(Delivered on 24/11/2017)

Per Mr. S.B. Sawarkar, Hon’ble Member

1.      The instant appeal is filed against the order of the District Forum, Wardha passed in complaint  No. 81/2010 dated 29/12/2010  partly granting  the complaint  and directing as under,

a.      The  O.P. committed deficiency  in service by  repudiating the insurance  claim of Kishor  Raut.

b.      The O.P. to provide the insurance claim of Rs.1,00,000/- and to provide  an interest at the  rate of 9% p.a. from the  date of  repudiation  till final payment.

c.       The O.P. to provide  Rs.2,000/- for physical and mental harassment and cost of Rs. 1,000/- to the complainant in the span of 30 days  from the date of  receipt of the order. If not paid  the  directed  amount  would carry  an interest  at  the rate of  12% from the date of the order.

d.      After  the submission of amount by the  O.P. in the Forum the Registrar to divide the  amount in three portions  out of which  portion one be given to the complainant No. 1 and remaining  two portions  be kept  in  the  fixed deposit of  a National Bank as  selected by  complainant  No.1 in the name of  complainant Nos.2&3 till  they become  major. Till this time  the amount  would not be  withdrawn  without  the  order of the Forum or  no loan  would be drawn upon it. However,  the interest  accrued  upon it  would  be drawn by the  complainant which  be informed  to the  concerned Bank.

2.      The complainant  Nos. 1,2&3 filed a complaint  to   claim the  insurance  claim of  the husband  deceased  life assured  (DLA) for the policy  taken from O.P. after accidental death of DLA on 08/09/2005. The O.P. repudiated  the claim  on 30/06/2009 upon which  the complainants gave notice. After  not  getting  reply filed  complaint  with a prayer  to declare  the O.P.  to have committed  deficiency in  service in repudiation  and  to provide her the policy  claim with all benefits and  Rs. 50,000/- for  physical and mental harassment  and a cost of Rs.10,000/- .

3.      On notice the opposite party (in short O.P.) Nos. 1&2 appeared and countered the complaint that the DLA had taken a policy of Rs. 1,00,000/- He died in the accident. However, at that time he was under influence of alcohol which was found in the Chemical Analysis. Also the nomination in the policy  is of different  person  than the  complainants. Hence,  the repudiation   does not involve  deficiency in service.

4.      The complainant  submitted that  the nominated person  of  the policy  was  father of the  DLA who had died. Hence,  the complainants are  the legal heirs of the  DLA  and the  postmortum report  says that  the DLA  had died  because of accident.

5.      The O.P. claimed that  the chemical analysis   has shown that  the viscera  of  the DLA contained  140 mg.  of  alcohol for  100 ml. of  blood and  blood contain  131 mg. of  alcohol for 100 ml.  Hence,  he was  under influenced  and  therefore cannot be paid  with  the claim.

6.      The learned Forum held that  though  liquor  type of  substance is found in the blood of the DLA still the death  is  in the  accident and  an offence is registered  against  the   another  driver. The O.P.  did not prove that the accident was  caused by  the DLA and  the nexus between the alcohol and  the death.  Hence,  the  DLA has not   violated  the conditions of the policy. Therefore, denial of the claim  is a deficiency in service. Also  the National Commission has held that the policy  claim can be paid  to the legal heirs of the DLA  and  it is not binding  to pay it  to the  nominated  person who has died. Hence,  passed the  order supra.

7.      Aggrieved against  the order, the O.P. filed an appeal  hence, is  referred as appellant.  Advocate  Shri. Rahate and Advocate Shri Quazi appeared for the appellant.  The original  Complainant  were referred as respondent  Nos. 1,2&3  who already filed written  notes of argument.

8.      The advocate for the appellant submitted that the learned Forum overlooked the fact that the DLA was driving the vehicle under the influence of alcohol when he met with an accident. Which  can be seen from the heavy amount  of  alcohol  found  in the  viscera  of  DLA  which  is much above   liquor influence  requirement  of  30 mg.  /100 mg. of blood.  The learned Forum held   no nexus between alcohol and death when the DLA had died in the vehicle  accident. When the  DLA was under influence of liquor  it clearly results  in the breach of conditions  of the policy. The influence  condition  itself proves  the breach. Also  the learned Forum  has went to  levying  penal  interest  which  cannot sustain  under the decision of the  Supreme Court. He relied on the following judgments.

          National Commission  Judgment passed in Dharmpal Vs. United  Insurance Co. published at  I (2013) CPJ 150 (NC). Wherein  it is held that  if the policy  puts the restriction that  driver  at the time  of driving  the  vehicle  should not be under intoxication  and when  the  driver  was under  influence of liquor this is  violation of terms and conditions  of the  policy which has to be construed  strictly. Hence,  repudiation  is justified.

10.    He also filed  the page 714 of  the book “Estimation of alcohol” which  showed sobriety  with  relation  to  presence of alcohol  present in  blood.  It shows that up to 60 mg.  the person  is  sober. Between  120to180 mgs  only 50% persons  remains sober. Above 180mgs intoxication takes place. The normal tolerable limit of alcohol is 20mg. per 100 cc.

11.    The advocate for the a appellant submitted that  the learned Forum  passed  an  unreasoned  order which  deserves  dismissal.

12.    Advocate Shri Tigase had appeared for the respondent  at the time of admission and had  filed written notes of argument but remained absent.

13.    The advocate for the respondent  in his written notes of arguments submitted that  the repudiation  ground  given by the  appellant  was absolutely false as the  deceased was  never drinking  the alcohol and accident took place because  of dash to his vehicle by the another  vehicle. Hence,  the  DLI  was  not responsible for  the  accident. Also  the appellant  submitted that  the policy was  nominated  in the name of  the husband and  sister of the DLI. However,  it is the  legal heirs  of the deceased  who are  liable to get  the benefit of the policy and not the nominee who might be  equal  share holders of the money.  Therefore,  the  submissions of the appellant  are not  applicable  in the present  case and the repudiation  is the glaring  case of  deficiency in service. Hence,  the  order of the learned Forum be maintained and appeal be dismissed with a cost of Rs. 2000/- upon the  appellant.

14.    We considered the contentions of both the  parties.  We do find that  there is report of Chemical Analyser on record  showing  alcohol  in  the viscera  of the deceased life assured which is almost to the extent of  140 milligrams  per 100 gms in  the various  parts included in the viscera. It shows that  it is beyond that  level of sobriety as is submitted by the appellant  by  submitting the  extract from the book which is  60 mgs. per 100 gms.  It  shows that  with the increase in the percentage of the alcohol the  intoxication rises.  This itself is positively  a breach  in the  conditions of the policy.  We also  find  the learned Forum wrongly came  to the  conclusion that  the  alcohol percentage  has no connection  with the death  of the  DLI  even when   there was alcohol in his blood  at the time of accident.

15.    We further find that  when a policy  is properly provided with a nomination, the  amount of the policy  becomes payable to the nominee.  The  respondent  can certainly file a Civil Suit  in Civil Court for  getting appropriate order and  can thus  claim  the amount which  legally belongs to  the nominee.  It is not for the appellant and also  in the powers of  learned  Forum  to decide the  legal heirs of the  DLA and provide the  benefits  of nominee to them.

16.    These grounds clearly show that  the learned Forum has  stepped  beyond the reasons  to hold that there was no breach of the policy condition and  allowed the complaint.  Therefore, the order of the learned Forum  deserves  to set aside in the light of the  case law submitted by the  learned advocate  of the  appellant.  The appeal therefore  deserves to be allowed.  Hence, the order below.

ORDER

i.        The appeal is allowed.

ii.       The order of the learned Forum is set aside. In the event the complaint  stands dismissed.

iii.      Parties to bear their own cost.

iv.      Stay if any  stands vacated.

v.       Copy of  the order be provided to both the parties, free of cost.