Life Insurance Corporation of India vs KARUNA SHARMA

THE respondent''s husband was holding life insurance policy when he met with an accident on 5.3.1994 and died on 11.3.1994. As per Clause 10 of the policy he claimed double accident benefit. THE appellant repudiated the claim of double accident benefit on the ground that when he met with an accident, he was under the influence of liquor. However, this plea did not find favour with the District Forum before which, the respondent had filed complaint seeking double accident benefit. THE complaint was allowed by impugned order dated 8.12.2000. Feeling aggrieved, the appellant has preferred the present appeal.

RELEVANT extracts of Clause 10 are as under: (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 90 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 the policies on the life of the life assured shall not exceed Rs. 5,00,000/-. The Corporation shall not be liable to pay the additional sum referred to in (a) or (b) if the disability or the death of the life assured shall: (1) be caused by intentional self-injury attempted of suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic. The only material being relied upon by the appellant is a reference made by investigating officer in the report that there was smell of alcohol. Record shows that there is no report of the doctor produced by the respondent to show that the respondent was under the influence of liquor. There is mere reference by the investigating officer. On the other hand, the medical certificate prepared by the doctor on examination of the deceased as well as the post-mortem report shows severe head injury, fracture of temporal bone, haemorrhage and the cause of death was due to head injury produced by the blunt force as could be in RTA. All injuries were ante-mortem in nature and fresh before death.

On the face of it there is no ambiguity that the respondent sustained bodily injury resulting solely or directly from the accident caused by outward visible means of solely, directly and independent of other causes. There is no indication of any kind that the death occurred due to being under the influence of intoxicating liquor, drug or narcotics. Nor is there any convincing evidence produced by the respondent showing that the deceased was under the influence of liquor. Let us assume that the deceased was under the influence of liquor when he met with an accident, still Clause 10(b) of the policy in our view did not attract nor did it disentitle the deceased from double accident benefit.

AS is apparent from Clause 10(b) one is entitled to double accident benefit under Clause if the following ingredients are fulfilled: (i) The deceased should sustain bodily injury resulting solely and directly from the accident. (ii) Such injury within 90 days of its occurrence solely, directly and independently of all other causes should result in death of the assured. Similarly, the appellant is not liable to pay additional sum referred above, if the disability or the death of the life assured is caused by intentional self-injury, attempted suicide, insanity, or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic. There is distinction between a person having consumed liquor or being under the influence of liquor, drug or narcotic. Onus is always upon the Insurance Company to prove that the accident had taken place solely on account of deceased being under the influence of intoxicating liquor or drug or narcotic while driving the vehicle. Merely because a person has consumed liquor does not mean that he was under the influence of liquor resulting in loss of power of reasoning or reflexes unless one suffers from this element he cannot be accused of being under the influence of liquor. The words "under the influence" are of great significance and that is why there are some permissible limits under the law which do not deem a person under the influence of liquor.

IN the instant case, the appellant had failed to prove by any evidence either medico legal or evidence collected by the police that the deceased was under the influence of intoxicating liquor or drug or narcotic when he suffered bodily injury resulting in death. On the contrary, there is convincing medical evidence that the deceased suffered bodily injury resulting solely, directly from the accident of outward visible means and it was independent of all other causes resulting in the death of the assured. There is only passing reference by police officer or a constable while preparing the injury sheet or report that the person was smelling alcohol. Smelling alcohol, by no stretch of imitation, means being under the influence of liquor. Insurance Company cannot escape from the liability to pay double accident benefit. In the absence of any evidence that the deceased was under the influence of intoxicating liquor while he met with an accident coupled with categorical report of the post mortem report as well as ML that the cause of death was solely because of head injury or so much so, the police officer who may be the rank of head constable or SI of ASI only mentioned that the deceased was unconscious at the time of arrival at the hospital and that smell of alcohol was there. As we have observed there is difference between smelling alcohol and a person being under the influence of alcohol that might have clouded his reasoning or reflexes.

WE, therefore, find it difficult to accept the contention of the Counsel for the appellant firstly for want of any evidence in this regard and secondly the post mortem report showing that the deceased suffered severe head injury, fracture in temporal bone, haemorrhage and the cause of death was solely due to head injury produced by the blunt force and all injuries were ante-mortem in nature.

IN the result, we dismiss the appeal being devoid of merit but feel inclined to reduce the rate of interest awarded by the District Forum, being on the higher side from 18% p.a. to that of 12% p.a. A copy of this order, as per the statutory requirements be forwarded to the parties, free of charge and also to the concerned District Forum and thereafter the file be consigned to the record room. Appeal dismissed.