STATE OF RAJASTHAN vs Jubeda Begum

THIS appeal under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as ''the Act of 1986'') has been filed by the appellants against the order dated 3.5.2003 passed by the learned District Forum, Bundi in Case No. 134/2002 by which the complaint filed by the complainant -respondent No. 1 under Section 12 of the Act of 1986 was allowed and the appellants were directed to pay Rs. 2 lacs to the complainant -respondent No. 1 along with interest @ 9% p.a. with effect from 5.3.2002 and the complainant -respondent No. 1 was also awarded Rs. 5,000/ - towards mental agony and Rs. 1,000/ - as cost of litigation.

IT arises in the following circumstances: The complainant -respondent No. 1 filed a complaint under Section 12 of the Act of 1986 before the learned District Forum, Bundi on 15.7.2002 stating inter alia that her husband Mustaq Hussain Jedi (hereinafter referred to as ''the deceased'') was an employee in the Panchayat Samiti Taleda and was working as Teacher Gr. III. It was further stated in the complaint that with effect from March, 1995, group insurance policy was introduced compulsorily by the State of Rajasthan (appellant No. 1) and the deceased was holder of policy and as per terms of that policy, if the employee had fallen from the staircase and had died thereafter, in such a case, Rs. 2 lacs would be paid to his LRs. It was further stated in the complaint that on 26.8.2000 at about 1.00 p.m., deceased had fallen from the staircase of his house, as a result of which he received injuries in his head and, thereafter, he was admitted in the Bundi Hospital from where he was referred to Kota. It was further stated in the complaint that at Kota, deceased was admitted in M.L. Baheti Hospital and Research Centre on 26.8.2000 where he was treated by Neuro Surgeon Dr. Mamraj, but on 27.8.2000, deceased succumbed to his injuries. It was further stated in the complaint that thereafter, the complainant -respondent No. 1, who is wife of deceased, preferred her claim under the group insurance policy before the appellants, but her claim was repudiated by the appellants stating that since deceased had died because of heart attack and in case of death by heart attack, the amount under the group insurance was not payable. Thereafter, the present complaint was filed. A reply was filed by the appellants stating that since deceased had died due to heart failure, therefore, his death was natural one and it could not be treated as accidental one and, thus, claim under the terms and conditions of the group insurance policy, was not payable and it was rightly repudiated by appellants. Hence, the present complaint deserves to be dismissed. After hearing both the parties, the learned District Forum, Bundi through impugned order dated 3.5.2003 allowed the complaint of the complainant -respondent No. 1 in the manner as indicated above holding inter alia that the complainant -respondent No. 1 being wife of the deceased was entitled to the amount under the group insurance policy and her claim was wrongly repudiated by the appellants. Aggrieved from the said order dated 3.5.2003 passed by the learned District Forum, Bundi, this appeal has been filed by the appellants. In this appeal, the main argument of the learned Counsel for the appellants is that the complainant -respondent No. 1 had failed to prove the fact that death of the deceased had taken place due to alleged injury on the head and for that, reliance has been placed on the inquiry report dated 5.3.2002 submitted by Shri L.R. Lotan, who conducted the investigation on behalf of the appellants, where he came to the conclusion that the cause of death of the deceased was heart attack and the death of the deceased was not treated by him as accidental one.

ON the other hand, the learned Counsel for the respondents has supported the impugned order.

WE have heard the learned Counsel appearing for the appellants and the learned Counsel appearing for the respondents and gone through the entire materials available on record. Before proceeding further, it may be stated here that there is no dispute on the point that deceased had fallen from the staircase of his house on 26.8.2000, as a result of which, he received injury on head and for that, the bed head ticket of Government General Hospital, Bundi may be referred to.

THERE is also no dispute on the point that thereafter, on 26.8.2000, deceased was admitted in M.L. Baheti Hospital and Research Centre, Kota and bed head ticket clearly reveals that it was a case of fall from the staircase and there was bleeding from scalp wounds and condition of the deceased was found serious one as he was unconscious.

THERE is also no dispute on the point that on 26.8.2000 at about 8.00 p.m. deceased had cardio -respiratory arrest and he was unconscious at that time also and he died on 27.8.2000 at about 3.30 a.m. It may be stated here that there is a death report dated 27.8.2000 submitted by concerned doctor of M.L. Baheti Hospital and Research Centre, Kota where cause of death of the deceased had been shown as head injury.

THERE is also no dispute on the point that the inquiry report submitted by Shri L.R. Lotan reveals that it was a case of simple heart attack and not pertaining to head injury.

THE question for consideration is whether in the facts and circumstances just narrated above, findings of the learned District Forum are liable to be confirmed one or not, especially though the cause of death of deceased had been shown by concerned doctor as head injury while in bed head ticket, immediate cause of death was cardiac arrest. All deaths may be attributed to one of three proximate causes, namely, coma, syncope or asphyxia. Since life is maintained by the interdependent action of the brain, the heart, and the lungs, the arrest of the function of one of them is quickly suceeded by the arrest of the function of the others, and life ceases. Syncope

THIS term is applied to a sudden cessation of the action of the heart, which may prove fatal. Syncope may be brought about by a large variety of causes, including shock, emotion, a blow on the epigastrium, or the evacuation of fluids, for example, the over -rapid withdrawal of fluid from an ascetic abdomen, or from a pleural cavity. The injection of fluid into the uterus may also induce syncope. Excessive haemorrhage, infective and chronic disease, extensive injury and disease of the heart, especially of the degenerative type, also coronary thrombosis, are frequent causes. Among many other causes, sudden immersion of the body in cold water, with impingement of the water upon the nasal and post nasal mucous membrane, and sudden constriction of the neck over the carotid sinuses are worthy of mention. Shock may be primary or secondary.

PRIMARY shock, a frequent cause of syncope, results from afferent impulses which cause reflex vasodilatation and a resultant serious fall in the blood -pressure due to the actual diminuation of the volume of the blood passing through the heart to the arteries. Secondary shock, or traumatic shock, would appear to result from a reduction in the blood volume due to loss of blood and plasma into the injured tissues, and an increased concentration of the blood in the circulatory system. When the loss of blood becomes such that it cannot maintain an effective circulation, the vital centres of the brain can no longer obtain a normal amount of blood and death results. Determination of death

DEATH is determined by the entire and permanent cessation of circulation and respiration. Ordinarily, these signs are considered sufficient to determine that death has actually taken place, but these alone should not be relied on, as absolute signs to avoid premature burial or cremation.

IT is incorrect to write heart failure or cardiac failure or cardiopulmonary arrest without mentioning the underlying pathological cause, which might be coronary artery disease or rheumatic valve lesions or senile myocardial degeneration. It should be remembered that every one dies of cardiopulmonary arrest or heart failure or cardiac failure which simply means cessation of circulation and respiration leading to somatic and then cellular death. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organisation.

THE symptomatology or modes of death, e.g., cardio -respiratory failure, asthenia, or asphyxia, coma, angina, cancer or tumour without specifying its site or nature, catarrh, congestion, debility, asthenia, organic disease, toxaemia, sepsis and haemorrhage should not be recorded as the cause of death, without mentioning the underlying pathological cause.

APART from this, severe injury of a vital organ, such as the crushing of the brain, heart, and lungs, is, as a rule, fatal. Wounds may cause depression of vital functions as a result of shock due to trauma. Death may occur from primary or neurogenic shock (vaso -vagal shock or reflex cardiac arrest).

THUS , it can be concluded that cardiac arrest itself cannot be treated as cause of death without mentioning the underlying pathological cause.

IN the present case, no doubt in the bed head ticket, it was stated that deceased had died because of cardio respiratory arrest, but that could not be treated or termed as cause of death because of the simple reason that bed head ticket clearly reveals that before death of deceased, which had taken place on 27.8.2000, he was admitted in Bundi Hospital and M.L. Baheti Hospital and Research Centre, Kota where it was found that he was having head injury and there was loss of blood also. Thus, pathological cause in the present case was nothing, but the head injury which had primarily resulted in the death of deceased in the form of cardio -respiratory arrest. Therefore, to say that death of the deceaed was result of simple cardiac arrest cannot be accepted and in view of the above reasons, the report submitted by the enquiry Officer Shri L.R. Lotan should be treated as rejected and on the contrary, the report submitted by the concerned doctor of M.L. Baheti Hospital and Research Centre, Kota that the cause of death of deceased was head injury has to be accepted.

APART from this, in the present case, there is no proof that deceased was suffering from heart problem at the time of taking policy nor there was any evidence to show that he was having knowledge of such disease at the time when the policy was taken and, therefore, the death of the deceased could not be treated because of heart failure alone, as just prior to that, he received head injury with loss of blood, as a result of falling from the staircase.

HAD there would have been long distance between the receiving of head injury and death, the position would have been different one, but, in the present case, the deceased received head injury on 26.8.2000 and he died on 27.8.2000. Therefore, from every point of view, there was clear nexus between the head injury and death of the deceased. It may be stated here that the definition of death according to Blacks Law Dictionary is the cessation of life; the ceasing to exist. According to physicians definition, it is a total stoppage of circulation of the blood and consequent thereupon, a cessation of the animal and vital functions.

IN the present case, no doubt death of deceased had taken place because of cardiac arrest, but it has happened because of stoppage of circulation of the blood as deceased was having head injury with loss of blood. Thus, in this case, heart attack was direct consequence of head injury and the concerned doctor has rightly observed that cause of death of deceased was head injury.

THEREFORE , the case of deceased would be covered by Clause 2 of Rule 6 of group insurance policy and not by Rule 7(1) of group insurance policy. For the reasons stated above, the findings of the learned District Forum to the effect that claim of the complainant -respondent No. 1 was wrongly repudiated by the appellants as the death of deceased had taken place because of falling from the staircase and, thus, it was not a case of heart failure, are liable to be confirmed one as they are based on correct appreciation of entire materials available on record and they do not suffer from any basic infirmity.

THE learned Counsel for the appellants has placed reliance on the decision of this State Commission in LIC of India v. Hundi Bai, II (2004) CPJ 344. In our considered opinion, the facts of that case stands distinguished from the facts of the present case because in the present case, the fact that deceased had fallen from the staircase of his house was not in dispute, the fact that he received head injury as a result of falling from staircase was also not in dispute and the fact that he was having bleeding from head was also not in dispute and moreover, the grounds mentioned above clearly make out a case in favour of the complainant -respondent No. 1. Therefore, this authority would not be helpful to the appellants.

IN view of the discussion made above, no interference is called for with the impugned order of the learned District Forum, Bundi dated 3.5.2003 and this appeal deserves to be dismissed. Accordingly, this appeal filed by the appellants is dismissed. Appeal dismissed.