NCDRC directs Bajaj Allianz to pay after accident policy holder suffers heart attack in fall

The National Consumer Disputes Redressal Commission has ordered Bajaj Allianz insurance company to not block compensation to the family of a person who died of a cardiac arrest during a fall.

Bajaj Allianz had refused to pay Rs 4 lakh claiming that the person was insured only for accidents and that the person must have died before he fell, rather than died after he fell.

The Commission, however, said it was difficult to arrive at such a conclusion, and directed the company to pay the money.

The case relates to Maniram Sahoo, an employee of Chhattisgarh State Power Holding Company Ltd, who 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.

Sahoo fell down from the electrical pole and died and a 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.

Sahoo’s employer paid a sum of Rs 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.

According to Bajaj Allianz, Maniram Sahoo did not die of injuries on account of falling from electric pole. It said according to the post-mortem report, he died due to heart failure, as he had been suffering from diabetes and heart disease.

However, the Commission dismissed the argument.

“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 thinking and common sense,” it said.

It pointed out that according to the post mortem, 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.”

“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.”