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KARNATAKA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, BANGALORE
Hon’ble Mr. Justice D.R. Vithal Rao, President &
Mr. Kumar Gowda, Member
S.B. GIRIJAMBA—Appellant
versus
THE SENIOR DIVISIONAL MANAGER, LIC OF INDIA & ORS. —Respondents
Appeal No. 26 of 1995—Decided on 30.12.1995

Headnote:Consumer Protection Act, 1986 - Sections 2(1)(g) r/w 2(1)(o) and 15 - Appeal against order of DF disallowing Complaint against rejection of accident benefit claim by LIC - LIC rejecting on ground that deceased was under influence of liquor intoxication at time of accident - Inquest and Post - mortem reports only raising a doubt that deceased bad consumed some a1chohol in food - No other evidence led by LIC Whether establishes accident due to liquor intoxication? (No) - Result Appeal a1lowed - Claim allowed with interest and costs. (para 28)

       Result: Appeal allowed.

       IMPORTANT POINT

       The decision of the District Forum that OP committed no deficiency in service by rejecting complainants claim to accident benefit on ground that deceased was under influence of intoxication at the time of accident is erroneous as not based on proper evidence.

ORDER

Mr. Justice D.R. Vithal Rao, President— This appeal by the complainant is directed against the order dated 29.12.94 passed by the District Forum, Madikeri in Complaint No. CPA/ K.69/94, dismissing the complaint.

The facts, briefly stated, are as follows : —

2. The husband of the complainant, late Shivacharya Shivalingappa had obtained a Life Insurance Policy for a sum of Rs. 1,00,000/- on 31.8.90 covering the accidental risk, that is, if ever the insured were to die out of the accident, the L.I.C. shall pay the amount equivalent to the sum insured to the legal heirs of the insured. The insured, the husband of the complainant met with an accident at about 4.00 p.m. on 21.8.93, while returning to his house on his motor-cycle and died due to the head injury sustained by him.

3. The complainant, thereafter, made claim with the opposite party for the amounts under the policy. The opposite party settled the claim on 9.1.94 and made payment of the insured amount of a sum of. Rs. 1,00,000/- to the complainant, but declined to make the payment of the amount equivalent to the sum insured under the accidental benefit amount. The opposite party repudiated the claim of the complainant of this accidental benefit amount on the ground that the insured died under the influence of intoxicating liquor at the time of the accident. The complainant filed the complaint claiming the said amount, that is, the accidental benefit amount with interest thereon.

4. The opposite party filed its version and averred that the accident was caused while the life assured was under the influence of the intoxicating liquor, and so, the complainant was not entitled to the benefit under the said clause under accident benefit Clause (1).

5. The opposite party further averred that the complaint under the provisions of the Act was untenable as the repudiation of the claim of the complainant under the accidental benefit scheme was repudiated after due enquiry.

6. During enquiry, the complainant examined herself as PW 1 and her relation one Mr. Shivakumar as PW 2 and got Exs. PI to P3 marked in evidence. Ex. PI is the receipt for the payment of premium. Ex. P2 is the certified copy of the Inquest Mahzar over the dead body of the deceased and Ex. P3 is the certified copy of the post-mortem report over the dead body of the deceased, the husband of the complainant. The opposite party did neither file any affidavit in evidence nor adduced any evidence.

7. The District Forum on consideration of this material placed on record by the parties held that the opposite party did not commit any deficiency in service in repudiating the claim of the complainant, and in that view, dismissed the complaint.

8. We have called for the records and received. We have heard the learned Counsel for the parties, perused the material on record.

9. It is not disputed that the late husband of the complainant had obtained a Life Insurance Policy for a sum of Rs. 1,00,000/-. It also covered the accidental risk, that is, if the Life Insured were to die out of the accident, then the L.I.C. was liable to pay the amount equivalent to the sum insured to the legal heirs of the insured.

10. The husband of the complainant, it is not disputed, died in an accident on 21.8.93. The husband of the complainant while he was returning to his house on his motor-cycle met with an accident, died due to head injury sustained by him.

11. It is also not disputed that the opposite party paid the insured sum of Rs. 1,00,000/- to the complainant on 9.1.94. But it repudiated the claim under the accident benefit scheme for a sum of Rs. 1,00,000/- that is, the amount equivalent to sum insured to the complainant on the ground that the life assured while he met with an accident and died was under the influence of the intoxicating liquor.

12. The complainant has stated that her husband was never taking any liquor and even on the date of the accident he had not taken the liquor. That is the evidence given by PW 2. But these two witnesses,






























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