Cardiac Death During Strenuous Overseas Employment Qualifies As Accidental Death: Ganjam Consumer Commission Directs IFFCO Tokio To Pay ₹10 Lakh
Pranav B Prem
The District Consumer Disputes Redressal Commission, Ganjam at Berhampur, presided over by Shri Satish Kumar Panigrahi (President I/c) and Smt. Saritri Pattanaik (Member), has held that a cardiac death occurring during strenuous overseas employment can qualify as an “accidental death” under a personal accident insurance policy. Consequently, the Commission directed IFFCO Tokio General Insurance Co. Ltd. to pay ₹10 lakh along with interest to the widow of an overseas mason who died while working in Oman.
The complaint was filed by Smt. Kumari Gochayat, the widow and nominee of the deceased insured, who had taken a Pravasi Bharatiya Bima Yojana Policy, 2006 from IFFCO Tokio. The policy was valid from 20.04.2015 to 19.04.2017 and assured a sum of ₹10 lakh in the event of accidental death or permanent total disability during overseas employment. During the subsistence of the policy, the insured, who was employed as a mason in Oman, died on 04.01.2017. The death certificate issued by the Royal Oman Police recorded the cause of death as “Cardiac Arrest of Unknown Reason” .
Following the death, the complainant submitted the requisite claim forms along with the death certificate and other supporting documents to the insurer. Despite completion of all formalities, the claim was neither settled nor was any clear decision communicated for a considerable period. Aggrieved by the inaction, the complainant approached the Consumer Commission alleging deficiency in service on the part of the insurer
IFFCO Tokio resisted the complaint by contending that the policy in question was an accidental death benefit policy and that death due to a heart attack constituted a natural death, which stood excluded under the policy terms. The insurer further argued that the complaint was not maintainable before the Consumer Commission as it involved complicated questions of fact and law requiring adjudication by a civil court. It was also alleged that the complainant had suppressed material facts and that the claim had already been repudiated by a letter dated 12.05.2017
After hearing both sides and perusing the record, the Commission examined whether the cardiac death could be treated as an accidental death in the facts of the case. The Commission observed that although a heart attack is ordinarily regarded as a natural death, the legal position is different where the death occurs during strenuous physical labour and a proximate causal nexus exists between the work conditions and the cardiac event. The Commission noted that masonry work, particularly in an overseas environment like Oman, involves intense physical strain and exposure to harsh conditions, which can precipitate or accelerate a cardiac event
Relying on the “Accident Doctrine” evolved by the Supreme Court, particularly in Shakuntala Chandrakant Shreshti v. Prabhakar Maruti Garvali, the Commission applied the well-settled Triple Test to determine liability. The test requires the existence of physical strain or stress, occurrence of the event during the course of employment, and acceleration or contribution to death by work conditions. The Commission found that all three conditions stood satisfied, noting that the deceased had died “in harness” while actively engaged in strenuous masonry work abroad
The Commission also took note of the fact that the death certificate mentioned “Cardiac Arrest of Unknown Reason,” which, according to the Commission, created a reasonable inference that contributory factors remained uninvestigated. It was observed that the insurer failed to produce any post-mortem report or cogent medical evidence to conclusively establish that the death was purely natural and fell within the exclusion clause. The burden of proving that a death falls under an exclusion, the Commission held, lies on the insurer, which had not been discharged in the present case
Rejecting the insurer’s objection on maintainability, the Commission held that Consumer Commissions are competent to adjudicate insurance disputes even when they involve mixed questions of fact and law. The plea of non-joinder of other legal heirs was also rejected, as the complainant was the nominee under the policy and was competent to maintain the complaint on her own
Holding the repudiation of the claim to be unjustified and amounting to deficiency in service, the Commission allowed the complaint in part. IFFCO Tokio was directed to pay the assured sum of ₹10,00,000 with interest at 9% per annum from the date of filing of the complaint, i.e., 25.07.2018, till the date of the order dated 05.01.2026. The insurer was also directed to pay ₹5,000 towards litigation costs, with a compliance period of forty-five days from receipt of the certified copy of the order.
Cause Title: Smt. Kumari Gochayat v. IFFCO Tokio General Insurance Co. Ltd. & Anr.
Case No.: DC/354/CC/39/2018
Coram: Shri Satish Kumar Panigrahi (President I/c) and Smt. Saritri Pattanaik (Member)
