FA   682/2008 in CC No. 394/2007 on the file of the

 District Forum, Prakasam at Ongole

Between :

Mattipati Mangamma,

W/o late M. Khajavali

Aged about 30 years, 2^nd line

Ramnagar, Ongole, Prakasam District    … appellant/complainant

And

The Branch Manager,

Life Insurance Corporation of India

Ongole                                                    

Prakasam District                              …. Respondent/Opposite party

Counsel for the Appellant            :           M/s. P. Venkat Rao

Counsel for the Respondent      :           Mr. G. Venugopal Rao

Coram           ;           Sri Syed Abdullah              …        Hon’ble Member

And

Sri R. Lakshminarasimha Rao…      Hon’ble Member

Monday, the Nineteenth  Day of July, Two Thousand Ten

Oral Order     :           ( As per Sri Syed Abdullah,  Hon’ble Member )

*******

The appellant is the unsuccessful complainant in CC 394/2007 before the District Forum, Prakasam District  at Ongole and the appeal is filed questioning the legality and propriety  of the order in dismissing the claim filed for recovery of the Double Insurance Benefit  which was denied to her by the opposite party.

The facts of the case are that  the complainant’s husband had obtained policy  from the opposite party  which is  an accidental  benefit policy, i.e., Double Benefit Scheme. The complainant’s husband, by name, Khajavali,  died on 24.09.2005 at Kondepi in a lorry accident.  The concerned police registered a case as Cr. No. 31/2005 U/s. 304-A IPC.  The complainant is a nominee  to the policy and on the death of her husband , the complainant  submitted her claim  to the opposite party  but the opposite party sent a sum of Rs.1,04,000/-  on 16.11.2006 treating it as ordinary policy denying Double Benefit  scheme. The complainant is entitled for a sum of Rs.2 lakhs  and non-payment of the said amount amounts to deficiency in service.

 The opposite party in its version had taken the stand that  while processing the claim, a police report and post-mortem were verified  and as well the driving licence.   From the post-mortem report it is found that the deceased was under  the influence of intoxication.  The policy conditions has stipulated  that the accidental benefit cannot be granted  in case the person dies by consuming alcohol. 

During enquiry, the complainant filed Ex. A-1 to A8 along with evidence affidavit  in support of her claim.   The opposite party filed Ex. B-1 to B-5 consisting of Ex.B-1, copy of the FIR, Ex.B-2 – post mortem certificate, Ex. B-3 – Inquest report, Ex. B-4 – Final report  submitted by the police to the concerned Magistrate, Ex. B-5 copy of the policy.

After going through the evidence on record, the District Forum found that  the accident occurred due to rash and negligent driving of the insured  but not otherwise.  It is observed that  it is clear from the police record  that   the deceased was  in drunken position while riding and  his wife was a  pillion rider at the time of  accident. As he was riding  the bike in drunken condition, the claim for the accidental benefit was dismissed.

 In the grounds of appeal,  it is pointed out that the Doctor’s certificate shows that the complainant’s husband  died due to shock and haemorrhage but not otherwise. So the double benefit which is to be given  cannot be denied. It is also contended that the District Forum gave importance  to the police report  rather than Doctor’s certificate.

Point for consideration is, whether  the impugned order suffers from factual and legal infirmity ?

Undisputedly,  the opposite party paid insurance claim amount of Rs.1,04,000/- giving only death benefit  but not personal accident benefit. The main question for consideration is whether the respondent/opposite party  is  justified  in denying the personal accident benefit as assured under Ex. A-5 policy. 

We have perused and gone through the details of the FIR, Inquest Report and Post-mortem Report.  Ex. B-1 FIR was registered based on the statement given by the complainant herself, in which, she herself  has stated that while the deceased and herself were going on their motor bike, tire was punctured so got it vulcanized at the shop   and thereafter her husband went aside and he seems to have consumed alcohol  which  she suspected it  and then both of them started on the bike.  While so, her husband had applied sudden brake  and that herself and her husband had fallen down from  the bike.  Some persons have admitted them in a hospital.  Ex. B-3 is the  Inquest report, in which, it is also noted  that the deceased had extensively consumed alcohol and drove the motor cycle  which caused accident with which he succumbed. The concerned police submitted Ex. B-4 report U/s. 174 Cr. P. C with an observation that the accused was under intoxication  at the time of driving two wheeler which has caused accident leading  to his death and consequent to his death the case was treated as closed. No doubt, Ex. A-6 post-mortem certificate  shows that the cause of death  was due to shock and haemorrhage as a result of  injuries to the vital organs but there is no mention  that the deceased was in intoxication condition or that alcohol was found in the stomach of the deceased.   Whatever it may be,  Ex. B-5 policy conditions No.10-2, (a ) and (b) (i) makes  it clear that the company shall not be liable to pay additional sum referred in (a) or (b)  above if the disability or the death of the life assured  takes place  by intentional self-injury, admitted suicide under insanity or immorality  or whilst  the assured is under the influence of intoxication of liquor, drug or narcotic etc.  when the complainant herself has stated in her statement  to the police that her husband suspected  to have consumed alcohol which resulted in  accident  while  driving the bike,. she cannot go back from her statement. Apart from it, the Inquestdars  also opined that  accidental death had taken place on account of in an intoxication condition  of the deceased person while driving the bike. Both on question of fact and law, the complainant is not entitled for accidental benefit.  As the accident had taken place while driving bike by the deceased in intoxicating condition the insurance company has no liability at all.  The post-mortem had taken place after 48  hours of the death, so it was possible for the doctor to find out the symptoms of alcohol at the time of Post-mortem.  So he did not mention in his certificate.  It is to be confirmed that eh accident had taken place on account of negligence of the deceased, as well,  on account of his intoxication.  The complainant though she is a nominee of the policy, she cannot claim  for the  Personal Accident Benefit.  The District Forum has rightly rejected the claim and there is no infirmity in its order.

In the result, the appeal is dismissed confirming the order passed by  the District Forum, Prakasam District at Ongle in C. C. No. 394/2007 dated 20.02.2008  as valid.  There is no order as to costs in the appeal.  Time for compliance four weeks.

Sd/-MEMBER

                                                                                                                                                                  Sd/- MEMBER