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2022 Supreme(Online)(NCDRC) 1451
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
DR. S.M. KANTIKAR, Presiding Member, MR. DINESH SINGH, Member
NARINDER KUMAR – Appellant
Versus
LIFE INSURANCE CORPORATION OF INDIA – Respondent
REVISION PETITION NO. 2805 OF 2016
For the Appellants/Petitioners:
For the Respondents:
The insurer's repudiation of accident benefits due to alleged intoxication was invalid due to insufficient evidence and misapplication of policy conditions.
Headnote:(A) Consumer Protection Act, 1986 - Section 21(b) - Insurance claim - Repudiation of accident benefit on intoxication grounds - Deceased insured drowned; insurer's claim of intoxication due to alcohol found unsubstantiated - Medical reports raise doubts regarding intoxication - Death recorded as due to asphyxia - District Forum's order affirmed. (Paras 5, 9, 11)
(B) Evidence - Medical examination reports - Material errors in the analysis of the deceased's blood alcohol content raise doubts on insurer's refusal to pay - The court insists on scrutiny of all evidence before concluding intoxication - Incorrect reliance on policy provision by insurance company. (Paras 8, 10)
Facts of the case:
The complainant's son died in an accident; insurance company paid only the sum assured, refusing accident benefits citing intoxication, which the District Forum disputed based on medical forensic evidence.
Findings of Court:
The court favored the District Forum's view that the death was due to drowning, not intoxication, highlighting errors in medical reports presented by the insurer.
Issues: Main issues addressed include whether the insurer's determination of intoxication was valid based on available evidence and the interpretation of applicable policy conditions.
Ratio Decidendi: The insurer's claim of intoxication was rejected due to insufficient evidence, reaffirming that policy exclusions must be firmly supported by evidence before application.
Result: The revision petition is allowed and the previous order by State Commission is set aside, with the District Forum's order being upheld.
| Table of Content |
|---|
| 1. death of insured alleged due to intoxication. (Para 3 , 4 , 5) |
| 2. errors in forensic evidence and issues with applying policy exclusions. (Para 9 , 10) |
| 3. order of district forum upheld. (Para 11) |
Appeared at the time of arguments
PER HON’BLE DR. S. M. KANTIKAR, PRESIDING MEMBER
1. This revision petition has been filed under Section 21 (b) of The Consumer Protection Act , 1986 in challenge to the Order dated 15.07.2016 of the H.P. State Consumer Disputes Redressal Commission (in short the ‘State Commission’) arising from the Order dated 12.04.2016 of the District Consumer Disputes Redressal Forum, Solan (in short the ‘District Forum) in C.C. No. 81 of 2015.
2. No one appeared for the petitioner (the ‘complainant’).
We heard the learned counsel for the respondent (the ‘insurance co.’).
We also perused the material on record.
3. Brief facts are that the complainant’s son, the deceased insured, had taken “Jeevan Anand” policy with profits and with accident benefit. The risk covered was Rs.4,70,000/- (Rs.2,35,000/- on account of sum assured and Rs.2,35,000/- on account of accident benefit). On 08.06.2014 the insured died due to accidental drowning in river. The insurance co. paid only Rs. 2,35,000/- against the sum assured but it repudiated the accident benefit claim on ground that the deceased insured was under the influence of alcohol (drunk) at the time of the accident which was a violation of condition no. 10(b)(i) of the policy.
4. As such the issue germane to the dispute is whether the death of the insured deceased had occurred due to intoxication (influence of alcohol).
5. The District Forum held that it has not been conclusively proved that the deceased was under the influence of alcohol. The District Forum also observed that as per the Post Mortem (PM) the death of the insured was due to ‘asphyxia’ and ‘wet drowning’, and not due to ‘intoxication’. It also noted certain material lapses and errors apropos the PM and the FSL reports, the relevant observations are reproduced below:
“The report of FSL (Annexure-6) shows that although as per result ethyl alcohol was found in blood of the deceased to the extent of 59.45 mg%, but the at some time, it also transpires that the doctor concerned, who conducted the post mortem examination of the deceased failed to take urine sample. There is not even a single whisper in the aforesaid report as to whether any urine of the deceased was sent for chemical examination. Further as per the FSL report, traces of ethyl alcohol were detected in the parcels P5, P6 and P8 and not detected in parcels P2, P3, P4 and P7. Parcels P2, P3 & P4 do not relate to deceased/life assured, whereas, it contained blood/urine of Sh. Dheeraj Sharma & Santiksh Chadda. The result in this report does not distinguish as to whether urine of the deceased was received in the Forensic Science Laboratory. We are of the view that it was incumbent upon the doctor concerned or the authorities to take urine sample and send the same for chemical examination. Since as per FSL report, no urine sample was taken, therefore, it cannot be said that the deceased was under the influence of liquor.”
The District Forum allowed the complaint and directed the insurance co. as below:
“The opposite parties were jointly and severally directed to pay Rs. 2.35 lacs to the complainant on account of double accident benefit along with interest @ 9% per annum from the date of complaint till payment. The complainant is also held entitled to Rs. 25,000/- as compensation for mental harassment etc. and Rs. 5,000/- towards litigation charges.”
6. The insurance co. filed appeal before the State Commission. The State Commission allowed the appeal and set aside the Order of the District Forum, consequently the complaint stood dismissed. It but altogether omitted to address the lapses and errors apropos the PM and the FSL reports which had been specifically pointed out by the District Forum. It only relied on the concerned condition of the polic
