IMORTANT POINTS
(1) Insurance policy - in the matter of Insurance claims, the Courts cannot adopt a beneficial/welfare approach, and have to go strictly by the words used in the concerned Insurance Policy.
(2) Agreement of Insurance - Thus it is not permissible for the Court to substitute the terms of the contract itself, under the garb of construing terms incorporated in the agreement of insurance.
(3) Equity - No exceptions can be made on the ground of equity.

ORDER

This Revision Petition has been filed by the Petitioner/Opposite Party-LIC, challenging the order dated 28.10.2016 passed by the Kerala State Consumer Dispute Redressal Commission, Thiruvananthapuram, in Appeal No. 349 of 2015 filed by LIC. Vide such Order, the State Commission had dismissed the Appeal filed by the Opposite Party-LIC and affirmed the District Forum’s Order dated 23.4.2015 passed in Complaint Case No. 570 of 2012 filed by the Respondent/Complainant-Dolly Jose, allowing the complaint and directing the Opposite Parties to pay Rs. 10,00,000/- (Rupees Ten Lakhs Only) to the Complainant alongwith costs of Rs. 2,500/- (Rupees Two Thousand and Five Hundred Only) within one month.

2. The brief facts of the case are that husband of the Complainant-Smt. Dolly Jose, was an Insurance Policy holder under Policy No. 777975414 of the Opposite Party. She was the nominee of the said policy. The Sum Assured of the Policy was Rs. 10,00,000/- (Rupees Ten Lakhs). The Policy was a Double Accident Benefit policy. Her husband expired on 23.3.2011 in a train accident by falling down from train. She submitted her Claim before the Opposite Party and only the Policy amount of Rs. 10,00,000/- was given. But the case of the Complainant was that she was entitled to Rs. 20,00,000/- as per the Policy as her husband had died in an accident, and as per the said Policy she was also entitled for the Double Accident Benefit of Rs. 10.00 lakhs. Thus, the Complainant filed a Consumer Complaint before the District Forum claiming such amount and compensation.

3. The Opposite Party contested the complaint through its version before the District Forum, and admitted the existence of the Policy and payment of basic sum assured Rs. 10,00,000/- on June 27, 2011. However, it was stated that the Complainant was not entitled to Double Accident Benefit of the Policy as the deceased was under the influence of alcohol at the time of accident, which was exempted as per Clause 11(b)(i) of the Policy conditions, and consequently the complaint was liable to be dismissed.

4. The District Forum vide its Order dated 23.4.2015 allowed the complaint as mentioned in Para1 above.

5. Dissatisfied with such Order, an Appeal was filed by the Opposite Party-LIC before the State Commission, Kerala. The State Commission, after hearing the parties and perusing the record, vide Order dated 28.10.2016 dismissed the Appeal with costs of Rs. 5,000/-.

6. Hence, the present Revision Petition.

7. The sum assured in the Insurance Policy was paid by the Petitioner-Insurance Company, but Double Accident Benefit was not acceded to since the Certificate of Chemical Analysis pertaining to the blood sample of the deceased who had fallen down while travelling in the train revealed that Ethyl alcohol to the level of 135.08 mg/100ml was found in such sample. Consequently, the Insurance Company relied upon the Clause 11(b)(i) which provided that the Insurer would not be liable to pay any Additional Sum if the disability or death of the Life Assured was caused by “intentional self injury, attempted suicide, insanity or immorality, or whilst the Life Assured is under the influence of intoxicating liquor, drug, narcotic or… “.

8. In “Baby Apoorva Rai Vs. New India Assurance Co. Ltd. & Ors., Consumer Case No. 401 of 2014, decided on 3.9.2015 (NC)”; the leave preferred by the Complainant in similar circumstances where the death of the Life Assured on account of drowning in swimming pool after he had consumed alcohol prior to his death was dismissed by this Commission. In the said judgment, it was also noted that according to Lyon’s Medical Jurisprudence and Toxicology” permissible limit for blood alcohol in India happens to be 30 mg%, although in many developed countries the threshold was higher.

9. Earlier on 17.11.2022, and thereafter on 6.12.2022 opportunities were granted to the Respondents to show how and what is the “threshold limit” according to any medical recognized journals for being clas