AI Structured Summary
Not yet generated for this judgment
Judgment
This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986, against the impugned order dated 01.09.2006, passed by the Himachal Pradesh State Consumer Disputes Redressal Commission (hereinafter referred as ''the State Commission'') in Appeal No. 19/2004, Life Insurance Corporation of India (LIC) vs. Smt. Anita Panwar & Ors. , vide which, while partly allowing the appeal, the order passed by the District Consumer Disputes Redressal Fora, dated 10.09.2003 in consumer complaint no. 108/2002, was modified.
Briefly stated, the facts of the case are that Sh. Ramesh Kumar Panwar, husband of complainant no. 1, Anita Panwar and father of the complainants no. 2 and 3, obtained insurance policy in the sum of Rs. 1 lakh from the LIC. According to the complainants, the said Ramesh Kumar Panwar died in an accident on 19.01.2001 after falling from a height and by that time, he had paid only two installments under the policy. After taking the policy, the insured had been subjected to medical examination. Upon his death, the complainant no. 1 lodged the complaint with the opposite party, LIC of India, but since the same was repudiated, they filed the consumer complaint in question seeking the following reliefs:-
(i) Rs. 1,00,000/- with interest @ 18% p.a. from the death date of the deceased i.e. 19.1.2001 till final payment.
(ii) Rs. 10,000/- as damages and compensation and Rs. 1,00,000/- as accidental benefit of sum assured."
The complaint was resisted by the LIC by filing a written statement in which they stated that they had rightly repudiated the claim in question as the deceased had suppressed material information at the time of obtaining the said policy. Moreover, after his death, the medical analysis report confirmed that there was 236mg% of alcohol in the body of the deceased and hence, he was in intoxicated condition. The claim had been repudiated as per clause 10(2)(b)(i) of the policy contract.
The District Forum after taking into account the evidence of the parties, allowed the consumer complaint and directed the opposite party, LIC to pay an amount of Rs. 2 lakhs to the complainant alongwith interest @ 12% per annum w.e.f. the date of filing of the complaint. Being aggrieved from this order, the opposite party, LIC filed an appeal before the State Commission, which was decided vide impugned order dated 01.09.2006. While upholding the award of a sum of Rs. 2 lakhs to the complainant, the State Commission directed that the amount of interest awarded on the said sum should be reduced from 12% to 9% per annum. Being aggrieved against the said order, the opposite party, the LIC is in front of me with the present revision petition.
It was contended at the time of hearing by the learned counsel for the petitioner LIC that the complainants were liable to obtain the sum insured under the policy i.e. Rs. 1 lakhs, but the double accident benefit was not payable to them as per condition 10(2)(b)(i) of the said policy because the life assured was found to be under the influence of the intoxicating liquor at the time of his death. The chemical analysis report brought out that that the level of alcohol in his blood was 236mg% and hence, the double accident benefit was not payable to the complainants. The
terms and conditions governing the insurance policy were binding upon both the parties as the contract of insurance is a contract of good faith. The learned counsel for the respondent, however, stated that there were concurrent findings of the consumer fora below, which did not require any interference in exercise of the revisional jurisdiction of this Commission. According to the respondents/complainants, the insured died due to accident resulting in head injury and not due to taking of alcohol. The opposite party, LIC had not been able to produce any evidence, whether the level of alcohol in his body was found to be sufficient to believe that he was in an intoxicated condition.
I have examined the entire material on record and given a thoughtful consideration to the arguments advanced before me.
The main point for consideration in the present case is whether the complainants are entitled to get double accident benefit under the policy in view of the post mortem report and chemical analysis report performed on the deceased insured. A perusal of the chemical analysis report, a copy of which has been placed on record, says that the level of alcohol in his blood was 236mg%, saying that the deceased was drunk at the time of his death. The post-mortem report mentions that the death was due to head injury. The post-mortem report also stated that the final opinion will be given after getting the chemical analysis report. Since the factum of the presence of 236mg% of alcohol in the body of the deceased has been established from the chemical analysis report, it is to be examined whether the deceased was in an intoxicated condition which resulted in his fall that could have led to the head injury.
The question whether a person is under the influence of intoxicating liquor or not has been examined in detail in an order recently delivered by this Commission in Consumer Case no. 401/2014, Baby Apoorva Rai vs. New India Assurance Co. Ltd. & Anr. , decided on 03.09.2015. In this order, various opinions about the quantity of alcohol present in the body of a person that would qualify him to be under the influence of intoxicating liquor have been examined in detail. The information contained in Modi''s Medical Jurisprudence and Toxicology, 24 th Edition, Lyon''s Medical Jurisprudence and Toxicology and the Manual for Physicians in National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, were examined in the said order. An article titled ''While Under the Influence of Intoxicating Liquor'' written by W. W. Thornton and published on 11.01.1928 in Indiana Law Journal was also examined. It has been held in the said order of this Commission dated 03.09.2015 as follows:- "10. Considering the opinion expressed in the Manual issued by All India Institute of Medical Sciences, which is the premier-most medical Institution in this Country, we are not inclined to accept the opinion expressed in Modi''s Medical Jurisprudence and Toxicology, particularly when the opinion of AIIMS also find corroboration from the opinion expressed in Lyon''s Medical Jurisprudence and Toxicology. Though, this is not a case of the death while driving after consuming alcohol, the maximum quantity of alcohol permitted by various countries for a person to drive a motor vehicle cannot be said to be an altogether irrelevant since the purpose of prohibiting driving after consuming liquor beyond the prescribed quantity is to ensure that the driver does not commit an accident on account of the effect of liquor on him. The purpose of the insurer behind excluding the cases of accident when the insured is under influence of intoxicating liquor is to ensure that the consumption of the liquor does not lead or contribute to happening of the accident in which the insured dies or injured. Therefore, consumption of liquor beyond a safe limit must necessarily disqualify the insured from getting the benefits of the insurance policy taken by
him. The quantity of alcohol allowed to the driver of a motor vehicle is not more than 100 mg/100 ml of the blood in any country, including USA though, in our country it is only 30 mg/100 ml of blood. Therefore, in our opinion, if a person is found to have consumed more than 103.14 mg of alcohol/100 ml of his blood, which is position in the case before us, it would be reasonable to say that he was under the influence of the intoxicating liquor at the time he died or got injured."
In the case in hand, it has been established from the chemical analysis report that the deceased had 236mg% of blood in his body which was much more than 100mg% and hence, it can be safely concluded that the deceased was under the influence of intoxicating liquor at the time of his fall, which resulted in head injury leading to his death.
The condition with regard to the payment of accident benefit as stated in the policy says as follows:-
"10-2. Accident Benefit: If at any time when this policy is in force for the full sum assured, the Life Assured before the expiry of the period for which the premium is payable or before the policy anniversary of which the age nearer birthday of the Life Assured is 70, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of
(a) .........................
(b) Death of the Life Assured: to pay an additional sum equal to the sum assured under this policy, if the Life Assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 120 days of its occurrence solely, directly and independently of all other causes result in the death of the Life Assured, however, such additional sum payable in respect of this policy, together with any such additional sums payable under other policies of the Life Assured shall not exceed Rs. 5,00,000/-. The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the Life Assured shall
(i) be caused by intentional self injury, attempted suicide, insanity or immorally or whilst the Life Assured is under the influence of intoxicating liquor, drug or narcotic."
Since the deceased was under the influence of intoxicating liquor at the time of his death, it is very clear from a plain reading of the conditions stated above that the opposite party, LIC was not liable to pay additional sum as accident benefit to the complainants. The orders passed by the consumer fora below are, therefore, not based on a correct appreciation of the facts and material on record and are liable to be set aside. This revision petition is, therefore, allowed and the orders passed by the District Forum as well as the State Commission are set aside. The petitioner, LIC is directed to pay the sum insured only under the policy i.e. Rs. 1 lakh to the complainants alongwith interest @ 9% per annum from the date of complaint till realisation. The double accident benefit is not payable to the complainants. There shall be no order as to costs.