Per :- Hon’ble Mr. Dhanraj Khamatkar, Member
None present for the Appellant. Heard Mr. Mahendra M. Vaze, Administrative Officer, on behalf of the Respondent/original Opponent.
[2] This appeal takes an exception to an order dated 11/6/2003 passed by the South Mumbai District Consumer Disputes Redressal Forum (hereinafter referred to as ‘the District Forum’ for the sake of brevity) in Consumer Complaint No.694 of 1998, Smt. Meeta Omprakash Bharti Vs. The Senior Divisional Manager, Life Insurance Corporation of India.
[3] Facts leading to this appeal can be summarized as under:-
Appellant/original Complainant (hereinafter referred to as ‘the Complainant’ for the sake of brevity) had taken three life insurance policies of double accident benefit coverage for her minor daughter, namely – ‘Divya’. The Complainant further contended that on 5/4/1993, when ‘Divya’ was sitting in the window she lost her balance and fell down. She succumbed to the injuries and died on the spot. The Complainant, in her capacity as a nominee of the deceased ‘Divya’, lodged a claim with the Respondent/original Opponent, namely – Life Insurance Corporation of India (hereinafter referred to as ‘the insurance company’ for the sake of brevity) and her claim was settled for the normal risk. However, the benefit of double accident was not given. The Complainant was asked to obtain the coroner’s verdict. The Complainant further stated that though alcohol was found in the blood of the deceased ‘Divya’ in the post-mortem report, she contended that it was within permissible limits and there was no breach of terms and conditions of the insurance policy on the part of the deceased ‘Divya’. Hence, as the insurance company did not sanction the claim for double accident benefit, the Complainant filed a consumer complaint inter-alia alleging deficiency in service on the part of the insurance company and claimed an amount of `3,40,200/- together with interest thereon @ 21% p.a., besides compensation in sum of `1,00,000/- towards mental agony.
[4] The insurance company resisted the complaint filing its written version and raised a contention to the effect that the claim of the Complainant is not tenable and not based on true facts. It is further contended that the insurance policies were taken by suppressing material information regarding the health and habits of the deceased which is fatal to the insurance policy. Insurance company further contended that the deceased died because of shock and hemorrhage under the influence of alcohol with intoxication of ‘Diazepam’. Main contention of the insurance company is that the death is caused due to intentional heavy injury, attempted suicide, insanity or immorality when she was under the influence of intoxicating liquor, drug or narcotic. Insurance company further pointed out the exception clause No.10(2)(b)(i) of the insurance policy. Therefore, the insurance company contended that the complaint may be dismissed.
[5] The District Forum after going through the complaint, written version filed by the insurance company, evidence adduced on the record by both the parties, terms and conditions of the insurance policies and the pleadings of the learned advocates dismissed the complaint on the ground that there was no deficiency in service on the part of the insurance company, by the impugned order. Feeling aggrieved by dismissal of consumer complaint by the District Forum by the impugned order, present appeal is filed by the Complainant challenging the impugned order.
[6] The appeal was lying unattended on the sine-die list. The appeal was placed before us on 22/8/2011. On 22/8/2011, husband of the Appellant/original Complainant appeared before us. The matter was adjourned to 10/1/2012. Today, nobody appeared on behalf Appellant/original Complainant. On behalf of the Respondent/original Opponent, Mr. Mahendra M. Vaze, Administrative Officer, remained present. The appeal being old one, we proceeded with the matter on merits.
[7] Admittedly, deceased ‘Divya’ was insured with the insurance company for double accident coverage benefit. It is also not disputed that on 5/4/1993, when deceased ‘Divya’ was sitting on the widow frame of her house, she met with an accident. She succumbed to the injuries and died on the spot. Being a nominee of deceased ‘Divya’, the Complainant lodged a claim with the insurance company and admittedly, the claim of normal risk is settled by the insurance company. However, benefit of double accident coverage was not given. The insurance company had repudiated the double accident benefit on the basis of exception clause No.10(2)(b)(i) of the insurance policy which provides that the insured is not entitled to double accident benefit for intentional heavy injury, attempted suicide while under the influence of intoxicating liquor, drug or narcotic. The Coroner’s Court had also come to the said conclusion. The District Forum observed that the chemical analyzer’s report positively showed that viscera and blood of the deceased ‘Divya’ contained ‘Diazepam’ and ‘Diazepam’ is a drug which helps intoxication. The District Forum has passed the impugned order after taking into consideration the facts of the case and the terms and conditions of the insurance policy. In our opinion, the order passed by the District Forum is just and proper and there is no substance in the present appeal filed by the Appellant/original Complainant. We hold accordingly and pass the following order:-
ORDER
Appeal stands dismissed.
No order as to costs.
Pronounced on 10th January, 2012
