A corporate concern had taken out a Group Personal Accident policy for its workers. During the poilcy period one of the worker died and the claim was lodged with the insurer.
Insurer asked for some of the relevant documents like:
Death Certificate
Post Moterm Report
FIR copy & Final Police report
Hospital's Certificate showing cause of death
Hospitalization and Indoor case papers.
Corporate concern was able to furnish the Death Certificate along with a brief note about the incident after much persuation from the deceased worker's family.
It was then noticed that the worker who died, had a road accident while driving motor bike on 6th May 2009 and had a fracture with minor injuries here and there. The worker got his fractured leg plastered from an Ayurvedic clinic but No FIR was made.
Subsequently, the injured worker complained "chest pain" on 20th May 2009 and was taken to a Government hospital, where he ultimately died.
The insurance company having noted all the facts and circumstance conveyed their inability to pay the claim since death was not caused as a consequence of the road accident but purely becasue of "heart failure", a primary cause, totally isolated and independent from the accidental injury.
Conclusion: Under Personal Accident Policy "Death claim" is payable, if, death is caused directly as aresult of an accident or on account of a cause directly attributable to that accident.
