The influence of alcohol at the time of death can justify the denial of a claim under a personal accident insurance scheme. The proviso to the insurance clause aims to prevent self-injury for insurance benefits.

JUDGMENT :

This is the second writ petition filed by the petitioner, after having obtained a judgment earlier in W.P.(C).No.12693/2020.

2. The petitioner is stated to be the wife of late Vijayakumar, who unfortunately died of drowning, after having accidentally tripped into a well on 18.10.2018. The petitioner says that her husband was covered by a Group Personal Accident Insurance Scheme ('Scheme' for short), namely Ext.P9; and thus that she was entitled to compensation to the sum of Rs.10 lakhs, but that this was denied on the allegation that her husband, at the time of death, was under the influence of alcohol. She says that this was irrelevant because, what is important as per Ext.P9 policy was the verified cause of death, which, according to her, cannot be attributed to the influence of alcohol – assuming that her husband was under such at the relevant time.

3. The petitioner says that she, therefore, had approached this Court through the aforementioned writ petition, namely, W.P.(C) No.12693/2020, which was disposed of, directing the competent Authority to reconsider the case, which has now entered in Ext.P8, wherein, it has been reiterated that, as per Ext.P9 policy, particularly Clause 6 thereof, any death due to accident, while under the influence of alcohol, would stand excluded from its ambit.

4. The petitioner submits that, therefore, she has been now constrained to challenge clause 6 of Ext.P9 because, the denial of a claim in the case of death, even if the accident was at a time when the deceased was under the influence of liquor – but the cause of death being not attributable to such condition – is arbitrary and capricious. She thus prays that the reliefs sought for in this writ petition be granted.

5. Sri. Lindons C. Davis – learned counsel for the petitioner, vehemently argued that the impugned clause in Ext.P9 is irrational and, therefore, untenable; and that, going by the various binding precedents, namely, Central Inland Water Transport Corporation Ltd. v. Brojo Nath [1986 (3) SCC 156] and L.I.C. of India & Anr. v. Consumer Education & Research Centre & Ors. [1995 (5) SCC 482], this Court is obligated to set aside such clauses, if it is found to be unjust and unfair. He argued that, since the Group Personal Accident Insurance Scheme was propounded as per Government orders, it is amenable to judicial review and that his client is, therefore, constrained to approach this Court because, even going by the police reports, namely Ext.P1, her husband did not die on account of consumption of alcohol, but because he accidentally tripped and fell into a well, which could have happened even to a person who was not under the influence of alcohol. He concluded arguing that, therefore, his client's challenge to clause 6 of Ext.P9 is for good reason because, what is relevant to be determined is not whether the deceased was under the influence of alcohol, but if the cause of death had any direct nexus to it.

6. In response, the learned Government Pleader – Sri. Rajeev Jyothish George, vehemently supported Ext.P9, saying that the object of the Group Personal Accident Insurance Scheme is to cover deaths which are beyond the control of human intervention or action. He submitted that, therefore, as is available in any other contract of insurance, Ext.P9 contains a proviso to clause 6, wherein, it mandates that no compensation shall be paid for death or disablement arising out of intentional self-injury, suicide, attempted suicide, death or disablement due to accident, while under the influence of intoxicating liquor or drugs. He pointed out that, in fact, there is one more exemption provided in the said proviso, namely, in the case of death or disablement while breaching law with criminal intent. He submitted that, these causes are stipulated with loadable intent because, otherwise, it would be used as a premium by unscrupulous people for the purpose of obtaining compensation under it, by either intentional self-injury or an attempt