BEFORE THE A.P.STATE CONSUMER DIPSUTES REDRESSAL COMMISSION :HYDERABAD
F.A.No.968/2007 against C.C.No.621/2005, Dist. Forum-1, Visakhapatnam.
Between:
The New India Assurance Co.Ltd.,
Rep. by its Divisional Officer –II, 2nd Floor,
Pavan Paradise, D.No.47-10-12, Near Diamond
Park, Dwarakanagar, Visakhapatnam. … Appellant/
Opp.party
And
Smt.Ankireddi Krishna Veni
W/o.late Surya Prakasa Rao, Hindu,
R/o.D.No.MIG 11-118, Rajeev Nagar,
Gajuwaka ,
Visakhapatnam. … Respondent/
Complainant
Counsel for the Appellant : Sri Kota Subba Rao
Counsel for the Respondent : Sri V.Gowrisankar Rao
CORAM:SMT. M.SHREESHA, HON’BLE MEMBER
AND
SRI K.SATYANAND, HON’BLE MEMBER
THURSDAY, THE TWENTIETH DAY OF AUGUST,
TWO THOUSAND NINE.
Oral Order (Per Smt M.Shreesha, Hon’ble Member)
***
Aggrieved by the order in C.D.No.621/2005 on the file of District Forum, Visakhapatnam , opposite party preferred this appeal
The brief facts as set out in the complaint are that the complainant’s husband late Anki Reddy Surya Prakash Rao who was working as Senior Foreman in the Naval Dockyard, Visakhapatanm had a Group Janata Personal Accident Policy for a sum of Rs.1 lakh which was valid from 28.3.2003 to 27.3.2004 and other policy under Group Personal Accident Insurance for a sum of Rs.2 lakh was also taken by the complainant’s husband which was in force for the same period. On 1.12.2003 the life assured died in a road accident and the same was intimated to the opposite party but the opposite party repudiated the claim and the complainant also got issued a legal notice and inspite of repeated requests the opposite party did not settle the claim. Hence the complaint seeking direction to the opposite party to pay a sum of Rs.2 lakhs towards Group Personal Accident Insurance Policy, Rs.1 lakh towards Group Janata Personal Accident Policy, to pay interest at 12% p.a. from 3.12.2003 and to pay Rs.25,000/- towards compensation for causing mental agony.
The opposite party filed counter admitting the issuance of both policies but submits that the postmortem report showed that the abdomen of the deceased contained 100 grams of partly digested food material mixed with 150 ml. of brown coloured fluid with a smell of alcohol and that the deceased was under the influence of alcohol at the time of alleged accident. They contend that this exclusion is under clause no.5 of exceptions under the policy wherein the insurance company is not liable to pay compensation if the deceased is under the influence of alcohol or drugs. Hence there is no deficiency in service on their behalf and seeks dismissal of the complaint with costs.
The District Forum based n evidence adduced i.e. Exs.A1 to A9 and Exs.B1 to B3 allowed the complaint directing the opposite party to pay Rs.3 lakhs towards Group Personal Accident Policy, to pay Rs.15,000/- towards compensation and Rs.1500/- towards costs and to pay interest @ 9% p.a on Rs.3 lakhs on failure to comply within two moths.
Aggrieved by the said order opposite party preferred this appeal.
The learned counsel for the appellant/opposite party filed his written arguments.
The facts not in dispute are that the insurance company has issued Janata Personal Accident Policy for a sum of Rs.1 lakh valid from 28.3.2003 to 27.3.2004 and it is also not in dispute that the complainant’s husband obtained another policy for a sum of Rs.2 lakhs which is also valid for the same period. The death of the insured on 1.12.2003 is also not in dispute. The case of the complainant is that inspite of repeated requests and issuance of legal notice opposite party failed to settle the claim. It is the case of the opposite party that the insured was driving the vehicle under the influence of the alcohol which is in violation of clauses 4 and 5 under Janata Personal Accident Policy and the post mortem certificate also clearly indicates that the deceased was under the influence of alcohol.
We have perused Ex.A8/B3 which is the post mortem report on which the opposite parties have relied upon. Ex.B3 states as follows: “about 100 gms of partly digested food material mixed with 150 ml. of Brown coloured fluid with a smell of alcohol” and the cause of death is given as ‘multiple injuries’. Ex.A9 which the FIR states that the insured was driving on scooter around 6 p.m. and a van came from the opposite party direction in rash and reckless manner hit the scooter on account of which the insured suffered severe injuries and loss of blood and he was immediately shifted to the hospital. Neither the postmortem report nor any other documentary evidence filed show that the insured was under the influence of alcohol which resulted in the accident. Mere mention of presence of 150 ml. of brown coloured liquid with the smell of alcohol cannot conclusively establish that the insured was drunk or that the driver of the vehicle was under the influence of alcohol which led to the accident. The post mortem report also does not conclusively state that the insured was under the influence of intoxicating liquor. Therefore we are of the opinion that the repudiation of the insurance policy on that ground alone is unjustified and we see no reason to interfere with the well considered order of the District Forum with respect of deficiency in service. We set aside the default clause of payment of interest at 9% since compensation by way of Rs.15,000/- has already been awarded.
In the result this appeal is allowed in part modifying the order of the District Forum only with respect to default clause of interest at 9% p.a. We confirm the rest of the order of the District Forum . Time for compliance four weeks. .
MEMBER
MEMBER
20.8.2009
