Rekha Gupta, Member
1. Revision Petition no. 1742 of 2007 has been filed by the petitioner who was the opposite party no.1 against respondent no.1 who was the complainant and respondent no. 2 who was the opposite party no. 2.
2. The brief facts of the case as gleaned from the record of the file are as follows:
3. The complainant/ respondent no. 1 took one Group Personal Accident Policy from United India Insurance Co. Ltd., with premium of Rs.1,700/- on 22.09.2003 at N T R Health University, Vijayawada. The policy period was 4 ½ years equivalent to MBBS course. In case of accidental death of earning parent the petitioner “ Insurance Company had to pay Rs.3,00,000/- to the respondent no. 1 apart from the tuition and boarding fees paid to the college by the United India Insurance Co. Ltd. The mother of the respondent no. 1 P Lakshmi Devi died due to heart attack suddenly on 27.11.2004, while she was talking to one Mr Dr M Sheshadri Reddy, Proddatur. The said doctor informed that respondent no.1s mother died due to heart attack. One month later the respondent no.1 approached the petitioner to settle the claim. The mother of the respondent no. 1 was doing cloth business at home. The respondent no. 1 got issued notice through advocate and the petitioners received the same, but did not sent any reply. Therefore, the petitioners committed deficiency of service and adopted unfair trade practice. Thus the complaint may be allowed.
4. Petitioner “ insurance company filed a counter admitting that the Group Personal Accidental Policy for medical students of N T R University of Health Services, Vijayawada was issued to the students. In case of accidental death of students it was for Rs.2,00,000/- and to the earning parent of the student against accidental death it was Rs.3,00,000/-. The policy was issued to the respondent as a medical student. The claim would be entertained by the petitioner “ insurance company in case of death of earning parent accidentally. There was no liability to the insurance company to pay the insured sum, in case the death was not due to accident. Lakshmi Devi died on 27.11.2004 due to heart attack confirmed by doctor at Proddatur. Heart attack was a natural cause of death and not an accidental death. There was no liability on the part of the insurance company to pay the amount. Lakshmi Devi was not an earning member. The father of the petitioner was an earning member and was alive. It was not correct that the deceased was doing cloth business at her home. It was invented and created for purpose of the case. It was not shown in the legal notice. It was not correct that respondent no. 2 was the branch of petitioner. Respondent no. 2 was under the control of Divisional Office, Kadapa. Respondent no. 2 was not concerned with the Group Personal Accidental Policy for medical students issued exclusively by the petitioner “ insurance company. The complaint was bad for misjoinder of unnecessary party i.e., - petitioner “ insurance company. Thus, the complaint may be dismissed with costs.
5. Respondent no. 2 filed a counter separately with the same facts stated by petitioner “ insurance company. The petitioner “ insurance company has stated that the policy was taken from petitioner and from Respondent no. 2. Hence, respondent no. 2 was not a necessary party to the complaint. Respondent no. 2 has been shown as party as respondent no. 2 in order to save the jurisdiction of complaint. Petitioner was only a competent party to settle the claim. Respondent no. 2 was the branch under the control of Divisional Office, Kadapa it had no connection with the Divisional Office, Vijayawada, i.e., petitioner “ insurance company, the complaint may be dismissed with costs.
6. District Consumer Disputes Redressal Forum, Kadapa (the District Forum) after hearing the counsel and perusing the materials on record allowed the complaint with following observations:
œIn the result, the complaint is partly allowed without costs and compensations, with directions to R 1 to deposit Rs.3,00,000/- in the name of the complainant in a nationalised bank, Kadapa and to pay monthly interest only to the complainant by 10th every succeeding month, and to pay the principal amount of Rs.3,00,000/- after completion of 4 ½ years course. Until then the complainant is not entitled to receive the principle amount of Rs.3,00,000/-. The complaint against R 2 is dismissed without costs. R 1 is directed to pay only tuition fees directly to the college for the remaining 2 ½ years course?.
7. Aggrieved by the order of the District forum, the petitioner filed an appeal before the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad, Circuit Bench at Tirupati. The State Commission vide its order dated 17.01.2007 dismissed the appeal.
8. Hence, the present revision petition.
9. The main grounds for the revision petition are as follows:
HonbleFora have failed to appreciate that the word accident is without doubt used with the intention of excluding the operation of natural causes including congenital or insidious disease or natural profession of some constitutional physical and mental defects. If a medical condition which leads to a death has to construe as accident than in other words we are replacing the word accident with death. Every death has unforeseen reasons; somebody may die because of a heart attack, cancer, or old age as every human being is born with seeds of mortality. But natural failures of ones body cannot be termed as accidental.
The State Commission has committed an error in considering the death by heart attack as accidental death.
The State Commission erred in applying the interpretation of the word accident as given under the Workmen Compensation Act whereas the case was not a workman but a beneficiary of a contract of insurance.
The State Commission was not justified in awarding benefits of the policy in the absence of the proof that the deceased mother was an earning parent.
The State Commission erred in not appreciating that there was no loss to the studies of the claimant on account of mothers death who was alleged to be an earning parent as it was proved that the expenses of the studies of the claimant were being borne by his father being an earning parent who is still alive.
As per the logic applied by the State Commission in respect of accidental death by this definition and logic no death would amount to a natural death.
10. We have heard the learned counsels for the parties and have also gone through the records of the case.
11. A perusal of the insurance policy shows that it is a Group Personal Accidental Policy for first year MBBS Student of the NTR Health University. As per the special exclusion in the event of death of earning parent due to accident, tuition and boarding fee up to prescribed limit will be payable. It also clear from the document signed by the Senior Divisional Manager, i.e., the Group Personal Accident Policy for Medical Students was to cover specifically loss of valuable lifes due to fatal accidents. As per the features of the policy which read as under:
(i) To insure the 1st year students studying MBBS and other medicine related course in the colleges affiliated to the NTR University of Health Sciences, against accidental death only for a sum insured of Rs.2 lakh.
(ii) To insure the earning parent of the student (name to be specified) against accidental death only for Rs.3 lakh.
(iii In the event of a claim due to the accidental death of the earning parent, tuition and boarding fee (up to prescribed limits) will be paid to the college authorities to ensure that the students complete his course.
12. It was designed to help the student who œmight become hapless victims of accidents which occur due to the negligence or someones negligence?.
13. It is apparent from the same that the Group Personal Accident Policy for medical students was designed to give financial help in case of death of the earning parent who was supporting the education of the student and due to the fatal accident the students to continue their education to complete the course. In the instant case, it is an admitted fact that the mother of the student died due to heart attack, while talking to one Dr M Sheshadri Reddy of Proddatur. It is also a fact that father of the complainant was an earning parent and is still alive.
14. It is not the case that the heart attack resulted due to any accidental mishap. It is also nowhere on record that the mother of the complainant was paying for the education of the complainant through her business. If all deaths, due to medical reasons are to be taken as death due to accident there would be no need for a separate accidental policy as one policy, i.e., Life Insurance Policy would cover all eventualities. Even in a Life Insurance Policy the double benefit scheme for death in an accident is separately provided for as an additional option with an add on premium.
15. Counsel for the respondent has cited a Supreme Court judgment titled “ Life Insurance Corporation of India and Another vs Hira Lal ( 2011) 14 SCC 445. The facts of the case are not applicable to the case on hand.
16. For the reason mentioned above, the revision petition is allowed and the orders of the State Commission and the District Forum are set aside and the complaint is dismissed with no order as to costs.