January 06, 2026 : The District Consumer Disputes Redressal Commission, Ganjam at Berhampur has held that a cardiac death occurring during strenuous overseas employment can be treated as an “accidental death” under a personal accident insurance policy. The Commission directed IFFCO Tokio General Insurance Co. Ltd. to pay ₹10 lakh with interest to the widow of an overseas mason who died while working in Oman.
The order was passed by a Bench comprising Shri Satish Kumar Panigrahi, President (I/c), and Smt. Saritri Pattanaik, Member, in a complaint filed by Smt. Kumari Gochayat. She is the widow and nominee of the deceased insured, who had taken a Pravasi Bharatiya Bima Yojana Policy, 2006. The policy was valid from April 20, 2015 to April 19, 2017 and provided a cover of ₹10 lakh for accidental death or permanent total disability during overseas employment.
During the currency of the policy, the insured was employed as a mason in Oman and died on January 4, 2017. The death certificate issued by the Royal Oman Police recorded the cause of death as “Cardiac Arrest of Unknown Reason”. After the death, the complainant submitted the claim along with all required documents. However, the insurer neither settled the claim nor clearly communicated its decision, prompting her to approach the Consumer Commission alleging deficiency in service.
The insurer contested the complaint, arguing that the policy covered only accidental death and that a heart attack amounted to a natural death excluded under the policy terms. It also raised objections on maintainability, claiming that the matter involved complex questions of fact and law and that other legal heirs had not been impleaded. IFFCO Tokio further stated that the claim had been repudiated by a letter dated May 12, 2017.
After examining the record, the Commission focused on whether the cardiac death could be treated as accidental in the facts of the case. It observed that while a heart attack is generally considered a natural death, a different legal position applies when death occurs during strenuous physical labour and there is a proximate causal link between work conditions and the cardiac event. The Commission noted that masonry work, especially in an overseas environment like Oman, involves intense physical strain and exposure to harsh conditions that can precipitate or accelerate a cardiac arrest.
Relying on the “accident doctrine” evolved by the Supreme Court, particularly in Shakuntala Chandrakant Shreshti v. Prabhakar Maruti Garvali, the Commission applied the well-established triple test. This test requires proof 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 all three elements satisfied, noting that the deceased died “in harness” while engaged in strenuous masonry work abroad.
The Commission also placed weight on the wording of the death certificate, which mentioned “cardiac arrest of unknown reason”. It held that this created a reasonable inference that contributory factors were not ruled out. The insurer, the Commission said, failed to produce a post-mortem report or any cogent medical evidence to establish that the death was purely natural and fell within the exclusion clause. The burden of proving an exclusion, it held, lies on the insurer and had not been discharged in this case.
Rejecting the insurer’s technical objections, the Commission held that Consumer Commissions are competent to decide insurance disputes even when they involve mixed questions of fact and law. The plea of non-joinder 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 to be unjustified and amounting to deficiency in service, the Commission allowed the complaint in part. It directed IFFCO Tokio to pay the assured sum of ₹10 lakh with interest at 9 percent per annum from July 25, 2018, the date of filing of the complaint, until January 5, 2026. The insurer was also directed to pay ₹5,000 towards litigation costs, with compliance required within 45 days of receipt of the order.
