RESERVED

State Consumer Disputes Redressal Commission

U.P., Lucknow.

Complaint No.302 of 2018

Urmila Devi w/o Late Sanjay Yadav,

Village, Rampur Udaybhan,  District, Ballia. ...Complainant. 

Versus

1- SBI General Insurance Company Ltd.

     through Office Incharge, Unit nos.414/414A

     and 413, 2^nd Floor, K’s Trident, 2^nd Floor,

     10, Rana Pratap Marg, Hazratganj,

     Lucknow-226001.

2- SBI General Insurance Company Ltd.

     through Branch Manager, Branch Office,

     at :- S-2/638 A, 4^th Floor, Chandra Chambers,

     Raj Krishna Chandra Nagar, Varanasi-221002

 3- SBI General Insurance Company Ltd.

     through Office Incharge, Corporate Office at:

     Natraj, 101, 201 & 301, Junction of Western

     Express Highway & Andheri Kurla- Road,

     Andheri(East) Mumbai-400069

4- State Bank of India through its Branch Manager,

     Branch Located at M.M.T.D. Collage,

     Ballia, U.P. Pin Code-277001             …Opposite Parties.

Present:-

Hon’ble Mr. Sushil Kumar, Presiding Member.

Hon’ble Mr. Vikas Saxena, Member. 

Sri Dhruv Kumar, Advocate for complainant.

Sri Mahendra Kumar Mishra, Advocate for OPs no.1 to 3.

Sri Saket Srivastava, Advocate for OP no.4.

Date   13.10.2022

JUDGMENT

Per Mr. Sushil Kumar, Member:          This complaint has been filed under Section 17 of the Consumer Protection Act, 1986 for the following reliefs.

1. Hold and declare the opposite parties to be guilty of deficiency in service and unfair trade practice as per provisions of the Consumer Protection Act, 1986.
2. Allow this complaint and direct the insurance company, i.e. opposite parties no.1 to 3 to pay a sum

of Rs.20,00,000.00 towards insurance claim amount with interest @ 14% p.a. form 20.6.2018 i.e. date of rejection of claim till the date of actual payment.

3. Award a sum of Rs.1,00,000.00 towards compensation for physical and mental harassment suffered by the complainant, due to arbitrary and wrong rejection of claim.
4. Award a sum of Rs.30,000.00 towards the cost of this complaint.
5. Award such other relief or reliefs which the Hon’ble Commission may deem fit and proper in the interest of justice.

The brief facts of the complaint are that the husband of the complainant, Late Sanjay Kumar Yadav had a saving bank account no.36547482112 with the opposite party no.4 Bank who offered an accidental insurance cover of Rs.20,00,000.00 for premium of Rs.1,000.00. The husband of the complainant had paid Rs.1,000.00 as premium for the said accidental insurance policy. Later on the deceased husband of the complainant demanded the policy form the opposite party no.4, the opposite party no.4 informed that the insurance policy is a  group insurance policy which is valid from 18.2.2017 to 17.2.02018 and the deceased is insured as group member.

On 1.5.2017, Late Sanjay Kumar Yadav was sitting in a case (TATA Safari Reg. no.UP 60, AD 9191) of his friend. The vehicle was being driven by Mr. Atul Pratap. The said vehicle met with an accident and the husband of the complainant Late Sanjay Kumar Yadav died on the spot while two other persons died in the hospital. The said vehicle belongs to Mr. Rana Pratap, the father of the Atup Pratap who was also injured in the accident. The FIR was lodged, panchnama was conducted and the postmortem was done.

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The complainant has given the information of death to the bank/op no.4, bank provided claim form to the complainant. After filling up the claim form the complainant submitted the claim form to the bank with all necessary documents. The complainant approached several times to the bank for settlement of her claim but every time it was assured that claim shall be paid very shortly. The complainant being poor housewife with responsibility of small children was forced to run from pillar to post, but to no avail.

The opposite party no.4 vide letter dated 2.7.2018 in reply to RTI application of the complainant dated 7.6.2018, informed the complainant that the claim has been repudiated on 20.6.2018 by the insurance company opposite party no.2. The opposite parties were under legal obligation to settle the claim at the earliest but the opposite party no.2 has wrongly and arbitrarily rejected the claim of the complainant. The opposite party no.4, Bank who is the IRDA licenced agent of the insurance company failed to discharge its duties in assisting the complainant for early settlement of the claim. Therefore, there is deficiency in services on the part of the bank, opposite party no.4.

The deceased husband of the complainant was not under the influence of Alcohol, as wrongly claimed by the insurance company. The opposite parties no.1 to 3 has arbitrary and wrongly rejected the claim of the complainant on the basis of false and twisted facts and willful misinterpretation of benefits under the policy. The opposite parties has rejected the claim of the complainant in a routine and mechanical manner. Hence, there is not only grave deficiency in the services on the part of the insurance company but also unfair

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trade practice by the opposite parties.  Therefore the complainant filed this complaint for the above reliefs.  

          The opposite parties no.1 to 3 has filed their written statement wherein it is submitted that on intimation of the death of the insured the answering respondent, promptly, acted for processing the claim. On careful perusal of the claim documents, it has been noted that the insured died due to complications of the accidental injuries. However, the post mortem report  clearly establishes that the insured was under influence of alcohol at the time to accident. Since any claim or claims under the policy in question arising from being under the influence or use/abuse of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a physician and taken as prescribed is not covered under the policy therefore, under the terms and conditions of the policy the claim was repudiated. It is also submitted that the answering respondent have acted strictly in accordance with the terms and conditions of the insurance policy issued in favour of the complainant and further in accordance with settled legal position. It is abundantly clear that there is neither deficiency in service on the part of the answering respondents nor the answering respondents are involved in any unfair trade practices and the present complaint is totally misconceived, frivolous and vexatious and is liable to be dismissed.    

          We have heard ld. Counsel for the complainant Sri Dhruv Kumar and ld. Counsel for the opposite parties no.1 to 3 Sri Mahnedra Kumar Mishra and opposite party no.4 Sri Saket Srivastava and perused the documents and evidence available on record.

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          Ld. Counsel for the opposite parties no.1 to 3 argued that at the time of accident deceased was under the influence of alcohol and as per the terms of the policy, if the insured person consumes the alcohol or any other intoxication unless prescribed by the physician then such insured is not covered under the policy. He further argued that as per the post-mortem, the deceased person consumed the alcohol before the death and the claimant not denying this fact but justifying her claim on the ground that at the time of accident the insured was occupant of the vehicle and not driving the vehicle. Although unable to establish that the vehicle was not being driven by the deceased/insured person. Therefore, repudiation is valid on the basis of sufficient grounds.

          Ld. Counsel for the complainant argued that at the time of accident dated 1.5.2017 Mr. Atul Pratap son of Sri Rana Pratap Singh, owner of the vehicle was driving he vehicle. Mr. Rana Pratap Singh himself informed the police authorities. Annexure E-1 endorsed this fact that the police report lodged by the owner of the vehicle Mr. Rana Pratap and he stated that his son Atul Pratap Singh was going to Faridpur while the accident occurred. Hence, this fact is established that the deceased person was not driving the vehicle at the time of accident.

          In the case of M. Sujatha vs. Bajaj Allianz General Insurance Company Limited, III(2015) CPJ 104 (NC), the Hon’ble National Commission has observed as under:-

          “Intoxication is perceived as a state of mind in which a person loses self-control and his ability to judge. As per sections 185 and 202, of the Motor Vehicle Act, it would be considered intoxicated only if the person is tested and found

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to have more than 30 mg. of alcohol in his blood, per 100 ml. In the present case, except for a mere nothing in the Final opinion Report and the FSL report, no test had been done to ascertain whether Blood Alcohol Concentration (BAC) had exceeded the legality stipulated limit. The mere smell of alcohol or presence of ethyl alcohol in the tissue samples cannot lead to an inference that person is incapable of taking care of himself.”

          Therefore, as per the above mentioned judgment, a person cannot be said to be intoxicated unless alcohol level exceeds the prescribed limits which can be confirmed through Blood Alcohol Concentration. Otherwise also this condition pertains with regard to driver only not to the passengers. Since the passengers do not drive the vehicle. Therefore, there is no effect of there being intoxicated or not. Thus, the contention of the opposite parties no.1 to 3 not to be considered right for rejection of the insurance claim.

          The complainant seeks Rs.1 lakh towards compensation for physical and mental harassment but since there was a doubt in the mind of the insurance company regarding the consumption of alcohol by the deceased person at the time of accident although this doubt was not proved valid. While considering the evidence produced by the parties before this Commission but the insurance company cannot be held liable to pay compensation for physical and mental harassment.   

          In view of the discussions made above the complaint deserves to be allowed.    

ORDER

The complaint is allowed. The opposite parties no.1 to 3 are directed to pay Rs.20,00,000.00 as insured amount

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alongwith interest @ 6% p.a. from the date of filing the complaint till the date of payment, to the complainant within three months from the date of order.

The opposite parties no.1 to 3 are also directed to pay Rs.20,000.00 as cost of complaint, to the complainant within three months from the date of order.

The stenographer is requested to upload this order on the Website of this Commission today itself.

Certified copy of this judgment be provided to the parties as per rules.

      (Vikas Saxena)                            (Sushil Kumar)

             Member                             Presiding Member   

Jafri PA II

Court No.2