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HIMACHAL PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Surjit Singh, President, Vijay Pal Khachi, Member.
Life Insurance Corporation Of India — Appellant
Vs.
Narinder Kumar — Respondent
First Appeal No. 176 of 2016
Decided on : 15-07-2016
Advocate Appeared:
For the Appellant :Mr. Sandeep Dutta, Advocate
For the Respondent:Mr. Yogesh Thakur, Advocate
The central legal point established in the judgment is the interpretation and application of the exclusion clause in the insurance policy regarding intoxication and its impact on the entitlement to double accident benefit.
Headnote:
Consumer Protection Act - Insurance Policy - 12 - Summary: The court discussed the Consumer Protection Act, 1986, specifically Section 12, and the insurance policy's condition regarding the payment of double accident benefit. The court analyzed the FSL report and postmortem examination report to determine the deceased's intoxication level and its impact on the claim for double accident benefit. The court also referred to a precedent to support its decision.
Fact of the Case:
The appellant appealed against the order of the District Consumer Disputes Redressal Forum, which allowed a complaint filed under Section 12 of the Consumer Protection Act, 1986. The complaint was related to the non-payment of double accident benefit under an insurance policy after the accidental death of the life assured.
Finding of the Court:
The court found that the deceased was intoxicated at the time of the accident based on the FSL report and postmortem examination report. It concluded that the exclusion clause in the insurance policy regarding intoxication applied, and therefore, the complaint was dismissed.
Issues: The main issue was whether the deceased's intoxication at the time of the accident affected the entitlement to double accident benefit under the insurance policy.
Ratio Decidendi: The court's decision was based on the interpretation of the insurance policy's exclusion clause related to intoxication and the evidence from the FSL report and postmortem examination report.
Final Decision: The court allowed the appeal, set aside the impugned order, and dismissed the complaint of the respondent.
ORDER :
Surjit Singh, President .(Oral)
Appellant has preferred this appeal against the order dated 12.04.2016, of learned District Consumer Disputes Redressal Forum, Solan, whereby a complaint, under Section 12 of the Consumer Protection Act, 1986, filed against it, by respondent, Narinder Kumar, has been allowed and a direction given to it to pay a sum of Rs. 2,35,000/-, with interest at the rate of 9%, per annum, from the date of filing of complaint, to the date of payment of the aforesaid amount of money, on account of double accident benefit, in accordance with condition No. 10 of the insurance policy and also to pay Rs. 25,000/-, as compensation and Rs. 5,000/-, as litigation expenses.
2. Admitted facts are that Shri Shubham Bhatti, aged about 20 years, had purchased a policy on his life from the appellant. In addition to paying premium for the sum assured, which was Rs. 2,35,000/-, he had been paying extra premium for getting double accident benefit, under the policy. As per this double accident benefit clause, in the event of life assured dying an accidental death, in addition to payment of sum assured, i.e. Rs. 2,35,000/-, to his nominee, an additional amount, equivalent to the sum assured, was payable.
3. Life assured died on 08.06.2014, on account of drowning in Giri river. Of course, this was a case of an accidental death. Claim was lodged by respondent, Narinder Kumar, the father of life assured, who was named as the person, entitled to receive money, in the event of life assured dying, when the policy was still in force. Sum assured was paid by the appellant, but the money, due on account of double accident benefit, was not paid and the claim was rejected on the ground that deceased was drunk at the time he died of drowning.
4. Respondent then filed a complaint, under Section 12 of the Consumer Protection Act, 1986. Appellant contested the complaint on the same ground, on which the claim had been repudiated. Learned District Forum has allowed the complaint, vide impugned order.
5. We have heard learned counsel for the parties and gone through the record.
6. Learned District Forum has observed that the FSL report, Annexure R-6, relied upon by the appellant, in support of the plea that deceased was having 59.45 mg% alcohol in his blood, does not stand connected with the deceased, because the report shows that blood and urine samples of two other persons, namely Deeraj and Santiksh Chada, were also sent by the same docket making reference to PMR No. 144/14, which PMR pertained only to the deceased. Also, it has been observed that urine sample of the deceased had not been sent and unless urine sample was taken and analysed and liquor was found in the urine, it could not be concluded that deceased was drunk or under the influence of liquor.
7. Postmortem examination report of deceased is available on the record of learned District Forum as Annexure R-3. It clearly records that it pertains to the dead-body of Shubham Bhatti, the life assured. FSL report, Annexure R-6, was sent by the Incharge of FSL, Junga, to IGMC and the concerned Doctor of IGMC, sent the same to SHO, Police Station, vide letter Annexure R-5. In this letter, Doctor clearly wrote that there was alcohol concentration to the extent of 59.45 mg%, in the blood of the deceased. Report, Annexure R-6, also says that parcel P-8, containing blood of deceased Shubham Bhatti, on analysis, was found to contain 59.45 mg% of ethyl alcohol. In view of these documents, there can be no escape from the finding that FSL report stands connected with the postmortem report, Annexure R-3 and since this postmortem report pertains to the postmortem of life assured, FSL report Annexure R-6, can be used as conclusive evidence to hold that deceased had consumed alcohol and its concentration, in his blood, was 59.45 mg%.
8. It is not the requirement of law that along with its presence in the blood, alcohol should be shown to be present in the urine of a person, to conclude that the person
