National Consumer Disputes Redressal
Lic Of India & Anr. vs Smt.Ranjit Kaur on 11 July, 2011
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO.2433 OF 2007 (Against order dtd. 26.03.2007 in Appeal No.367 of 2007 of the State Commission, Punjab) Life Insurance Corporation of India & Anr. ....... Petitioner (s) Vs. Smt.Ranjit Kaur ........ Respondent (s) BEFORE : HONBLE MR. JUSTICE ASHOK BHAN, PRESIDENT HONBLE MRS. VINEETA RAI, MEMBER For the Petitioners : Mr.Mohinder Singh, Advocate For the Respondent : Mr.Himanshu Upadhyay, Advocate Pronounced on 11th of July, 2011 ORDER
PER VINEETA RAI, MEMBER The Life Insurance Corporation of India & another (hereinafter referred to as the Petitioner) have filed the present revision petition against the order of the State Consumer Disputes Redressal Commission, Punjab (hereinafter referred to as the State Commission) which had rejected Petitioners appeal in favour of Smt.Ranjit Kaur (hereinafter referred to as the Respondent).
The facts of the case according to the Respondent are that her husband, Malkiat Singh had taken a Double Accident Benefit policy on 28.09.2001 from the Petitioner/Insurance Corporation for a sum of Rs.1 lakh. As per the provisions of this policy, in case the insuree dies in an accident then the Insurance Corporation is liable to pay double the amount plus bonus on the amount of insurance taken. On 18.07.2004, Malkiat Singh died due to electric shock while working in the field and necessary information regarding this accident was conveyed both to the Police as well as to the Petitioner/Insurance Corporation. Since the death of the insuree was accidental and this was also confirmed as per inquiry and the post-mortem reports, Respondent being the nominee lodged a claim with the Petitioner/Insurance Corporation for payment of the sum assured as per the provisions of the policy and after several visits the Petitioner/Insurance Corporation settled the claimed at Rs.1,14,000/- i.e. Rs.1 lakh being the insured amount and Rs.14,00/- as bonus but repudiated the double accidental benefit part of the claim.
Aggrieved by this repudiation, Respondent filed a complaint before the District Forum on grounds of deficiency in service and negligence on the part of the Petitioner and requested that Petitioner be directed to pay the full amount under the double accident benefit policy along with all benefits as well as interest @ 24% on this amount from the date of death of the insuree till realization. Rs.25,000/- was sought on account of mental agony and Rs.25,000/- as litigation cost. The Petitioner/Insurance Corporation while accepting that the insuree died due to electrocution while operating the motor, justified repudiation of payment of the accidental benefit amount on the grounds that the viscera report confirmed that alcohol beyond the permissible was found in the deceased blood thus proving that the insuree was under the influence of alcohol at the time of his death.
As per the policy, the Insurance Corporation is not liable to pay the additional accidental benefit amount in case the life assured is under the influence of any intoxicating drug or narcotics at the time of death. Further, the insuree had not indicated in his personal history on the proposal form that he was in the habit of taking alcohol and this amounted to willful suppression of material facts with intention to defraud the Petitioner/Insurance Corporation. The District Forum after hearing both parties and considering the evidence on record accepted the complaint, inter alia, on the grounds that the Petitioner was not able to place any document of verifiable nature on record that there was direct nexus between the alcohol consumed by the insuree and his death.
The report of the Chemical Examiner did indicate that there was alcohol concentration in the blood/viscera to the extent of 86.25 mg /100 ml. of blood but this could not be treated as conclusive proof that the insuree was intoxicated at the time of death because it has also come in evidence that the specific clinical picture of alcohol intoxication also depends on other factors such as quantity and frequency of consumption etc. Regarding the contention of the Petitioner that the case is covered under the exclusion clause of the Policy, the District Forum observed as follows:
Even otherwise, it may be noticed that the corporation wants to take the benefit of exclusion clause which is embedded in the policy Ex.R-2. We have not been able to lay our hands on any document whether the life assured had any knowledge of the said clause or such terms and conditions of the policy disentitling the life assured to the benefit were conveyed to him. The Apex Court in M/s Modern Insulators Ltd. Vs. The Oriental Insurance Company Ltd. 2001 (1) Apex Court Journal 398(SC) held that if the insurance company wants to take the benefit of exclusion clause in order to make it a case of No claim in the guise of the said defence, it is enjoined on the opposite party to prove that such a clause was notified and duly communicated to the insured. It is not the duty of the insured to call for these terms and conditions.
In the absence of anything to the contrary therefore, we have no option but to hold that the CC would be entitled to the double accident benefit scheme under the policy, the instalments of the premium of which were already paid by the life assured before his death, and, which amount comes to Rs.2,00,000/-.
The District Forum, therefore, directed the Petitioner/Insurance Corporation to pay to the Respondent a sum of Rs.2 lakhs minus Rs.1,14,000/- which had already been paid to the Respondent along with interest @ 9% per annum on that amount from the date of death of the insuree till realization, Rs.3,000/- as compensation and Rs.1,000/- as costs.
Aggrieved by this order, Petitioner/Insurance Corporation filed an appeal before the State Commission which rejected the appeal.
The operative part of the order of the State Commission reads as follows:
It is not being seriously disputed that the deceased had an electric shock but what the appellant counsel is putting forth is that the electric shock was due to influence of intoxicating substance i.e. liquor. Firstly, there is nothing in the evidence that it was because of influence of liquor that electrocution had occurred. Secondly, there is a big question mark as to whether, with that much content of liquor as was found on chemical examination, the deceased could be said to be under the influence of liquor. Even as per the opinion of doctor, the influence of liquor on a particular person will depend on specific clinical picture of alcohol intoxication, on the quantity and frequency of consumption, duration of drinking at that level. So, even according to the doctor, it will be depend from person to person and on the above indications as to whether a person having about 86.25 mg/100 ml. of alcohol could be said to be under the influence of liquor.
For the foregoing reasons, we find nothing wrong in the approach of the District Forum when it allowed the complaint. The appeal is dismissed in limine.
Hence, the present revision petition.
Counsel for both parties made oral submissions.
Counsel for Petitioner/Insurance Corporation reiterated that as per the provisions of the relevant insurance policy, the Petitioner/Insurance Corporation shall not be liable to pay the additional sum if the death of the life assured was caused whilst under the influence of intoxicating liquor, drug or narcotic. In the instant case there was adequate evidence to prove that the insuree had consumed more than the permissible amount of alcohol required to cause intoxication and therefore, the claim was rightly repudiated.
Counsel for Respondent on the other hand contended that there was no nexus between the alcohol found in the viscera/blood of the deceased and the cause of his death was electrocution. Further, both the District Forum and the State Commission had observed that as per the evidence available, it was not possible to conclude that the deceased at the time of his death was intoxicated.
We have heard learned counsel for both parties and have carefully gone through the evidence on record.
The fact that death of the insuree was caused because of the electrocution during the subsistence of the insurance policy is not in dispute. The only issue under dispute is whether the insuree was intoxicated at the time of his death which as per the exclusion clause in the Insurance Policy would justify repudiation of the double accident benefit insurance claim. While it is a fact that the Chemical Examiner in his report had stated that the blood alcohol concentration in the body of the deceased was 86.25 mg per 100 ml. of blood which as per the American Medical Examinations definitions is higher than the alcohol concentration level of impairment, it has also come in evidence that this by itself is not adequate proof that the deceased was intoxicated at the time of his death. As rightly observed by the leaned fora below, the specific clinical picture of alcohol intoxication also depends on the quantity and frequency of consumption and duration of drinking at that level and, therefore, mere presence of alcohol even above the usually prescribed limits is not a conclusive proof of intoxication. Apart from this, there is also no evidence that there was a nexus between the death caused by electric shock and consumption of liquor.
Under these circumstances, we are in agreement with the findings of the fora below which are based on credible documentary and oral evidence that the Petitioner/Insurance Corporation was not justified in repudiating the double accident benefit insurance claim of the Respondent. The order of the State Commission is, therefore, upheld in toto and the revision petition is dismissed with no order as to costs.
Sd/-
..
(ASHOK BHAN J.) PRESIDENT Sd/-
..
(VINEETA RAI) MEMBER /sks/