REKHA GUPTA, PRESIDING MEMBER The present revision no. 2638 of 2016 has been filed against the judgment dated 10.03.2016 of the Chhattisgarh State Consumer Disputes Redressal Commission, Raipur (the ‘State Commission’) in First Appeal no. 50 of 2016. 2. The brief facts of the case as per the petitioner/ complainant are that a group accident benefit policy was issued in favour of the petitioner’s husband late Shri Bideshi Ram by respondent no. 2 through respondent no. 1. According to the above-mentioned policy, if the policy holder dies accidentally/ unexpectedly then his nominee will be entitled to Rs.5,00,000/-. The husband of the petitioner on 12.01.2015 was coming as per his daily routine from Balod to his village Ranitarai by cycle, when he slipped into the Kharkhara Canal resulting in his death by drowning in the canal. After the death of petitioner’s husband, the petitioner filed the claim through respondent no. 3, but respondent no. 1 denied/ repudiated the claim saying that at the time of incident the deceased person had consumed alcohol and as per the post mortem report 200 CC alcohol were found with food particles in his stomach. Thus they repudiated the claim on 16.03.2015 on the ground that the deceased was intoxicated. But no alcohol had been consumed by the deceased at the time of incident. He may have smelt of alcohol due to taking syrups for cold and cough or due to stale food particles. More over the post mortem report specifically says the cause of death was due to drowning in water resulting in asphyxiation. Accordingly, non-payment of claim comes under deficiency in service and unfair trade practice by respondent no.1. Thus, the petitioner shall be given the amount of Rs.5,00,000/- with interest, Rs.2,00,000/- for the mental harassment and any other relief. 3. The respondent no.1 in his reply has stated that there has been no fault on their part nor has there been any negligent or mala fide intention on their part. Thus, the complaint was outside the jurisdiction of the Court and is liable to be dismissed. 4. In their reply, the insurance company has further contended that they were not liable to pay if the terms and conditions are not met/ fulfilled and if the policy holder, at the time of incident, was under the influence of alcohol or drugs or any other intoxicating substance. According to the post mortem report of deceased Bideshi Ram, given by the doctor, it states that the residues of undigested food and 200 CC alcohol have been found in the deceased’s stomach. Thus, at the time of death the deceased was under the influence of alcohol and consequently insurance company has not done any deficiency in service in repudiating the claim. Hence, the complaint should be dismissed with cost. 5. Respondent no. 2 and 3 admitted that the petitioner’s husband late Shri Bideshi Ram had a savings account in the branch of respondent no. 3 from which insurance premium was given to respondent no. 2 through respondent no.3 and accordingly the insurance policy was issued. The insurance claim was sent to respondent no. 1 through respondent no. 2 and respondent no. 3 on 12.01.2015 after the death of the policy holder, which respondent no. 1 – Insurance company rejected on 04.03.2015 on the ground that the deceased policy holder had consumed alcohol. The petitioner thinks that the respondent no. 1 is liable and not the respondent no. 2 and respondent no. 3 thus, the relief shall be sought from respondent no.1 and not the respondent no. 2 and respondent no. 3. Therefore, the application against the respondent no. 2 and respondent no. 3 should be dismissed. 6. The District Consumer Disputes Redressal Forum, Durg (‘the District Forum) vide its order dated 13.01.2016 while dismissing the complaint observed as under: “According to the observation of the proceeding the post mortem report of the deceased states that there was the residues of alcohol around 200 ml, hence, that’s clear the deceased was intoxicated that can be put in the category of violation of the terms and conditions of the insurance rules. Henceforth we are satisfied with the insurance companies argument that since the deceased was intoxicated has violated the terms and conditions of the insurance company and therefore, they have rejected the claim of the complainant and hence, cannot be put in the category of claimant. In relation to the above, the respondent insurance company has cited the following judgments: “Baby Apurva Rai vs New India Insurance Company Ltd., - Consumer Case no. 402 of 2014 dated 03.09.2015 (NC) and The Oriental Insurance Company Ltd., vs Smt Anju Malhotra – 2007 (1) CJ L J 8 (Chhattisgarh State Commission, Raipur) giving them benefit is correct. According to the above evidence/ facts we conclude that the respondent has not any deficiency in service and unfair trade practices. Henceforth, we didn’t accept the applicant’s claim and we dismiss the complaint”. 7. Aggrieved by the order of the District Forum, the petitioner filed an appeal before the State Commission. The State Commission while dismissing the appeal observed as under: “The applicant/ complainant have submitted the deceased investigation report. In this post mortem report the doctor has examined the dead body and has clearly stated that there were the residues of the alcohol. However, there has been stated that the death of the deceased is due to drowning which is of accidental nature. The complainant/ applicant in his complaint clause 3 has pleaded that on dated 12.01.2015 as per the daily routine was coming from Balod by doing his work of raj mistry from his cycle was coming to his village Ranitrai in the way he fallen down in the Kharkhara nahar/ canal and died due to drowning. The applicant/ complainant has presented the A – 11 documents which is written to Branch Manager by the applicant/ complainant in which it is clearly stated that on 12.01.2014 her husband died due to sudden fall and in consequence drowning in water of which the post mortem has been done. According to the statement of the applicant it is clear that her husband died due to drowning and in the post mortem report the residues of alcohol (200 cc) have been found. In this proceeding the investigation of the deceased report that has been presented to the doctor has clearly stated that the deceased stomach has the residues of alcohol (200 cc) which is above the prescribed limit and according to the applicant her husband died due to falling and drowning and in this circumstances it cannot be denied the possibility that the deceased fell because of unconsciousness state and in result of which he drowned in the canal and his death was misshaped and in this circumstances it is in violation of the terms of insurance. District Forum had concluded that the deceased was under the influence of alcohol which is opposite to the terms of insurance policy, resulting which the non-applicant has dismissed the claim of the applicant, in which there is no deficiency in service, its completely correct and there is no interference required. Thus the order passed by the District Forum date 13.01.2016 the appeal of the applicant devoid of the facts is repealed”. 8. Hence, the present revision petition. 9. We have heard the learned counsel for the petitioner and have gone through the record. Learned counsel for the petitioner has contended that as per the post mortem report against column no., 4 the contents of stomach contains semi digested food with alcohol of 200 CC. He further contended that the insurance company have committed deficiency in service in repudiating the claim on the basis of the post mortem report. The District Forum and the State Commission had also erred in dismissing the complaint and the appeal. Both the fora ignored the contention of the complainant that “in fact the deceased has not taken any alcohol at the time of incident. The smell of the alcohol may be because of the medicines or because of any product of the food which cannot be the violation of the insurance policy”. Learned counsel for the petitioner has stated that the deceased had taken syrup for cold and cough. 10. We have heard the learned counsel for the petitioner and have gone through the record very carefully. The claim was repudiated vide letter dated 04.03.2015 and reads as under: “It is evident from post mortem report of victim, that abdomen consist of semi digested food with alcohol of 200 cc”. We would like to draw your attention to part III General Exclusions point 3 which reads as “any claim of the insured person (ii) whilst under the influence of liquor or drugs or other intoxicants. Thus, as victim, was under influence of alcohol at the time of accident same is endorsed in post mortem report. We regret to convey you our inability to consider your subject claim as per exclusion mentioned above. Your subject claim thus stands repudiated”. 11. We have also gone through the insurance policy. In part 3 of the policy “General Exclusion”, reads as under: Part III – General Exclusions Provided always that the company shall not be liable under this policy for – - < >< >
Any claim of the insured person from intentional self-injury, suicide or attempted suicide whilst under the influence of liquor or drugs or other intoxicants;
12. We have then gone through the post mortem report, wherein it has been clearly mentioned that in the stomach they have found semi digested food along with 200 CC of alcohol. Learned counsel for the petitioner has stated that the insured deceased had consumed syrup for cough and cold which may have given the result of 200 ml of alcohol. The same would still come in the category of intoxicants. 13. The Hon’ble Supreme Court in Mrs Rubi (Chandra) Dutta vs M/s United India Insurance Co. Ltd., 2011 (3) Scale 654 has observed: “Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21 (b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums. The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts. This is not the manner in which revisional powers should be invoked. In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21 (b) of the Act has been transgressed. It was not a case where such a view could have been taken by setting aside the concurrent findings of two fora.” 14. In view of the above, we find that no jurisdictional or legal error or misrepresentation of facts have been shown to us which calls for interference in the exercise of powers under Section 21 (b) of Act. The order of the State Commission does not call for any interference nor does it suffer from any infirmity or erroneous exercise of jurisdiction or material irregularity. Thus, the present revision petition as also the complaint is dismissed. | 
