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REPORTABLE  

IN THE SUPREME COURT OF INDIA  CIVIL APPELLATE JURISDICTION  

 Civil Appeal No. 3413 of 2019  

(Arising out of SLP (C) No. 32335 of 2016)  

Smt. Alka Shukla                                    .... Appellant  

        Versus  

 Life Insurance Corporation of India                               ....Respondent  

J U D G M E N T       

 Dr Dhananjaya Y Chandrachud, J        

1  The present appeal arises from a judgement of the National Consumer  

Disputes Redressal Commission1 which reversed the judgment of the Chhattisgarh  

State Consumer Disputes Redressal Commission2. The SCDRC had affirmed the  

view of the District Consumer Disputes Redressal Forum, Durg3  allowing  an   

accident insurance claim.  

2 The spouse of the appellant obtained three insurance policies from the Life  

Insurance Corporation of India4 :   

(i) New Bima Gold Policy;  

                                                 1 “NCDRC”  2 “SCDRC”  3 “the District Forum”  4 “LIC of India”

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(ii) LIC Jeevan Tarang Policy; and  

(iii) Twenty Years Money Back Policy with profits and accident benefit.  

The details of the policies are tabulated below:  

Policy No Policy  Number  

Date of  Commenceme

nt  

Total Term Sum  Assured  

(Rs)  

Premium  (in Rs)  

1 Bima Gold  Policy  370473369  

27.06.1992 75-20 50,000 3188/-  yearly  

2 LIC New  Bima Gold  Policy  384067139  

10.08.2006 178-10 2,00,000 21134/-  yearly  

3 Twenty  Years  Money Back  Policy (with  accident  benefit)  385316764  

11.01.2008 179-12 2,00,000 7641/-   half-yearly  

Condition 10 (2) of the first policy, condition 10 (b) of the second policy and condition  

11(b) of the third policy contain a stipulation for accident benefit, on which the  

controversy in the present case rests. The stipulation in the New Bima Gold Policy in  

relation to accident benefit is extracted below, in so far as is material:  

“(b) Death of Life Assured : In addition to sum assured under  

Basic Plan, an additional sum equal to the Accident Benefit  

Sum Assured shall be payable under this policy, if the Life  

Assured shall sustain any bodily injury resulting solely  

and directly from the accident caused by outward, violent  

and visible means and such injury shall within 180 days of  

its occurrence solely, directly and independently of all other  

causes result in death of the Life Assured.”   

           (Emphasis supplied)  

The stipulations in the other two policies are similar, where the accident benefit was  

payable if the assured sustained any bodily injury resulting solely and directly from the  

accident caused by “outward, violent and visible means”, and that such injury “solely

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and directly and independently of other causes” results in death.  On 3 March 2012,  

the spouse of the appellant, while riding his motorcycle, experienced pain in the chest  

and shoulder, suffered a heart attack and fell from the motorcycle. He was attended to  

at 10:10 pm on 3 March 2012 by Dr Ajay Goverdhan, a general physician. He was  

referred to Dr SS Dhillon who diagnosed the mishap as having been caused by “a  

sudden fall from the bike”.  Dr Dhillon noted that the patient was experiencing pain in  

the left side of the chest and in the shoulder and there was a myocardial infarction. He  

referred the patient to a specialist medical center. He was taken to the Chandulal  

Chandrakar Memorial Hospital at Bhilai. The OPD card notes the following position at  

admission:  

“Sweating, radiating to left shoulder and 2 episodes of  

vomiting Following this patient was taken to Dhillon Nursing  

Home where ECG taken showed Ant. Wall M1. He was given  

loading dose of Ant. Platelet and Referred. On his way to the  

hospital, Pt. collapsed. On reaching here, on examination Pt.  

had so sign of life.\HR, O/nil, BP-NR, Pupil B/L fixed.”  

As the above diagnosis indicates, the patient had died by the time that he had been  

admitted to the above hospital. The report of the physician indicates that death had  

occurred due to an acute myocardial infarction.  

 3 Dr Ajay Goverdhan furnished his report in Claim Form B indicating that: (i) the   

cause of death was an acute myocardial infarction; and (ii) the symptoms of illness  

were pain in the chest and shoulder.  The insurance claim was settled in respect of  

the basic cover of insurance. However, the insurer repudiated the claim under the  

accident benefit component of the insurance policy on the ground that the death of the  

insured had occurred due to a heart attack and not due to an accident.   

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4 The appellant filed a consumer complaint under the Consumer Protection Act  

1986 before the District Forum. On 2 May 2013, the District Forum allowed the  

complaint and directed the respondent to pay the accident benefit under the three  

policies together with interest at 6 percent per annum.  The SCDRC by its judgment  

dated 14 March 2014 rejected the appeal of the insurer holding that:  

(i) It appeared that the death of the insured was due to a fall from the motorcycle;  

and  

(ii) The main cause for the heart attack was the fall from a motorcycle which was  

an accident under the terms of the policy.    

 In a revision by the insurer, the NCDRC by its judgment dated 29 April 2016 reversed  

the judgment of the District Forum, which had been affirmed by the SCDRC.  The  

NCDRC held that in the terms of the accident cover, the sum assured was payable in  

the event of an accident caused by “outward, violent and visible means”. Adverting to  

the medical evidence, the NCDRC held that the pain in the chest and shoulder and  

the sudden fall from the motorcycle were not the result of an accident caused by  

outward violent or visible means.  The award of compensation in terms of the accident  

benefit was accordingly set aside.  Assailing the decision of the NCDRC, the spouse  

of the insured has filed the present appeal.  

 5 The issue before this Court is: (i) whether the assured’s death was due to a  

bodily injury resulting from an accident caused by outward, violent and visible means;  

and (ii)  whether the injury was proximately caused by the accident. It is only when  

both the questions are answered in the affirmative that the complainant would be   

entitled to claim under the policy.  

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6 During the course of the hearing, learned counsel appearing for the appellant  

argued that the assured suffered a heart attack as a result of the injuries sustained  

due to a fall from the motorcycle, which was within the purview of the policy. On the  

other hand, learned counsel for the respondent argued that the medical reports are  

indicative of the fact that the death of the assured was due to a heart attack and not  

an accident and therefore, no claim arises under the policy. It was also argued that  

while determining the insurance cover for accidental death, a distinction has to be  

made between ‘accidental means’ and ‘accidental result’. The distinction sought to be  

introduced is with a view to make the application of the insurance cover more  

restrictive.   

 The rival submissions fall for our consideration.   

 7 The policy of insurance indicates that a claim on account of the accident benefit  

is payable only if the following conditions are satisfied: (i) the assured sustained bodily  

injuries resulting solely and directly from an accident; (ii) the accident was caused by  

“outward, violent and visible means”; and (iii) that such injury “solely and directly and  

independently of other causes” results in the death of the assured. These conditions  

are cumulative. The terms “bodily injury” and “outward, violent and visible means”  

have not been defined in the policy. In Union of India v Sunil Kumar Ghosh5, this  

Court dealt with the expression ‘accident’ and held thus:  

“13…An accident is an occurrence or an event which is  

unforeseen and startles one when it takes place but does not  

startle one when it does not take place. It is the happening of  

the unexpected, not the happening of the expected, which is  

called an accident. In other words an event or occurrence the  

happening of which is ordinarily expected in the normal  

course by almost everyone undertaking a rail journey cannot  

be called an “accident”. But the happening of something  

which is not inherent in the normal course of events, and  

                                                 5 (1984) 4 SCC 246

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which is not ordinarily expected to happen or occur, is called  

a mishap or an accident.”  

P Ramanatha Aiyar’s Law Lexicon6, defines the expression ‘accident’ as:  

“an event that takes place without one’s foresight or  

expectation; and event that proceeds from an unknown  

cause, or is an unusual effect of a known cause, and  

therefore not expected, chance, causality, contingency.”  

The expression ‘accident’ in the context of an accident insurance policy has been  

explained in MacGillivray on Insurance Law7:  

“In the context of an accidental insurance policy the word is  

usually contained in phrases such as “injury by accident”,  

“accidental injury”, “injury caused by or resulting from an  

accident” or “injury caused by accidental means” and in each  

of these phrases it has the connotation of an unexpected  

occurrence outside the normal course of events.”   

Colinvaux’s Law of Insurance8 explains the expression ‘bodily injury’ thus:   

“It is usual for the policy to require an accident to manifest  

itself as “bodily injury” to the assured. The most obvious form  

of bodily injury is external trauma causing physical injury, but  

the phrase is not limited to injury to the exterior of the body:  

the term “bodily injury”, when used in a personal accident  

policy, is not limited to lesions, abrasions or broken bones.  

Nor is it essential that there should be an external mark of  

injury on the assured’s body…”  

The word ‘violent’ according to Black Law’s Dictionary9 means:   

“1. Of, relating to, or characterised by strong physical force  

<violent blows to legs>. 2. Resulting from extreme or intense  

force <violent death>. 3. Vehemently or passionately  

threatening <violent words>.”  

                                                 6 3rd Edition  7 12th Edition  8 11th Edition – See pg. 1133 for case laws relied upon.  9 10th Edition

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The word ‘visible’ according to Black Law’s Dictionary10 means something which is:   

“1. Perceptible to the eye; discernible by sight. 2. Clear,  

distinct, and conspicuous.”  

A passage from Colinvaux’s Law of Insurance11 discusses the effect and the impact  

of the expressions “violent, external and visible”:  

““Violent”. The notion of violence... is not limited to the  

situation where another person does violence to the assured,  

and it has been said that the word is used simply as the  

antithesis of “without any violence at all”. “Violent means”  

include any external, impersonal cause, such as drowning, or  

the inhalation of gas. Thus, ‘violent’ does not necessarily  

imply actual violence, as where the assured is bitten by a  

dog… The element of violence will obviously be present  

where the injury is inflicted by a third party or by some natural  

phenomenon, since there could otherwise be no effect upon  

the body of the assured.”  

““External”. It is the means of causing the injury which must  

be external, rather than the injury itself. Thus, a rupture or  

other internal injury is quite capable of falling within the ambit  

of a personal accident policy. Given this distinction, it appears  

that the word “external” in these policies merely serves to  

reiterate the general principle that the injury must not be  

attributable to natural causes. It will therefore be obvious that  

a given type of injury may fall within or without the policy  

according to the event which caused it, and it is this cause  

which must always be examined.”  

““Visible”. It is probable that this word adds nothing to the  

policy coverage, since every external cause must also be  

visible. It appears to be included merely for purposes of  

emphasis.”  

An accident postulates a mishap or an untoward happening, something which is  

unexpected and unforeseen. A bodily injury caused by an accident is not limited to  

any visible physical marks in the form of  lesions, abrasions or broken bones on the  

body. A bodily injury can be caused by violent means that are external and relate to  

                                                 10 10th Edition  11 11th Edition – See pg. 1126 for case laws relied upon.

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the use of strong physical force or even threatening someone by the use of violent  

words or actions.   

 8 There is a divergence of opinion between courts across international  

jurisdictions - including the UK, US, Canada and Singapore on whether a distinction  

should be maintained between ‘accidental means’ and ‘accidental result’ while  

deciding accidental insurance claims. The distinction was laid out in Clidero v  

Scottish Accident Insurance Co12, where the Scottish Court of Session (First  

Division) unanimously held  that the injury suffered by the insured to his colon on  

slipping while putting on his stocking, which then led to his death was not caused by  

“violent, accidental, external and visible means” because the insured’s conduct in  

putting on his stockings was intentional and voluntary and there was no other external  

factor that affected the insured’s movement which resulted in the injury. It was held  

thus:  

“…The death being accidental in the sense in which I have  

mentioned, and the means which lead to the death as  

accidental, are to my mind two quite different things. A person  

may do certain acts, the result of which acts may produce  

unforeseen consequences, and may produce what is  

commonly called accidental death, but the means are exactly  

what the man intended to use, and did use, and was prepared  

to use. The means were not accidental, but the result might  

be accidental…”  

The above distinction was applied by the US Supreme Court in Landress v Phoenix  

Mutual Life Insurance13, where the insured while playing golf suffered a sunstroke  

and died. The complainant sought recovery of the amounts stipulated in one policy, to  

be paid if death resulted “directly and independently of all other causes from bodily  

injuries effected through external, violent and accidental means, and not directly or  

indirectly, wholly or partly from disease or physical or mental infirmity,” and, in the  

                                                 12 (1892) 19 R. 355  13 291 US 491, 496 (1934)

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other policy, if death resulted “from bodily injuries effected directly and independently  

of all other causes through external, violent and accidental means.” The majority,  

while denying the insurance claim, laid down a strict test which differentiated between   

‘accidental means’ and an ‘accidental result’. This distinction emerges from the  

following extract:  

“Petitioner argues that the death, resulting from voluntary  

exposure to the sun's rays under normal conditions, was  

accidental in the common or popular sense of the term, and  

should therefore be held to be within the liability clauses of  

the policies. But it is not enough, to establish liability under  

these clauses, that the death or injury was accidental in the  

understanding of the average man—that the result of the  

exposure 'was something unforeseen, unexpected,  

extraordinary, an unlooked-for mishap, and so an accident,'  

see Lewis v. Ocean Accident & Guarantee Corp., 224 N.Y.  

18, 21, 120 N.E. 56, 57, 7 A.L.R. 1129; see, also, AEtna Life  

Insurance Co. v. Portland Gas & Coke Co. (C.C.A.) 229 F.  

552, L.R.A. 1916D, 1027, for here the carefully chosen  

words defining liability distinguish between the result  

and the external means which produces it. The insurance  

is not against an accidental result. The stipulated  

payments are to be made only if the bodily injury, though  

unforeseen, is effected by means which are external and  

accidental. The external means is stated to be the rays of the  

sun, to which the insured voluntarily exposed himself.  

Petitioner's pleadings do not suggest that there was anything  

in the sun's rays, the weather, or other circumstances  

external to the insured's own body and operating to produce  

the unanticipated injury, which was unknown or unforeseen  

by the insured.”                 (Emphasis supplied)  

   However, Justice Cardozo in his dissenting opinion warned about the inherent  

problem in creating a distinction between ‘accidental means’ and ‘accidental result’:   

“The attempted distinction between accidental results and  

accidental means will plunge this branch of the law into a  

Serbonian Bog. …  

…  

When a man has died in such a way that his death is spoken  

of as an accident, he has died because of an accident, and  

hence by accidental means …  

…  

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The insured did not do anything which in its ordinary  

consequences was fraught with danger. The allegations of  

the complaint show that he was playing golf in the same  

conditions in which he had often played before. The heat was  

not extraordinary; the exertion not unusual. By misadventure  

or accident, an external force, which had hitherto been  

beneficent, was transformed into a force of violence, as much  

so as a stroke of lightning. The opinion of the court concedes  

that death 'from sunstroke, when resulting from voluntary  

exposure to the sun's rays,' is 'an accident.' Why? To be sure,  

the death is not intentional, but that does not make it an  

'accident,' as the word is commonly understood, any more  

than death from indigestion or pneumonia. If there was no  

accident in the means, there was none in the result, for  

the two were inseparable. No cause that reasonably can  

be styled an accident intervened between them. The  

process of causation was unbroken from exposure up to  

death. There was an accident throughout, or there was  

no accident at all.”                    (Emphasis supplied)  

In a decision of the Court of Appeal in UK in Dhak v Insurance Company of North  

America (UK) Ltd14, the insured to relieve herself of backpain started consuming  

alcohol and died due to acute alcoholism. The accidental insurance policy provided for  

benefits payable for “bodily injury resulting in death or injury within 12 months of the  

accident occurring during the period of insurance and caused directly or indirectly by  

the accident.” The term “bodily injury” was defined as one “caused by accidental  

means.” The court held that the words “caused by accidental means” were a clear  

indication that the terms of the policy required the court to concentrate on the cause of  

the injury and to inquire whether it was by accidental means. It held thus:  

“I have come to the conclusion, however, that it has not been  

established that the bodily injury to the deceased was  

“caused by accidental means” within the meaning of the  

policy. In reaching this conclusion I have been persuaded that  

the words “caused by accidental means” are a clear indication  

that it is the cause of the injury to which the court must direct  

its attention.  

…  

                                                 14 [1996] 1 WLR 936

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In my judgment, however, whatever the position may be in  

some other jurisdictions, the terms of this policy require a  

court in this country to concentrate on the cause of the injury  

and to inquire whether the injury was caused by accidental  

means…  

…  

…the deceased must have been well aware of the  

consequences and dangers of drinking alcohol to excess and  

that she must be taken to have foreseen what might happen  

in the event of someone drinking to excess… I am satisfied  

that there must have been a point at which she would have  

realised that any further drinking would be dangerous and  

that vital bodily functions might be impaired or interrupted.”  

The Canadian Supreme Court, in American International Assurance Life Company  

Ltd and American Life Insurance Company v Dorothy Martin15, has taken a  

contrary view and moved away from the distinction laid out in Landress (supra). This  

case dealt with the interpretation of an accidental death benefit provision, which  

stipulated that “the Company will pay the amount of the Accidental Death Benefit …  

upon receipt of due proof that the Life Insured's death resulted  

directly, and independently of all other causes, from bodily injury effected solely  

through external, violent and accidental means”. The insured in the course of treating  

a peptic ulcer, developed an addiction to opiate medications and died due to high  

levels of Demerol in his body. The insurers challenged the claim on the ground that  

the death was not through “accidental means” and that self-injection of Demerol was a  

deliberate act making the death a foreseeable consequence. Chief Justice McLachlin,  

speaking for the Bench held thus:  

“The first question to be considered is whether deaths caused  

by accidental means form a subclass of accidental deaths. To  

put the question another way, is the category of deaths  

caused by accidental means narrower than that of accidental  

deaths?  

                                                 15 [2003] 1 SCR 158

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The insurers argue that… a death is only caused  

by accidental means when both the death and the actions  

that are among its immediate causes are accidental.  

…  

This view seems to me, however, to be problematic.  

Almost all accidents have some deliberate actions  

among their immediate causes. To insist that these  

actions, too, must be accidental would result in the  

insured rarely, if ever, obtaining coverage. Consequently,  

this cannot be the meaning of the phrase “accidental  

means” in the policy. Insurance policies must be  

interpreted in a way that gives effect to the reasonable  

expectations of the parties: Reid Crowther & Partners  

Ltd.v. Simcoe & Erie General Insurance Co., [1993] 1 S.C.R  

252, at p. 269. A policy that seldom applied to what  

reasonable people would consider an accidental death would  

violate this principle.  

In my view, the phrase “accidental means” conveys the idea  

that the consequences of the actions and events that  

produced death were unexpected.   

It follows that to ascertain whether a given means of  

death is “accidental”, we must consider whether the  

consequences were expected. We cannot usefully  

separate off the “means” from the rest of the causal  

chain and ask whether they were deliberate. Cardozo J.  

emphasized in his dissenting judgment  

in Landress v. Phoenix Mutual Life Insurance Co., 291 U.S  

491 (1934), at p. 501, that “[i]f there was no accident in the  

means, there was none in the result”. The converse is  

equally true: if there was no accident in the result, there  

can be none in the means. As Cardozo J. went on to say,  

either “[t]here was an accident throughout, or there was no  

accident at all”. Hence, to determine whether death occurred  

by accidental means, we must look to the chain of events as  

a whole, and we must consider whether the insured expected  

death to be a consequence of his actions and circumstances.  

...Usually we intend the consequences of our actions.  

However, sometimes our actions have unintended or  

unexpected results. When death is the unexpected result  

of an action, we say that the death was “accidental”, or  

that it was brought about by “accidental means” as  

opposed to “intentional means”. In ordinary language,  

then, “death  

by accidental means” and “accidental death” have the  

same meaning.  

…  

13  

I conclude that the phrase “accidental means” in this  

insurance policy does not refer to a narrow subclass of the  

broader category of “accidental deaths”.  

“Accidental death” and “ death by accidental means”  

connote a death that was in some sense unexpected. The  

two phrases have essentially the same meaning.”                               

(Emphasis supplied)  

The Court of Appeal of Singapore in Quek Kwee Kee Victoria v American  

International Assurance Co. Ltd16, agreed with the Canadian Supreme Court in  

Dorothy Martin (supra) and noted that the courts in many jurisdictions have moved  

away from the distinction laid out in Landress (supra):  

“… we prefer the view that the use of phrases such as  

“accidental means” would not restrict the situations covered  

by a personal accident insurance policy to those where the  

proximate cause of the insured’s injury or death was not a  

deliberate or voluntary action on the part of the insured. For  

example, if a person injures himself by driving off a cliff in the  

mistaken belief that the road continued, that person would  

have met with an “accident” just as much as one who slips  

and fractures his leg while walking on a slippery surface. It  

would, in our view, accord with ordinary experience to hold  

that the injury suffered by an insured in such cases would be  

a result of “accidental means”. In this regard, we find  

ourselves in agreement with the observations of McLachlin  

CJ in Martin…  

…  

…courts in the Commonwealth have moved away from this  

distinction between intended means and unintended results.  

Although this still appears to be good law in England (see, for  

example, Dhak v Insurance Co of North America [1996] 1  

WLR 936 (“Dhak”) at 949), the distinction has been rejected  

in New Zealand (see Groves at 127–128), the United States  

(see Wickman v Northwestern National Insurance Co 908 F  

2d 1077 (1st Cir 1990) (“Wickman”)), Scotland (see MacLeod  

v New Hampshire Insurance Co Ltd 1998 SLT 1191),  

Australia (see the judgment of Wilson, Deane and Dawson JJ  

in Australian Casualty Co Ltd v Federico [1986] HCA 32 at  

[18]–[20]) and Canada (see Martin v American International  

Assurance Life Co [2003] SCC 16 (“Martin”) at [10]–[13])…”  

                                                 16 [2017] 1 SLR 461  

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9 The respondent has placed reliance upon a decision of a Single Judge of the  

Patna High Court in Kamlawati Devi v State of Bihar17, where the deceased who  

was on election duty was threatened by armed miscreants while relieving himself  

which triggered a heart attack. Justice Aftab Alam (as his Lordship then was) while  

discussing precedent from other jurisdictions and authorities on Insurance Law noted  

that there exists a divergence of opinion about whether a distinction exists between an  

‘accidental result’ and ‘accidental means’ while assessing a claim under an accident  

insurance policy. The court while holding that the act of threatening by armed  

miscreants was covered by the expression “external violent and any other visible  

means”, held thus:  

“A plain reading of the cover clause in the M.O.U. would  

make it clear that it is intended to impose a twofold limitation.  

A death in order to qualify for the insurance cover must not  

only be accidental but the accident causing death must itself  

result from some external, violent and other visible means.  

This two fold limitation is based on what is called, in the Law  

of Insurance, the distinction between ‘accidental result’ and  

‘accidental means’. An unexpected and unforeseen  

consequence or result from a normal or routine activity may  

constitute an accident but it would not qualify as ‘accidental  

means’. Thus, if a person suffers a fatal heart attack while  

dancing (considered to be a normal activity) the death may be  

called ‘accidental’ but it would fail to attract the insurance  

cover because it was not due to ‘accidental means’. On the  

other hand, if a person dies due to heart attack suffered as a  

result of over-exertion on being chased by a ferocious dog  

(an unintended occurrence, and not a normal activity) the  

death might attract the insurance cover as it was caused by  

‘accidental means’.  

…  

On examining this branch of the law of insurance one finds a  

series of decisions which tend to do away with the distinction  

between ‘accidental result/death’ and ‘accidental means’. One  

also finds another set of decisions which though maintaining  

the formal distinction between ‘accidental result’ and  

‘accidental means’ have so interpreted the key words in the  

restrictive clause (e.g. accident, external, violence and any  

                                                 17 (2002) 3 PLJR 450

15  

other means etc.) as to greatly relax the rigours of the  

ordinary meanings of those words.”  

On the facts of the case, the High Court held:   

 “In the light of the above there can be no denying that the  

death of Parshuram Singh was an accidental death caused  

by accidental means. If the view expressed in the book, the  

Law of Insurance that the words “by violent, external and  

visible means” add little if anything to an accident policy is to  

be accepted, then his death would attract the insurance cover  

without anything else. But even if the applicability clause in  

the M.O.U. is to be given a literal interpretation and the  

distinction between accidental result and accidental means is  

to be maintained, I come to the unescapable conclusion that  

the act of threatening by the armed miscreants was plainly  

covered by the expression “external, violent and any other  

visible means” and the deceased encountering those threats  

while he had gone to relieve himself was clearly an accident  

that triggered off the heart attack and, thus, resulting solely  

and directly into his death. It appears to me, therefore, that  

the death of the petitioner's husband was fully covered by the  

cover clause in the M.O.U.”  

In a Letters Patent Appeal, the Division Bench of the Patna High Court in Branch  

Manager, United India Insurance Co v State of Bihar18 affirmed the aforesaid  

judgment and held thus:   

“... In the present matters, it appears that the Insurance  

Companies are belabouring under misapprehension that  

unless the person suffers an external visible injury by external  

visible means the Insurance Company would not be  

answerable to it. In our opinion, the phraseology used in the  

cover does not have the scope to read external visible injury.  

The phrase simply says—“in the event of death only resulting  

solely and directly from accident caused by external violent  

and any other visible means.””    

There exists a divergence of opinion on whether ‘accidental means’ and ‘accidental  

death’ are to be read as similar or whether in order for an accidental insurance claim  

to succeed, the means causing the injury or death also have to be accidental in  

                                                 18 (2003) 51 (2) BLJR 117

16  

nature. For the purposes of this case, it is not necessary to conclusively decide this  

question. In order to sustain a claim under the accident benefit cover, it must be  

established that the assured has sustained a bodily injury which resulted solely and  

directly from the accident. There must, in other words exist a proximate causal  

relationship between the accident and the bodily injury. Moreover, the accident must  

be caused by outward violent and visible means. The expression “outward violent and  

visible” signifies that the cause of the accident must be external. Moreover, the injury  

must be the cause of the death within the period of 180 days. There has to be  

proximate  relationship between the injury and the death to the exclusion of all other  

causes. The outcome of the present case involves interpretation of the accident  

benefit cover. Breaking down the clause into its components, what it postulates is that:  

(i) The assured must sustain a bodily injury;  

(ii) The injury must solely and directly result from an accident;  

(iii) The accident must be caused by outward, violent and visible means;  

(iv) The injury must solely, directly and independently of all other causes result  

in the death of the assured; and  

(v) Death must ensue within a period of 180 days from the injury caused in the  

accident.     

What needs to be determined is whether the insured suffered a heart attack as a  

result of the injuries sustained from the fall from the motorcycle or whether the fall was  

a result of the assured suffering a heart attack in the first place.  

   10 The plain reading of the policy is to be accepted as our guide. Under the policy,  

in order for the complainant to prove her claim, she must show direct and positive

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proof that the accident of the assured falling from his motorcycle caused bodily injury  

by external/outward, violent and visible means. The complainant will have to prove  

that the accident and the injuries sustained as a result were a direct or proximate  

cause of her husband’s death.   

 11 In the present case, no post mortem of the deceased or police investigation  

was conducted. In the absence of a post mortem report indicating the nature of  

injuries sustained by the insured, we would have to rely upon the medical report that  

indicates the exact cause of death. The medical report of Dr Ajay Goverdhan who  

examined the assured on the date of the accident indicated that the insured suffered  

shoulder and chest pain and that the exact cause of death was an acute myocardial  

infraction. The insured was referred to a specialist, Dr SS Dhillon, who also recorded  

in his report that the diagnosis did not show the cause of death to be accidental. Dr S  

S Dhillon noted that the insured was experiencing pain in the left side of the chest and  

in the shoulder and there was a myocardial infarction. The insured was referred to  

Chandu Lal Memorial Hospital, a specialist medical center, where the OPD records  

noted that an ECG was taken at Dhillon Nursing Home and the insured was sweating  

and that he had chest pain, radiating to the left shoulder along with two episodes of  

vomiting. He died before he reached the hospital. There is no material on record to  

indicate that the assured sustained specific injuries as a result of a fall from the  

motorcycle or that the injuries were caused by outward, violent and visible means,  

which was the sole and proximate cause of his death. There is no direct nexus or  

causation between the assured suffering a heart attack and injuries sustained in an  

accident by outward, violent and visible means.  Nothing has been brought on record  

to show that the injuries sustained by falling from the motorcycle aggravated the  

assured’s condition that eventually led to his death. In the absence of any evidence to

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the contrary, the medical evidence on record is itself proof that the insured died due to  

a heart attack and not due to an accident of falling from the motorcycle.  The heart  

attack had a distinct effect of the insured falling off from his motorcycle.   

In a case decided by the NCDRC - LIC of India v Smt Mamta Rani19 - clause 10.2 of  

the insurance policy provided an accident benefit cover if the assured sustained any  

bodily injury resulting solely and directly from the accident caused by outward, violent  

and visible means. The assured died of a heart attack. The district and state forums  

allowed the claim of the complainant for accidental benefit. However, the NCDRC  

rejected the claim and held thus:  

“… it is clear that in case of death of life assured, the  

additional accident benefit equal to the sum assured is  

payable only if the life assured dies because of any bodily  

injury resulting solely and directly from an accident by  

outward, violent and visible means. In the instant case, as per  

the record, the life assured died on 01.07.2002 due to heart  

attack. There is no evidence on record to indicate that the life  

assured died because of some injury suffered in an accident.  

Thus, the fora below have committed a material illegality in  

awarding the accident benefit to the respondents against the  

terms and conditions of the insurance contract.”  

Similarly, in Swaranjit Kaur v ICICI Lombard General Insurance Co Ltd20, the  

assured while travelling on his scooter, suffered a heart attack and fell from his  

scooter. The claim for accidental benefit cover was repudiated on the ground that the  

insured had died a natural death because of heart attack. The state commission set  

aside the order of the district forum allowing the claim. The NCDRC while upholding  

the state commission’s judgment, noted that the onus to prove that the insured had  

died as a result of an accident and not a heart attack was on the claimant. It held thus:  

“…On perusal of the copy of repudiation letter, it is clear that  

the respondents repudiated the insurance claim on the  

                                                 19 II (2014) CPJ 624 (NC) : RP No. 4468 of 2012  20 2015 SCC OnLine NCDRC 4168  

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ground that cause of death of insured was heart attack. On  

perusal of the report of the investigator, we find that the stand  

of the petitioners in the statement made before the  

investigator on 17.8.2006 was that while driving the scooter  

insured suffered a heart attack, consequently, he fell down  

from the scooter and died. From this, it is clear that the  

accident took place after the insured had suffered heart  

attack. Otherwise also, in order to succeed in the insurance  

claim, the onus of proving that the insured had died as a  

result of accident was on the petitioners. Undisputedly,  

incident was not reported to the police nor post mortem to  

establish cause of death was done. No evidence has been  

produced by the petitioners to prove the cause of death of the  

insured. There is nothing in the statement of the petitioners as  

recorded by the investigator that the insured had suffered any  

bodily injuries due to fall from the scooter. Thus, under the  

circumstances, the conclusion of the State Commission that  

cause of death of the insured was heart attack and not an  

accident cannot be faulted…”  

The High Court of Madras held in Life Insurance Corporation v Minor Rohini21 that  

in the absence of any evidence that the assured had sustained any bodily injury  

resulting solely and directly from the accident caused by outward, violent or visible  

means, it cannot be said that the death due to a heart attack would amount to an  

accident for the purposes of accidental insurance claim under the policy.  

In Krishna Wati v LIC of India22, the NCDRC had to deal with whether the accidental  

injuries which resulted in the death of the assured due to a heart attack after three  

days of the accident could be termed as an accidental death or a natural death. The  

assured while riding his bicycle was attacked by a cow and upon arriving at the  

hospital complained of pain in the legs and in the chest, because of a fall from his  

bicycle. The NCDRC relied on the investigation report and the allowed the claim for  

accident insurance. It held thus:  

“… In our view, from the record as it is, it is apparent that first  

the accident took place, resulted in injuries and chest pain  

which ultimately resulted in 'death'. May be, the death in the  

                                                 21 2012 (1) MWN (Civil) 740. Also see New India Assurance Company Limited v K. Thilagam 2009 (2) TN MAC 197  22 1 (2006) CPJ 21 (NC)

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medical terms be described as 'due to heart-attack, but the  

main cause for leading to heart-attack was injury caused due  

to accident. Accident is the basis for causing chest pain and  

thereafter heart-attack…”   

12 In the present case, there is no evidence to show that any bodily injuries were  

suffered due to the fall from the motorcycle or that they led to the assured suffering a  

heart attack.  There is no evidence to show that the accident took place as a result of  

any outward, violent and visible means. The assured died as a result of a heart attack  

which was not attributable to the accident.   

 13 For the above reasons, we are of the view that the judgment of the NCDRC  

dated 29 April 2016 does not suffer from any error. The appeal shall accordingly stand  

dismissed. There shall be no order as to costs.  

…………...…...….......………………........J.                                                                 [Dr Dhananjaya Y Chandrachud]  

…..…..…....…........……………….…........J.                            [Hemant Gupta]   

  New Delhi;   April 24, 2019.