State Consumer Disputes Redressal Commission
M/S.Icici Lombard General Insurance ... vs S.Jayalakshmi And Another Chittoor on 24 October, 2008
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD. FA. No.1356/2008 against CC.No.20/2008 District Consumer Forum-II, Tirupati. Between: 1.
M/s.ICICI Lombard General Insurance Co.Ltd., Rep. by its Branch Manager, Tilak Road, Tirupati, Chittoor District.
2.The Claim Operation Manager (BA), M/s.ICICI Lombard General Insurance Co.Ltd.
Interface Building No.11, 401/402, 4th Floor, New Link Road, Malad (W), Mumbai 400 064.
3.ICICI Bank Ltd.
Rep. by its Branch Manager, Holding Office at Tilak Road, Tirupati, Chittoor District.
Appellants/O.Ps. 1 to 3.
And
1.S.Jayalakshmi, W/o.late S.Dwarakanadh, Hindu, Aged about 53 years, Occ: Housewife, D.No.6-16, Padmavathipuram, Tirupati, Chittoor District.
2.S.Bhanuprakash, S/o.late S.Dwarakanadh, Hindu, Aged about 26 years, Unemployee, D.No.6-16, Padmavathipuram, Tirupati, Chittoor District.
Respondents/Complainants.
Counsel for the Appellants : Mr.Ravishankar Jandhyala.
Counsel for the Respondents : Admn.Stage.
QUORUM: THE HONBLE MR.JUSTICE D.APPA RAO, PRESIDENT, AND SMT.M.SHREESHA,HONBLE LADY MEMBER, FRIDAY, THE TWENTY FOURTH DAY OF OCTOBER, TWO THOUSAND EIGHT.
Oral Order (Per Honble Mr.Justice D.Appa Rao, President) *******
1. Having heard the learned counsel for the appellants and perusal of appeal record, we are of the opinion that this appeal can be disposed of at the stage of admission itself.
2. This is an appeal filed by M/s.ICICI Lombard General Insurance Company against the order of the District Consumer ForumII, Tirupati in directing waiver of loan amount of Rs.5,42,064/- taken under the housing loan on 30.07.2002.
3. The case of the complainants in brief is that the first complainant is the wife and the second complainant is the son of one S.Dwarakanadh. He availed housing loan on 30.07.2002 for Rs.4,50,000/- by pledging his property, where under he has advantage of insurance coverage. He had to pay monthly instalment of Rs.5,892/- for 132 months. While so, on 18.08.2005 at about 9.00 p.m. while he was going on Renigunta - Tirupathi main road and by the time he crossed CRS railway gate, he met with an accident and died on spot. As per the conditions of the policy, there was a free personal accident insurance. Therefore, the complainants submitted their claim form along with the requisite documents. However the same was repudiated, Therefore, they sought for waiver of the loan amount besides return of the title deeds.
4. The appellants resisted the case. While admitting that the complainants are entitled to insurance coverage and they need not to pay the rest of the loan amount to a tune of Rs.5,42,064/- and return of the documents, however the claim was repudiated as the post mortem certificate establishes that he was under the influence of alcohol. The complainants are not entitled to claim waiver of loan nor return of documents.
5. On behalf of the complainants, Exs.A.1 to A.10 were filed and on behalf of opposite parties Exs.B.1, the policy copy, was filed.
6. The District Forum after considering the evidence placed on record opined that the deceased died in a road accident. He was not under the influence of alcohol. By virtue of the terms of the policy, the complainants are entitled to waiver of the rest of the instalments, namely Rs.5,42,064/- besides return of title deeds. Therefore, the appellants were directed to waive the loan amount, besides return of the title deeds together with costs of Rs.500/-.
7. Aggrieved by the said decision, the Insurance Company preferred this appeal contending that that at the time of accident, the deceased was in intoxicated condition. Part (2) of the Schedule Clause (2) and (iv) of the policy stipulates that if the insured was under the influence of intoxicated liquor or drug, he was not entitled to the benefit. It was a violation of policy condition.
Consequently, the policy was repudiated. There was no deficiency in service.
Therefore, it prayed that the complaint be dismissed by allowing the appeal.
8. It is an undisputed fact that Dwarakanath, the insured had availed housing loan on 30.07.2002. There is also a special condition in the loan agreement, wherein he was given free personal accident insurance whereby in case of his death by accident during the policy period, the remaining amount need not be paid and the balance of loan, if any, would be waived and the title deeds would be returned. It is not in dispute that Dwarakanath, the policy holder died in an accident that took place on 18.08.2005 at 9.00 p.m. Ex.A.6 is the post mortem certificate filed by the very complainants. In Ex.A.6 under the column D the contents of abdomen revealed that the stomach of the deceased contained 150 ml of brown coloured fluid smells alcohol. Mucosa Nil particular.
9. From this the insurance company intends to draw an inference that the deceased was under influence of alcohol at the time of accident. However, we have observed that in the very certificate, there was a mention that it was not valid for insurance claim. The insurance company has not produced any independent evidence to show that the deceased was under the influence of alcohol at the time of accident. Simply because the stomach smells alcohol, it cannot be said that he had taken alcohol. There may be variety of reasons for such a smelling. Apart from it the stomach contained 150 ml of brown coloured fluid.
The percentage of alcohol is not known. There is no proof that this would renders a person intoxicated. No sample of the fluid was sent for chemical analysis in order to find out the nature of the fluid. By stray observation, one cannot deduce that the deceased was under the influence of liquor. Assuming without admitting that he had taken alcohol the Insurance Company has to prove that he was under its influence and was intoxicated. The insurance company shall not assume from the observations made in the record. It has to investigate and determine the fact independently. It search for reasons to repudiate. The appellants did not appoint any investigator nor get investigated as to the circumstances under which the accident took place. From a stray observation, it cannot be concluded that the deceased was in a drunken condition, which led to his death. The District Forum has considered the evidence in right perspective. We do not see any mis-appreciation of fact or law in this regard. We do not see any merits in the appeal.
10. In the result, the appeal is dismissed. However, no costs. Time for compliance four weeks.
PRESIDENT LADY MEMBER Dt:24.10.2008.