Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 50.
Instituted on : 19.01.2011.
Decided on : 15.05.2015.
Smt. Satyawanti widow of Sh. Raj Kumar resident of Village Majri P.O. Gubana Tehsil-Bahadurgarh, District Jhajjar.
………..Complainant.
Vs.
- Reliance General Insurance Co. Ltd. SCO 212-213-214, Sector-34A, Chandigarh(Through its Manager).
- Reliance General Insurance Co. Ltd. SCO 400-402, HDFC Bank Building, 2nd Floor, Model Town, Delhi Road, Rohtak (Through its Branch Manager).
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
Present: Sh.Sanjay Kagtan, Advocate for the complainant.
Sh.Yogesh Sharma, Advocate for the opposite parties.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that she is widow of late Sh.Raj Kumar and has 3 minor children and has also filed the present complaint on their behalf. It is averred that the husband of complainant took a personal accident insurance policy of Rs.500000/- from the opposite party no.2 on 15.01.2009 vide certificate no.2013392914100001-75 effective from 15.01.2009 to 14.01.2010. It is averred that the husband of the complainant was murdered on 20.10.2009 by some villagers and FIR No.379 dated 31.10.2009 was lodged in P.S.Sadar Bahadurgarh and the alleged murder comes in the definition of accident. It is averred that complainant supplied all the relevant documents to settle the claim to the opposite party but till today no intimation has been received by the complainant about the settlement of claim. Complainant requested the opposite parties personally and also served a legal notice but to no effect and the opposite parties had finally refused to settle the claim. As such it is averred that the act of opposite parties is illegal and there is deficiency in service on the part of the opposite parties and the complainant has sought the insured sum of Rs.500000/- alongwith interest, compensation and litigation expenses.
2. On notice opposite parties appeared and filed their written reply submitting therein that it is denied that the husband of the complainant was murdered on 20.10.2009. As per chemical analysis report and investigation report of Royal Associates the following facts were observed: “The deceased Raj Kumar died due to the consumption of Alcohol as per the chemical analysis report issued by the Forensic Science Laboratory Karnal. It is averred that any death, injury or disablement under the influence of alcohol is not covered under the policy issued and is specifically excluded vide exception no.6(b) which clearly says that the company will not be liable under the said policy for the payment of compensation in respect of death, injury or disablement of the insured person whilst under the influence of intoxicating liquor or drugs. As such the claim is not covered as per the policy terms and conditions and the same was rightly rejected and the same was conveyed to the complainant vide letter dated 12.04.2010. It is averred that the present complaint may kindly be dismissed with costs.
3. Both the parties led evidence in support of their case.
4. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C8 & Ex.C9 in additional evidence and closed his evidence. On the other hand, ld. Counsel for the opposite parties has tendered affidavit Ex.R1, documents Ex.R2 to Ex.R10 and has closed the evidence.
5. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
6. In the present case it is not disputed that as per personal accident insurance Ex.C8, Raj Kumar husband of the complainant was insured with the opposite party for a sum of Rs.500000/-. It is also not disputed that as per copy of FIR Ex.C5 the husband of the complainant was murdered on dated 20.10.2009 and his dead body was found in the well and FIR was lodged u/s 302, 201, 34 IPC by the police. As per copy of PMR Ex.C6 the information furnished by the police is “By drowning in the well”. Complainant has also placed on record copy of judgment Ex.C9 whereby the case was registered against the accused persons in FIR No.379 dated 31.10.2009. After the death of her husband, complainant filed the claim with the opposite parties but the opposite parties vide their letter Ex.R5 has repudiated the claim on the ground that: “The deceased Raj Kumar died due to the consumption of Alcohol as per the chemical analysis report issued by the Forensic Science Laboratory Karnal. Any death, injury or disablement under the influence of alcohol is not covered under the policy issued to you and is specifically excluded vide exception no.6(b) which clearly says that: “The company shall not be liable under this policy for payment of compensation in respect of death, injury or disablement of the insured person whilst under the influence of intoxicating liquor or drugs”.
7. After going through the file and hearing the parties it is observed that the claim of the complainant has been repudiated by the opposite party on the ground that the deceased Raj Kumar had died due to the consumption of Alcohol as mentioned in the FSL Report, which is not covered under the policy. In this regard we have observed the FSL report Ex.R6 whereby it is submitted that “Ethyl alcohol was detected in exhibits-ia,1b and 1c”. In this regard Hon’ble National Commission, New Delhi in 1(2015) CPJ676(NC) titled M.Raja Gangu, M.Sujatha Vs. Life Insurance Corporation of India has held that: “Doctor who performed post-mortem had not sent blood sample from dead body for analysis for blood alcohol concentration-Report from FSL not conclusive-Mere smell of alcohol or presence of ethyl alcohol in the tissue samples cannot lead to inference that person is incapable of taking care of himself”, as per IV(2014) CPJ 126(NC) titled as Matber Singh Vs. Oriental Insurance Co. Ltd. & Anr. Hon’ble National Commission, New Delhi has held that: “Death due to drowning-Personal accident-Claim repudiated-Deficiency in service-Drowning in the river was sole and direct cause of death-Death occurred when deceased accidentally fell into river-Death covered by policy under section ‘Personal Accident’-Insurance company was under contractual obligation to pay sum of $25000 to complainant, being the assignee under policy, without any deduction-Repudiation not justified” and Hon’ble National Commission in 2014(2)CPC 335 titled United India Insurance Co. Ltd. Vs. Sheela & Ors., has held that: “Mere taking of alcohol without proving limit of diet can be a proof of intoxication-No nexus between intoxication and cause of death proved in the present case even from post mortem report”. In the present case also as per the report of FSL only Ethyl alcohol was detected in exhibits-1a, 1b and 1c” and there is no report about the blood alcohol concentration in the body of the deceased. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case it is observed that mere presence of alcohol even above the usually prescribed limits is not a conclusive proof of intoxication. Moreover the death has caused due to drowning in the well and there is no nexus between intoxication and the cause of death. As such the repudiation of claim by the opposite parties is illegal and unjustified and the complainant is entitled for the claim amount as per policy.
8. In view of the facts and circumstances of the case, it is directed that the opposite parties shall pay the insured sum of Rs.500000/-(Rupees five lac only) along with interest @9% p.a. from the date of filing the present complaint i.e. 19.01.2011 till its actual realization and shall also pay a sum of Rs.2200/-(Rupees two thousand two hundred only) as litigation expenses to the complainant within one month from the date of decision failing which the opposite parties shall be liable to pay interest @ 12% p.a. on the awarded amount from the date of decision. Complaint is allowed accordingly.
9. Copy of this order be supplied to both the parties free of costs.
10. File be consigned to the record room after due compliance.
Announced in open court:
15.05.2015.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
