Haryana

StateCommission

A/686/2015

RELIANCE GEN.INSURANCE CO. - Complainant(s)

Versus

SATYAWANTI - Opp.Party(s)

P.M.GOYAL

18 Jul 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      686 of 2015

Date of Institution:      20.08.2015

Date of Decision :      18.07.2016

 

M/s Reliance General Insurance Company Limited, SCO 400-402, HDFC Bank Building, 2^nd Floor, Model Town, Delhi Road, Rohtak, through Shri Amit Chawla, Deputy Manager (Legal) Reliance General Insurance Company, SCO 145-146, Sector 9-C, Madhya Marg, Chandigarh.

                                      Appellant/Opposite Party

Versus

 

Smt. Satyawanti wife of Shri Raj Kumar, Resident of Village Majri, P.O. Gubana, Tehsil Bahadurgarh, District Rohtak.

                                      Respondent/Complainant

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member                                                                                                                                         

Present:               Shri Gaurav Sharma, Advocate for appellant.

                             Shri Amardeep Hooda, Advocate for respondent.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

Reliance General Insurance Company Limited (for short ‘the Insurance Company’)-Opposite Party, is in appeal against the order dated May 15^th, 2015 passed by District Consumer Disputes Redressal Forum, Rohtak (for short ‘the District Forum’) in Complaint No.50 of 2011.

2.      Raj Kumar (since deceased)-husband of Satyawanti-complainant/respondent, obtained Peronal Accident Insurance Policy (Exhibit C-8) from the Insurance company, for the period January 15^th, 2009 to January, 14^th, 2010 for Rs.5.00 lacs.

3.      On October 20^th, 2009 at about 4.00 P.M., the insured had gone for routine walk but did not return. On October 25^th, 2009, the dead body of the deceased was recovered from a Well. First Information Report No.379 dated 31.10.2009, under Section 302/201 of the Indian Penal Code, (Exhibit C-5) was lodged in Police Station Sadar Bahadurgarh. Postmortem examination of the dead body of deceased was conducted in Post Graduate Institute of Medical Sciences (PGIMS), Rohtak vide report Exhibit C-6.  Viscera of the deceased was sent to Forensic Science Laboratory, Haryana, Madhuban (FSL), Karnal and the reports of FSL are Exhibits R-6 and R-7. Claim being filed, the Insurance Company did not pay the insured amount to the complainant on the ground that the insured died due to the consumption of alcohol and therefore the Insurance Company was not liable to pay the insured amount  as per Exclusion Clause  6(b) of the Insurance Policy. Aggrieved, complainant filed complaint under Section 12 of the Consumer Protection Act, 1986.

4.        The Insurance Company in its reply pleaded that as per the report of FSL and investigation report of Royal Associates, the insured/deceased died due to the consumption of alcohol and therefore as per exclusion clause 6(b), the Insurance Company was not liable to pay the insured amount.

5.      After evaluating the pleadings and evidence of the parties, the District Forum vide impugned order allowed complaint and directed the Insurance Company as under:-

“ ……….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.”

6.      It is not disputed that the insured/deceased was insured with the Insurance Company for Rs.5.00. It is also not in dispute that the insured died during the subsistence of the policy.

7.      The solitary contention raised by the learned counsel for the appellants/Insurance Company is that the insured was under the influence of liquor at the time of his death and for that reason the Insurance Company was not liable to indemnify the complainant. 

8.      The contention raised is not tenable in view of clause 6 (b) of the terms and conditions (Exhibit R-11) of the Insurance Policy and the evidence produced by the parties.

9.      For ready reference Clause 6(b) of the policy is reproduced as under:-

“Provided always that the Company shall not be liable under this policy for-

xxx

6.      Payment of compensation in respect of death, injury or disablement of the insured Person

(a)     xxx

(b)     whilst under the influence of intoxicating liquor or drugs”

10.    There is nothing on the record to show that the insured/deceased was under the influence of liquor at the time of his death.  In the Post Mortem Report (Exhibit C-6), in the column ‘Information furnished by Police’, it has been clearly mentioned that the death occurred due to drowning in Well. The FSL report (Exhibit R-6) also does not speak that the deceased was under the influence of liquor. A relevant extract of FSL report is as under:-

                   “Results of examination.

                   1.      Ethyl alcohol was detected in exhibits-la, 1b and 1c.

                   2.      No common poison could be detected in exhibit-1d.”

11.    Onus was upon the Insurance Company to prove that the insured was under the influence of alcohol at the time of his death. Mere presence of alcohol in the stomach cannot be authenticated evidence that the deceased had consumed alcohol beyond the permissible limits. Both the PMR and FSL reports are silent about the quantity of alcohol consumed by the deceased. So, the case of the complainant does not fall under clause 6(b) of the policy.

12.    In Life Insurance Corporation of India & another vs. Ranjit Kaur, III(2011) CPJ 232 (NC), Hon’ble National Commission held as under:-

10. The fact that death of the insuree was caused because of the electrocution during the subsistence of the insurance policy is not in dispute. The only issue under dispute is whether the insuree was intoxicated at the time of his death which as per the exclusion clause in the Insurance Policy would justify repudiation of the double accident benefit insurance claim. While it is a fact that the Chemical Examiner in his report had stated that the blood alcohol concentration in the body of the deceased was 86.25 mg per 100 ml. of blood which as per the American Medical Examinations definitions is higher than the alcohol concentration level of impairment, it has also come in evidence that this by itself is not adequate proof that the deceased was intoxicated at the time of his death. As rightly observed by the learned Fora below, the specific clinical picture of alcohol intoxication also depends on the quantity and frequency of consumption and duration of drinking at that level and, therefore, mere presence of alcohol even above the usually prescribed limits is not a conclusive proof of intoxication….”.

13.    Thus, mere presence of alcohol in the stomach, parts of liver, spleen and large intestine, cannot be termed that the deceased/insured was under the influence of alcohol. No evidence has been produced by the Insurance Company to show that the deceased was under the influence of liquor. So, the Insurance Company was not justified to pay the claim of the complainant.

14.    In view of the above, the appeal fails. It is dismissed.  

15.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced 18.07.2016

Diwan Singh Chauhan Member

B.M. Bedi Judicial Member

Nawab Singh President

CL