By: Smt. Syeda Shahnur Ali, Member(L)
Corrected by Sri Kamal De, President
The case of the Complainant, in short is that the husband of the complainant was a policy holder of LICI and the complainant was/is the nominee of the policy, which was issued by the op no1. The op no. 2, being the Divisional Office certified the same being Policy number 499201790. The deceased Sekh Karim Ali s/o Sekh Rahaman Ali was the insured and the husband of the claimant. He took LIC’s Jeevan Saral Policy which commenced from 28/12/2010 and paid half yearly Installment premium of RS 3032/- The certificate of policy shows that the Death Benefit sum assured under main plan is RS 1, 25,000/-and Accident Benefit sum Assured is RS 1, 25,000/-.The insured paid premium for both plans i.e for Main plan as well as for Accident benefit for a total sum of Rs 3032/-. The nominee received a sum of Rs 1, 25,000/.-as Death benefit paid by the op no 1, but the ops did not pay the Accidental benefits to the nominee of the deceased. Hence, the case.
The OPs entered appearance and contested the case by filing WV wherein it is stated that the LICI has paid Rs. 1,25,000/- as death benefit to the Complainant, being the nominee of the policyholder. The claimant, however, has also claimed for accidental benefit. It is alleged that the insured, i.e., the Husband of the Complainant died under the influence of intoxicating liquor. PM report reflects presence of alcohol in the stomach of the deceased life insured. It is the case of the OPs that the LICI is not responsible to pay accidental death benefit under the policy as it is clearly stated in the policy condition that the LICI shall not be liable to pay any additional sum as accidental benefit if the death of the life assured is caused under the influence of intoxicating liquor. Since the documents on record sufficiently prove that at the time of death the victim was under the influence of alcohol, the claimant is not entitled to accident benefit under the policy. The OPs have prayed for dismissal of the case.
Points for consideration
- Whether the deceased insured died due to or under the influence of intoxicated liquor?
- Whether the Complainant is entitled to get accidental death benefit of Rs. 125000/-?
Decision with reasons
Point Nos. 1 & 2:
Both these points are taken up together for the sake of brevity of discussion.
We have perused the documents filed from the end of both the parties. The bone of contention in between the parties is whether the death of deceased insured took place under the influence of intoxicating liquor, or self-injury, or attempted suicide, or insanity, or immorality, etc., etc.
It appears from materials on record that the Complainant has filed a copy of complaint lodged before the Medical Officer, Haldia SD Hospital through the OC, Bhabanipur P.S. stating that the deceased on 15-11-2013 at about 7.30 a.m. boarded a tracker bearing no. WB-30A/2697. Another trailer bearing no. NL-02K/5087 which was coming from the opposite direction, dashed the tracker on which the deceased life assured boarded and as a result, the victim died. We also find that UD Case No. 34/13 dated 15-11-2013 was registered on such complaint.
Such fact has not been challenged from the side of the OPs. From the PM Report it appears that the death was caused due to head injury, rapture etc. However, PM report shows smell of alcohol in the stomach of the life assured. At the same time, it is also a fact that no chemical report or viscera report is forthcoming before the Forum to hold conclusively that the insured died solely due to or under the influence of intoxicating liquor or such consumption of liquor was beyond the permissible limit. There is nothing on record to show that the deceased life assured was in anyway responsible for the said accident or he was driving the ill-fated tracker. The cause of death due to influence of liquor is, thus, not established beyond all reasonable doubt. PM report also reflects multiple injuries like head injuries, rapture all over the body of the deceased life assured. So, it cannot reasonably be inferred that the presence of liquor in the stomach of the deceased life assured was the cause of his death. We cannot hold that the cause of death of the insured was liquor consumption. There is no such finding or observation in the PM Report also. In such circumstances, the stubborn refusal of the OPs to extend accidental insured benefit to the Complainant is not comprehensible and acceptable to us.
There is no denying the fact that the OPs received premium from the deceased life insured in respect of both death benefit and accident benefit. So, the Complainant is entitled to accidental benefit under the policy.
On all such scores and counts, we find merit in the petition of complaint. OPs cannot avoid extending due privileges of accident benefit under the policy to the Complainant.
Both these points, thus, answered in favour of the Complainant.
In the result, the case succeeds.
Hence,
ORDERED
that the C.C. No. 39/2015 be and the same is allowed on contest against the OPs. The OPs shall pay Rs. 1,25,000/- to the Complainant as accidental death benefit together with compensation for a sum of Rs. 5,000/- and litigation cost of Rs. 5,000/- within 40 days from the date of this order, failing which, the Complainant may proceed with execution case as per provisions of the Act and in that case, the OPs shall be liable to pay interest @ 9% p.a. over Rs. 1,25,000/- from this date till full and final payment is made.
