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 influence' rather than mere consumption.

JUDGMENT :

HARISANKAR V. MENON, J.

The petitioner, an insurance company, has filed the captioned writ petition, seeking to challenge the award dated 14.09.2022, passed by the Permanent Lok Adalat, Thiruvananthapuram in O.P.No.42 of 2021 (Ext.P7).

2. One Babu was found unconscious on the roadside, on 30.11.2020 and was taken to a hospital in an ambulance. He was also treated at the hospital when he was brought there. However, on 01.12.2020, he passed away. Ext.P5 is the post- mortem certificate dated 02.12.2020. Ext.P6 is the toxicology report with respect to a sample collected on 01.12.2020. In this toxicology report, it is stated that alcohol tested “positive” with respect to the sample taken as above. The deceased had an insurance policy. The legal heirs of the deceased raised a claim with the insurance company, on the basis of Ext.P1 insurance policy, pointing out that the deceased was riding a motorcycle bearing Reg. No. KL-20-D-5674, and while he was riding, he met with an accident and later passed away, and hence compensation requires to be awarded to them. The claim lodged by the legal heirs is produced along with the writ petition as Ext.P2. The petitioner company filed Ext.P3 written statement. The petitioner also relied on the F.I.R., post-mortem report and the toxicology report to contend that;

i. the accident was not the cause of death. According to the petitioner, the cause of death was “occlusive coronary artery disease”.

ii. the deceased was under the influence of alcohol.

iii. therefore, with reference to various clauses under Ext.P1 insurance policy, the legal heirs were not entitled for any claim.

3. The Permanent Lok Adalat considered the issue elaborately. As regards the first issue, the Permanent Lok Adalat referred to the principles laid down by the Apex Court in Alka Shukla v. Life Insurance Corporation of India [2019 (2) KLT 3098], and found that even as per the post-mortem certificate, the injuries sustained in the accident could have accelerated the death. Therefore, the contention raised was not accepted. As regards the second issue also, with reference to the principles laid down in Oriental Insurance Company Ltd., Mattancherry v. Vineetha Nair and Others [2016 (4) KHC 392], the same was decided against the petitioner. Ultimately, by Ext.P7 award, the respondents herein were found entitled to get an amount of Rs.15 lakhs towards compensation. It is seeking to challenge Ext.P7 award that the captioned writ petition has been instituted by the insurance company.

4. Sri.S.Arun Raj, the learned Standing Counsel for the petitioner would contend that;

i. the death was not on account of any accident but was on account of the reason highlighted in the post-mortem certificate. He would also rely on the F.I.R. to contend that the same does not make any reference to any accident. He further refers to the treatment summary/accident-cum-wound certificate to contend that there is no reference to any accident.

ii. He would also rely on the toxicology report to contend that, admittedly, the deceased had consumed alcohol and, therefore, the insurance claim was, in any event, not allowable to the legal heirs.

5. Per contra, Sri.R.T.Pradeep, the learned counsel for the respondents, would invite the attention of this Court to the detailed consideration made by the Permanent Lok Adalat to state that the death was solely on account of the accident and perhaps the accident would have accelerated the cause of death. As regards the consumption of alcohol, he would point out that, there is much difference between mere consumption of alcohol and being under the “influence of alcohol”, which is the sole reason which could be highlighted by the insurance company for disallowing the claim.

6. I have considered the rival contentions, as well as the connected records.

7. As rightly contended by the learned counsel for the petitioner, the post-mortem report itself indicates that the injuries sustained in the accident could have accelerated or pr