INSURANCE CLAIM CANNOT BE DENIED DUE TO DROWNING IN POOL

A company cannot deny an accident insurance policy claim to a man who had died due to drowning in a swimming pool, the National Consumer Commission has said.

"In our view, in the present case, the death caused to the insured is an accidental death as it was not natural and that the insured did not intend to die by drowning," Commission President Justice M B Shah said.

The apex consumer panel noted that as per the terms of policy, the insurance company was to pay the claims, if the insured sustained any bodily injury resulting solely and directly from accident caused by "external, violence and visible means".

"Violent means included any external, impersonal cause, such as drowning or inhalation of gas or even undue exertion on the part of the assured," the Commission Bench also comprising member Rajyalakshmi Rao explained. "In such cases, the death is not due to internal cause and that any cause which is not internal must be external. But this does not mean that the injury must be external," the Commission said, referring to the English laws as most of the companies had borrowed their forms of policy from there.

Holding repudiation of the claim as "totally unjustified", the Commission asked the National Insurance Company Ltd (NICL) to pay Rs 25 lakh to Chennai resident Padma Ramanathan, wife of deceased with an interest of 12 percent.

N Ramanathan, a parter in a Chartered Accountants firms, who obtained a personal accident insurance policy for one year period between June 1996 to 1997, had died within one month while swimming at Madras Gymkhana Club.

The NICL had denied his claims saying that since Ramanathan had not died due to bodily injury -- solely and directly -- caused by the external and visible means, so the claim did not come within the purview of the policy.

Source:
New Delhi
The Economic Times