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Judgment
The petitioners 1 to 4 who are respondents in O.P. No. 51/2018 before the Permanent Lok Adalath (for Public Utilities), Ernakulam are before this
Court challenging Ext.P4 Award.
The respondents who are the petitioners in the Original Petition before the Permanent Lok Adalath, Ernakulam are legal heirs of late Joseph
Sebastian, who was an ASI in Manarkad Police Station, Kottayam. The said late Joseph Sebastian had two insurance policies obtained under Group
Personal Accident Insurance Scheme framed by the Government of Kerala under Ext.P2 order dated 23.11.2010. On 29.07.2014, while the deceased
Joseph Sebastian was discharging his duties, he suffered an injury on his right leg. He was taken to Medical College Hospital, Kottayam on 31.07.2014
and was treated as inpatient till 05.08.2014. Due to the fracture and treatment, Joseph Sebastian availed medical leave for five weeks. On 13.08.2014,
the said late Joseph Sebastian fell unconscious and was taken to Marian Hospital, Pala. As the physical condition of Joseph Sebastian worsened, he
was rushed to Amrita Hospital, Ernakulam. Joseph Sebastian passed away on 16.08.2014 while he was under treatment for Pulmonary Thrombo
Embolism.
The respondents herein preferred Ext.P1 O.P No.51/2018 before the Permanent Lok Adalath (for Public Utilities), Ernakulam seeking to direct
petitioners 1 to 3 to pay full compensation amount covered by the two insurance policies with interest @ 9% per annum from 16.08.2014 onwards. An
amount of `50,000/- was claimed towards costs also. The Permanent Lok Adalath considered the evidence adduced by the respondents through PW1
to PW4. Exts.P1 to P18 produced by respondents were also considered.
After appreciating the evidence on record, the Permanent Lok Adalath held that it is proved by the petitioners that the late Joseph Sebastian died
due to accident which will come within the sweep of the conditions mentioned in the insurance policy. The Permanent Lok Adalath held that the
petitioners are entitled to get the amounts claimed. Accordingly, the petitioners were directed to pay full compensation amount covered by the policies
in question along with the litigation expenses of `10,000/-. It is aggrieved by Ext.P4 Award, the petitioners have approached this Court.
The learned Government Pleader representing the petitioners brought to the attention of this Court various clauses of Ext.P2 Scheme. The learned
Government Pleader contended that the term 'accident' is defined in clause 2 (a) of Ext.P2 Scheme as “bodily injury sustained by the member on
account of any sudden unforeseen or unexpected event which is solely or directly the result of an external, violent or visible meansâ€. The learned
Government Pleader argued that though what happened on 29.07.2014, resulting in the injuries of the deceased was an accident, the death was not as
a consequence of such accident. There is no proximity to the death with the alleged extent.
Referring to Clause 11 of Ext.P2 Scheme, the learned Government Pleader argued that it is necessary for any claimant to produce:
(i) Claim Form
(ii) FIR from Police Department wherever applicable (iii) Mahazar from Police Department
(iv) Death Certificate
(v) Postmortem report
(vi) Form No.1 (Nomination form) to claim the insurance amount. In the case of the petitioner, since it was not an accident as contemplated by Ext.P2
Scheme, there was no FIR registered by the Police Department. Mahazar was also not prepared. No Postmortem report was produced. The learned
Government Pleader argued that in the absence of the mandatory documents contemplated under clause 11 (e), the Permanent Lok Adalat ought not
have awarded the insurance amount to the respondents.
The learned Government Pleader further pointed out that the Permanent Lok Adalat has not applied its mind properly, which is evident from the
fact that even in the Award passed in the Permanent Lok Adalat, the number of insurance policies shown, are erroneous. The learned Government
Pleader contended that even assuming that insurance amount was legally payable, 9% interest awarded by the Permanent Lok Adalat was excessive
and the Lok Adalat ought not have awarded any cost.
I have heard the learned Government Pleader and the learned counsel appearing for the respondents.
The factum of accident on 29.07.2014 is not disputed. The injuries sustained by the deceased are also not disputed. Consequent to the accident, the
deceased was under treatment in Medical College Hospital, Kottayam from 13.07.2014 to 05.08.2014. The deceased was on medical leave even
thereafter. It is not in dispute that the deceased fell unconscious within ten days of discharge from Medical College Hospital, Kottayam and had to be
taken to hospitals. The deceased passed away on 16.08.2014.
The hospital authorities recorded the cause of death of the deceased as 'Pulmonary Thrombo Embolism' The contention is that 'Pulmonary
Thrombo Embolism' which resulted in the death of the deceased, is not as a consequence of the accident and injuries suffered by the deceased on
29.07.2014.
The Permanent Lok Adalat has considered the evidence adduced by PW2, who is a Professor in Orthopaedic Department of the Kottayam
Medical College. PW2 stated that right foot 5th metatarsal bone of the deceased was fractured. 'Pulmonary Thrombo Embolism' will occur if blood
clotted in any part of the body and through bllood circulation, the same will reach the lungs resulting in obstruction to breathing process which will
culminate in death. PW2 observed that after applying plaster of parries on the deceased, two weeks later blood clot occurred in his calf muscles and
this might have reached his lungs resulting in his death.
PW3, a Cardiologist of Pala Marian Medical Centre, had treated the deceased. PW3 stated that the deceased was unconscious when he was
brought to the hospital and his Blood Pressure was not recorded. The oxygen saturation in the blood of the deceased was very low. Those who
brought the deceased to the hospital informed that the fracture occurred and plaster of parries was applied at the Medical College Hospital, Kottayam.
According to PW3, since the condition of the deceased was worse after giving immediate medical aid, he was referred to AIMS Hospital, Ernakulam.
The deceased had put in an ambulance with ventilator support.
PW3 also stated that the condition of the deceased was serious because blood clot might have been very large. The said evidence adduced on
behalf of the respondents through Exts.P2 and P3 would show that there was proximity of the accident of the deceased occurred on 29.07.2014 with
his death on 16.08.2014. The period between the date of the accident and the date of the death cannot be a reason to hold that the death is not as a
result of the accident.
The learned Government Pleader relied on the judgment Alka Shukla v. Life Insurance Corporation of India [AIR 2019 SC 2088] to contend that
in the absence of Postmortem report indicating the nature of injuries sustained by the insurer, necessarily the medical report will have to be relied on.
The judgment of the Hon'ble Apex Court found from the medical reports available, that there is no direct nexus between the assured suffering a
heart attack and injuries sustained in an accident by outward, violent and visible means. The judgment of the Hon'ble Apex Court is distinguishable on
facts in as much as in the present case two competent medical professionals had entered the witness box and gave evidence that the demise of the
deceased was as a result of 'Pulmonary Thrombo Embolism' which stage has arisen consequent to the accident of the deceased on 29.07.2014. This
Court does not doubt the veracity of the evidence adduced by medical professionals.
In the circumstances, this Court finds no reason to interfere with the Award passed by the Permanent Lok Adalat. The writ petition is accordingly
dismissed.