SMT. SYEDA SHAHNUR ALI, PRESIDENT-IN-CHARGE

The present case originates over repudiation of Complainant’s case by the OP No. 1.

Briefly narrated, case of the complainant, is that, her husband, Ranajit Samanta, during his lifetime, opted for United Suraksha Yojana (USY) being policy no. OG-14-2422-6401-00000745, launched by the OP No. 2 by paying requisite premium thereof.  The OP No. 2, in association with the OP No. 1, assured general public of making payment as enumerated under the afore mentioned scheme.  It is the case of the Complainant that her husband died of a road accident on 13-02-2014 and so, the Complainant, being the nominee, lodged insurance claim with the OPs.  However, the OP No. 1 repudiated her claim vide its letter dated 11-12-2015.  Hence, this case.

OP No. 1 contested the case by filing W.V. whereof it is stated that although Complainant’s husband died on 13-02-2014, it received written intimation in this regard on 07-07-2015.  Thereafter, it asked for some documents from the Complainant, but she failed to satisfy its need within time.  As such, it had no other alternative but to repudiate the claim.  It is further stated that insofar as the cause of death is concerned, different documents speaks in different voices.  According to one version, Complainant’s husband died of a motor cycle accident and going by the other version, he fell down on the road from a trolley van. It is also asserted that if Complainant’s husband indeed died of motor cycle accident, then the Complainant is entitled to get compensation from the United India Insurance Co. Ltd. under the Motor Vehicles Act.  In that case, the Complainant cannot claim double benefit over the death of her husband from both Insurers.  Further, it transpires from the In-patient record of Tamluk District Hospital that at the time of accident, he was in an inebriated state.  Therefore, in terms of Exclusion Clause 4.2 of the policy concerned, the OP Insurer is not liable to settle any claim. 

On the other hand, it is the case of the OP No. 2 that the Complainant submitted her claim to the OP No. 1, who rejected the claim on the ground that at the time of accident, the deceased person was under the influence of alcohol.  It is stated that insofar as the OP No. 1 repudiated the claim as per governing rules and regulations of the insurance policy concerned, the Complainant is not entitled to any benefit. 

We are to consider, whether the Complainant is entitled to any benefit, or not.

Decision with reasons

We have given our anxious thought to the arguments advanced by the Ld. Lawyers of concerned parties.  We have also carefully gone through the documents on record.

The relevant portion of the repudiation letter dated 11-12-2015, issued by the OP No. 1 is appended below for better illustration.

“Verification of the claim documents reveal that the aforesaid claimant succumbed to death due to head injury due to fall from trolley van.  The documents provided states that the claimant was under the influence of alcohol at the time of accident.  We regret to inform you that the claim stands repudiated as the policy does not extend coverage for expenses incurred on the treatment of any illness arising out of use of Alcohol.

The relevant clause of the policy is given below for your reference:

Exclusions 4.2

Hence, we regret to inform you that the claim is inadmissible and thus repudiated.”

A bare perusal of the repudiation letter goes to show that, according to the OP No. 1, the instant claim of the Complainant is inadmissible on account of accidental death of her husband in an inherited condition.  On a reading between the lines of Clause No. 4.2 we tend to infer that no indemnity is available for any such claim that is directly or indirectly caused/arises out of/attributable to the intoxicated state of the victim.  In other words, in case the inherited condition of the victim contributes in any manner whatsoever to the occurrence of peril, such claim is not admissible under the policy.  So, let us see, whether the Complainant’s husband was responsible in any manner for his accidental death.

On going through the FIR lodged by the Complainant on 29-03-2014 before the Officer-in-Charge, Nandakumer Police Station, we find that the victim sustained grave injury when a motor cycle bearing registration no. WB-30N-5650 hit him from the back side on 07-02-2014 and ultimately he succumbed to such injury on 13-02-2014. 

From the copy of Charge Sheet dated 05-06-2014 filed before the Ld. CJM, Purba Medinipur u/s 279/304(A), IPC, it transpires that one Yamaha motor cycle bearing registration no. WB-30N/5650 was seized by the Police together with R/C book, driving license, life time tax token, I/C of concerned vehicle and one Subhash Chandra Maiti S/o Sri Kanta Maiti was charge sheeted in connection with the accident.  It also appears that the police examined nine persons in connection with the said accident and recorded their statements u/s 161 CrPC.  It is further stated in the charge sheet that the police found prima facie evidence against the accused, Subhash Chandra Maiti.  There is no mention of any such fact in the charge sheet that the victim was in an inebriated condition at the time of accident and most importantly, that the victim had a fall from the trolley or that he was in any manner responsible for the accident.      

Curiously, photocopy of one I.P.C. of N.R.S. Medical College Hospital dated 08-02-2014 bearing Sl. No. 637 has been filed from the side of the OP No. 1 to show that the victim had a fall from the trolley van.  On careful scrutiny of the same, it is found that the same relates to one Raghunath Samanta S/o Narayan Samanta, whereas the name of the Complainant’s husband is Rnajit Samanta.  We find another piece of document being placed on record from the side of the OP No. 1, i.e., a letter from the ASI, Nandakumar P.S. to the Officer-in-Charge of Entally P.S. where also the cause of injury has been attributed to the fall from the trolley van.  However, there is a mismatch with regard to the timing of accident as reported in these documents.  As per the ASI letter, the accident occurred at 14-00 hrs. on 07-02-2014, whereas, as per the NRS Hospital report, the accident took place at 7 p.m. on 07-02-2014. 

Significantly, there is complete unanimity in between the version of FIR and charge sheet pertaining to the accident.  It is also important to keep in mind that police have charge-sheeted a person in the said case and also seized the offending motor cycle.  Most importantly, a competent Court of Law has taken due cognizance of the Charge Sheet which has been filed after recording the statements of nine witnesses u/s 161 CrPC.  On the other hand, besides the afore mentioned discrepancy in the documents relied upon by the OP No. 1, we cannot lose sight of the fact that the OP No. 1 has not filed any affidavit either from the ASI of Nandakumar P.S., Sri Subrata Das Gupta or the concerned doctor of NRS Hospital, Kolkata. No doubt, from the perspective of evidential value of both sets of documents filed by the respective parties in support of their claims, the documents filed from the side of the Complainant would certainly prevail over the documents filed by the OP No. 1.

In either case scenario – be it a fall from the trolley or injury sustained over hitting by the motor cycle, we have to keep in mind that it was purely an accidental death and as such, the OP No. 1 cannot abdicate its liability to indemnify the Complainant. 

Drawing our attention to a noting in the P.M. report that runs as under: “Wt. 110 gm. contain yellow fluid 100 gm. Mm congested”, it is contended by the Ld. Lawyer for the OP No. 1 that at the time of accident, the deceased was in an inebriated condition. However, he stopped short of clarifying the relationship between yellow fluid and alcohol.    

As we know, the legal limit of blood alcohol content (BAC) or blood alcohol concentration in India is 0.03% or 30 mg. per 100 ml. of blood.  If a person driving a car has a BAC level higher than that, he or she can be booked u/c 185 of the Motor Vehicles Act. 

However, it is important to keep in mind that for the overwhelming majority of individuals, alcohol is metabolized at relatively predictable rate.  Most people can expect BAC to drop at a rate of .015 per hour.  This means that following one’s last alcoholic drink, the alcohol in one’s body is being metabolized and eliminated at a rate of .015.  If one manages to get one’s BAC to 0.10, it would take just 7 hours for the alcohol to get eliminated from one’s system.  In the present case, the accident took place on 07-02-2014, whereas, P.M. done on 14-02-2014.  It is unbelievable that even after 7 days, the doctor, who conducted the P.M., found traces of such abnormally high level of alcohol in the body system of the victim.  Moreover, as per convention, BAC level is mentioned in mg.  We find no reason as to why the concerned doctor would deviate from normal practice and measure it in g.  Also, we find no relationship between a yellow fluid and alcohol.  Taking all such improbabilities into account, we find no rationale in the contention made by the OP No. 1.

Now coming to the issue of acquiring double benefit out of a single incident, as articulated from the side of the OP No. 1, it bears mentioning that there is nothing to show that the Complainant staked any claim before the United India Insurance Co. Ltd. or there is any such clause in the policy concerned that absolves the OP No. 1 of all financial liabilities in case the peril is indemnifiable by another Insurer. The objection of the OP No. 1 on this score has got no leg to stand upon in the eye of the law.

In the light of our foregoing discussion, we find, the claim of the Complainant has been unjustifiably repudiated by the OP No. 1.  Hence, we hold them liable to pay Rs. 1,00,000/- being the insured sum together with compensation and litigation cost.

Accordingly, this case is decided in favour of the Complainant.

Hence,

O R D E R E D

that C.C. no. 30/2016 be and the same is allowed on contest against the OPs.  OP No. 1 is directed to pay Rs. 1,00,000/- to the Complainant, within 40 days hence, being the insurance benefit along with a litigation cost of Rs. 5,000/-.  Besides, it is also directed to pay interest @ 10% p.a. over Rs. 1,00,000/- from this date till the order is complied with in toto.  In default, Complainant would be at liberty to execute this order in accordance with law.