. National Insurance Co., Ltd., where death from a sudden heart attack caused by a cold wave was ruled as accidental. However, the Commission emphasized that there was no cold wave or external cause in this case. The insured's death was due to a heart attack while being taken for surgery. The Commission referred to the Supreme Court's judgment in Smt. Alka Shukla vs. Life Insurance Corporation of India. The Court in this case ruled that for death to be accidental, it must result from an outward, violent, and visible injury. In that case, the insured died from a heart attack after falling off a bike, and the Court said the heart attack was the main cause of death, not the fall. Since there was no accident in this case, the State Commission upheld the District Commission's decision and dismissed the appeal.

Case Title: Smt. Govinda Rajula Radha Kumari Vs. United India Insurance Company Limited

Case Number: F.A. No. 143/2020