- (1.) ORDER passed by District Consumer Disp utes Redressal Forum, Rajnandgaon (hereinafter called "District Forum" for short) in complaint case No. 62/07 on 18.8.2008 is under challenge in this appeal, which has been preferred by the Insurance Company who has been directed to pay Rs. 5,50,000 to the respondent/complainant, which was the amount of insurance of the policy of the deceased Gautam Chand Jain.
(2.) BRIEFLY stated facts of the case are that an insurance policy was issued by the appellant Insurance Company in favour of the deceased Gautam Chand Jain and the sum assured was Rs. 4,00,000. In addition to it another policy of Rs. 1,50,000 was also purchased by the deceased. Both policies were issued under the head of Individual Personal Accident Policy and the death in accident was the condition precedent for payment of the insurance amount. As per complainant/respondent the deceased died on 30.12.2006 at about 10.30 p.m. near bathroom after falling down near the wall and sustaining head injuries thereby resulting in brain haemorrhage and death. He was immediately attended by qualified doctor but could not be saved. As it was a case of unnatural death so, the matter was reported to the police and autopsy was conducted on the dead body. Finding was that of accidental death. Then claim for sum assured as per policies was preferred by the respondent before Insurance Company which was repudiated on the ground that death was not accidental and was on account of brain haemorrhage because of earlier diseases of high blood pressure resultingin, fall on the ground and failure of heart. It has been averred by the Insurance Company in reply that the death was natural one.
(3.) LEARNED District Forum after taking into consideration the material placed by both parties allowed the complaint and awarded the insurance amount. This appeal has been preferred on the ground that the death of Gautam Chand Jain was not accidental and so no sum was payable under the insurance policy.;