IN THE HIGH COURT OF KERALA AT ERNAKULAM
GOPINATH P., J.
National Insurance Company Ltd., Represented By The Dy. Manager – Petitioner
Versus
State Of Kerala, Rerpesented By The Chief Secretary, Government Secretariat and Ors. – Respondents
WP(C) No. 3566 Of 2016
Decided On : 24-06-2024
Insurance - Liability under Group Personal Accident Insurance Policy - Motor Vehicles Act, 1988 - [PUBLIC SECTOR INSURANCE COMPANY] - [LIABILITY UNDER GROUP PERSONAL ACCIDENT INSURANCE POLICY] - [Motor Vehicles Act, 1988, Section 185] - The court discussed the Proviso to Clause (4) of Memorandum of Understanding, Clause (5)(b) and (c) of the Group Personal Accident Insurance Policy, and referred to the judgments in Sreedevi v. State of Kerala and Iffco Tokio General Insurance Company Limited v. Pearl Beverages Limited. The court interpreted the provisions to establish that the insurance company is not liable to compensate if the deceased was under the influence of alcohol at the time of the accident, as per the terms of the policy and the Motor Vehicles Act, 1988.
Fact of the Case:
The petitioner, a Public Sector Insurance Company, challenged an award by the Permanent Lok Adalat, which found the petitioner liable to compensate the respondents under a Group Personal Accident Insurance coverage after the death of an individual in a motorbike accident. The petitioner had repudiated the claim on the ground that the deceased was riding the vehicle under the influence of alcohol.
Finding of the Court:
The court found that the petitioner is not liable to compensate as the deceased was under the influence of alcohol at the time of the accident, based on the terms of the insurance policy and the Motor Vehicles Act, 1988.
Issues: The issues involved the liability of the insurance company under the Group Personal Accident Insurance Policy and the influence of alcohol on the deceased at the time of the accident.
Ratio Decidendi: The court held that the insurance company is not liable to compensate if the deceased was under the influence of alcohol at the time of the accident, as per the terms of the policy and the Motor Vehicles Act, 1988.
Final Decision: The writ petition was allowed, and the award of the Permanent Lok Adalat was quashed.
JUDGMENT :
The petitioner is a Public Sector Insurance Company. This writ petition is filed challenging Ext.P8 Award of the Permanent Lok Adalat at Thiruvananthapuram for Public Utility Services, finding that the petitioner is liable to compensate the petitioners before the Lok Adalat (respondent Nos.4 to 7 herein) under a Group Personal Accident Insurance coverage extended by the petitioner Company to the State Government Employees and Teachers.
2. The claim arose on account of the death of one Udayakumar, who died as result of an accident while riding a motor bike. The deceased Udayakumar was at the relevant time serving the Kerala Police as Assistant Sub Inspector. The petitioner-Company had repudiated the claim on the ground that the deceased was, at the time of the accident, riding the vehicle under the influence of alcohol. The party respondents herein approached the Permanent Lok Adalath, Thiruvananthapuram and the Permanent Lok Adalat, by Ext.P8 Award, has found that the petitioner is liable to pay the amounts due under the policy in question.
3. Learned counsel appearing for the petitioner would submit that Ext.P8 Award of the Permanent Lok Adalat is legally unsustainable. It is submitted that, Ext.P2 is the Memorandum of Understanding executed between the Government of Kerala and the petitioner-Company. It is submitted that the Proviso to Clause (4) of Memorandum of Understanding clearly provides that no claim will be payable under the policy for any death or disability, if such death or disability happens while under the influence of intoxicating drugs or alcohol and also while committing breach of law with criminal intent. It is submitted that the terms of policy (which are on record as Ext.P3) would also indicate that the same Clause was carried forward to the terms. Reference is made in this regard to Clause (5)(b) and 5(e) of Ext.P3 policy. It is submitted that, in the present case, Ext.P6 report of the Assistant Chemical Examiner to Government of Kerala, Thiruvananthapuram will show that the deceased was found to be under the influence of alcohol. It is pointed out that in Ext.P6, the quantity of Ethyl alcohol per 100 ml of blood was found to be 86.25 mg while the limit prescribed in Section 185 of the Motor Vehicles Act, 1988 (hereinafter referred to as ‘the M.V Act’) is 30 mg. Learned counsel appearing for the petitioner also places reliance on the judgment of this Court in Sreedevi V. State of Kerala [2024(2) KLT 37] to contend that a challenge to a similar Clause, restricting the claim, if the person suffering disability or death was under the influence of alcohol, was found to be valid by this Court. Learned counsel also places reliance on the judgment of the Supreme Court in Iffco Tokio General Insurance Company Limited V. Pearl Beverages Limited [(2021) 7 SCC 704] to contend that where there is clear material to show that the person who suffered disablement or death was under the influence of alcohol, it will be well within the right of the Insurance Company to reject the claim in a case where the terms of the Policy indicate that no claim will be entertained if it is found that the person who suffered disablement or death was under the influence of alcohol at the relevant time.
4. Heard the learned Government Pleader appearing for responded Nos.1, 2, 3 and 8.
5. Despite service of notice, there is no appearance for respondent Nos.4 to 7.
6. Having heard the learned counsel appearing for the petitioner and the learned Government Pleader, I am of the view that the petitioner is entitled to succeed. The Proviso to Clause (4) of Ext.P2 Memorandum of Understanding reads as follows:-
Iffco Tokio General Insurance Company Limited V. Pearl Beverages Limited
The main legal point established is that the insurance company is not liable to compensate if the deceased was under the influence of alcohol at the time of the accident, as per the terms of the poli....
An insurance claim for death is maintainable where injuries from an accident accelerate a pre-existing condition, and an exclusion clause for alcohol consumption requires proof of being 'under the in....
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 insuran....
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 P....
Insurance claims must strictly adhere to policy terms; no liberal interpretations allowed.
A person driving a motor vehicle with the permission of the registered owner, who holds a policy with personal accident coverage for the owner-driver, steps into the shoes of the owner and is entitle....
A breach of essential terms of an insurance policy, such as using a private vehicle for hire, precludes the claimant from receiving benefits under the policy.
Personal Accident Coverage under Motor Vehicle Policy is applicable to the insured, with the court affirming prior judgments supporting the claimants’ position.
Login now and unlock free premium legal research
Login to SupremeToday AI and access free legal analysis, AI highlights, and smart tools.
Login
now!
India’s Legal research and Law Firm App, Download now!
Copyright © 2023 Vikas Info Solution Pvt Ltd. All Rights Reserved.