National Consumer Disputes Redressal
Life Insurance Corporation Of India And ... vs Priyanka Singh on 14 October, 2005
Equivalent citations: III(2007)CPJ436(NC)
ORDER
B.K. Taimni, Presiding Member
1. Appellant was the opposite party before the State Commission, where the respondent/ complainant had filed a complaint alleging deficiency in service on the part of the appellant.
2. Very briefly the facts leading to filing the complaint are that the complainant's husband late Sidharth Singh had obtained an L.I.C. Policy for Rs. 6,00,000 with 'Double Accident Benefit'. The insured died in the morning at 8.00 a.m. on 8.5.2001, on account of sudden firing of rifle on himself while checking the rifle of his mother. An F.I.R. was lodged. Post-mortem was carried out; Viscera was also chemically examined. When the claim was preferred with the appellant, they settled the claim of the main policy but it is the case of the respondent/complainant that appellant Insurance Company did not give her, i.e., the widow of the deceased, benefit accruing from "Double Accident Benefit" under the policy. When this amount was not given, alleging deficiency in service, a complaint was filed before the State Commission, who after hearing the parties and perusal of the material on record, directed the appellant to pay Rs. 5,00,000 admissible under the Double Accident Benefit along with interest (c) 12% from 1.1.2002 till payment along with compensation of Rs. 1,00,000 for mental agony and Rs. 5,000 as cost of litigation. Aggrieved by this order, this appeal has been filed before this Commission.
3. We heard the learned Counsel for both the parties. Basic facts are not disputed, hence are not being reproduced. The basic contention of the learned Counsel for the appellant is that as per terms of Policy Conditions 10(2)(b) and 10(2)(b)(i), the claim is not payable. These conditions read as follows:
(b) Death of the Life Assured-to pay an additional sum equal to the sum assured 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 120 days of the occurrence solely, directly and independently of all other causes result in the death of the life assured. However, such additional sum payable in respect of this policy, together with any such additional sums payable under other policies on the life of the assured shall not exceed Rs. 5,00,000. The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the life assured shall:
(i) be caused by intentional self injury, attempt suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic; or
4. It is the case of the appellant that this was a case of suicide which had occurred under the influence of intoxicating liquor, hence any death caused on account of influence of liquor is not payable within the terms of the policy. For this he also drew our attention to the report of the "State Forensic Science Laboratory, Rajasthan," in which it is clearly held that "quantity of ethyl alcohol in blood sample was estimated 109.25 mg / 100 ml". As per medical literature, "HWVCOX 'Medical Jurisprudence and Toxicology', Seventh Edition PC Dikshit" brought on record, there are three stages of alcoholic intoxication, which reads as follows:
Stage of Excitement (50 to 150 mg percent) Feeling of well-being, slight excitement, increased confidence, lack of self-control are usually seen. There is a heightened sexual desire, but performance is reduced. The visual acuity is reduced. It also alters time and space orientation. There is poor judgment and mental concentration is retarded.
Stage of Incoordination (150 to 250 mg percent) The sense of perception and the skilled movements are affected. Inhibition of higher occur, resulting in a change in the conduct of the individual. He becomes irritable, grey, quarrelsome and sleepy. There is incoordination and clumsiness of fine and skilled movements. There is altered speech and fine tremors in the fingers. Nausea and vomiting are common. Pulse is increased and flushing of the face occurs. The sense of touch, smell and hearing is diminished. The pupils are dilated but their reaction to light is hopeful sign.
Stage of Comma The motor and sensory cells are deeply affected. There is slurring of speech and coordination is greatly affected. The person may stagger and may even fall. There is strenuous breathing and rapid pulse and temperature becomes sub normal. The pupils are contracted but on painful stimulate they dilate and then there is a slow return to the contracted stage which is known as Me Ewan Sign. The patient may die or may recover in 8 to 10 hours with acute depression, nausea and headache. If coma is for more than five hours, death may occur due to asphyxia as a result of respiratory paralysis.
5. Learned Counsel for the appellant relies on the first stage which was the stage in the instant case with regard to the deceased. In persons found with alcohol 50 to 150 mg percent, in their blood "...the visual acuity is reduced, time and space orientation is also altered, there is poor judgment and mental concentration is retarded". In view of this fallout of alcohol consumption, the deceased should be deemed to be under alcohol, which ousts him from being eligible for "Double Accident Benefit" under the policy as per terms of the policy. On the other hand, the learned Counsel for the respondent/complainant drew our attention to the medical literature relating to the textbook of 'Biochemistry' in which the wording used is:
Pre-intoxication 50 - 150 mg/dl' Signs of instability, decreased neuromuscular coordination, judgment and control required for quick responses such as car driving are impaired.
Intoxicating stage 150 - 300 mg / dl' speech impaired, motor skills are incoordinaled.
6. It is his case that in view of this textbook of Biochemistry, the deceased cannot be said to be an intoxicated as alcohol found in his blood was only 109 mg percent; at best as per the report of the laboratory, the deceased could be said to be in pre-intoxication stage.
7. We have very carefully gone through the material on record. We are concerned with the interpretation of the word 'intoxication in the context of the policy. If one reads policy condition 10(2)(b) along with Sub-section (1), the deduction is quite clear that the 'spirit' of the terms and conditions of the policy is, that the man has to be in his senses and, in our view, a normal meaning of word 'intoxicating liquor' 10(2)(b)(i) has to be given to the material brought on record. Oxford Dictionary states Intoxication means 'make drunk; excite or elate beyond self control.' In the Text book of Biochemistry produced by the respondent/complainant, the normal reading should be 5 mg /dl. Next stage, the social stage where the reading should be 50 mg/dl. In the literature it is made clear that 50 -150 mg decreases "neuromuscular coordination and also brings in sense of instability". We should not forget that this was allegedly the case of firing on self as a result of checking the rifle of the deceased's own mother. If we see these three stages in the "Medical Jurisprudence and Toxicology", reproduced earlier, during 'the stage of Excitement' (50 to 150 mg percent) one has "feeling of well being slight excitement..., the visual acuity is reduced...there is poor judgment and mental concentration is retarded...". All these factors have a direct relationship on what happened in this case, when as a result of checking the weapon, which obviously was loaded and not checked for this purpose by the person checking the rifle-the deceased in this case -shot himself. We cannot be oblivious that rifle was being checked by a person having quantity of ethyl alcohol of 109.92 mg/100 ml in his blood, whose faculties stood impaired in above forms. A person having alcohol level of 109.92 mg/100 ml in the blood cannot be said to be in normal condition, in any case, to handle a gun in such a stage. It cannot be said that he was not under intoxication as a result of alcohol, especially if we see that a person having this high reading of contents of ethyl alcohol in blood shall result in decreased neuromuscular coordination, a poor judgment and reorientation of mental concentration. Reading the sprit of the policy and also material brought on record, in our view, it was not a simply case of self firing by a gun while checking, especially when we see as a result of material on record, that a person having 109 mg/ 100ml in his blood would result in decreased concentration, judgment and responses mechanism, decreased coordination, which resulted in self firing of the gun without really finding out/checking of the weapon that it is a loaded weapon. In our view, even as per meaning given to the 'intoxication' in Oxford Dictionary, the deceased shall fall in the category of 'intoxicated'. In the light of above, our deduction is quite clear that this was only on account of above impairments resulting from alcohol in his blood, which led to self firing upon himself without ascertaining if the gun was loaded or otherwise?
8. Problem is not 'definitional'? Question is how to construct a particular word and read its meaning in this case 'Intoxication' - within the terms and conditions of the policy, keeping in view the facts and circumstances of this case? Will a person whose visual acuity is reduced,...there is poor judgment and mental concentration is retarded...and handling a loaded gun, pointing at himself and shooting himself dead, be said to have done so while under intoxication? In our view, with all these stated impairments and seen in the sequence of events leading to shooting himself dead, cannot but lead us to conclude that this episode occurred on account of the fact that he was under 'intoxication as a result of consumption of alcohol-found in his blood sample and thus making him ineligible from the benefits of double accident policy read within the terms of policy as incorporated in Condition 10(2)(b)(i).
9. In view of above discussion, we find that the State Commission erred in concluding that the deceased shall fall outside the provisions of the terms of the policy as reproduced earlier. In our view, it was under the influence of intoxicating liquor with concomitant fall out that the unfortunate accident happened. Thus, the respondent complainant shall not be entitled to 'double accident benefit' Under the terms of the policy, in view of which we are unable to sustain the order passed by the State Commission, which is set aside. The appeal is allowed and complaint is dismissed.
No order as to costs.