Life Insurance Corporation of India vs RAMPATI

THIS is an appeal filed under Section 15 of the Consumer Protection Act by the opposite party Life Insurance Corporation of India aggrieved by a direction of the District Forum, Ludhiana allowing the complaint and directing the payment of Accident Benefits covered with insured amount of Rs. 50,000/- alongwith interest and ancillary reliefs.

THE facts are not in dispute. THE insured Sh. Vikram Sharma got himself insured against Twenty Years Money Back Policy with profits (with accident benefit) with the opposite party on payment of Rs. 819/- vide Policy No. 160526322 for a sum of Rs. 50,000/- valid from 15.3.1994. During the subsistence of the policy, Sh. Vikram Sharma died on 5.1.1996. THE death was reported to the Police Station (Ex. A-5), Focal Point, Ludhiana, THE complainant being a nominee filed claim before the Life Insurance Corporation of India for settlement. THE opposite party paid Rs. 55,062/- but declined the accident benefits. THE opposite party also deducted a sum of Rs. 1688/- as premium for the quarters of 9/95 and 12/95 @ Rs.819/- per quarter but the same stood already paid. On notice, the opposite parties filed their written version that the deceased had consumed excess alcohol and died due to consumption of excess alcohol and stated that the complainant was not entitled to accident benefits as per clause No. 10(b)(i) of the policy and prayed for dismissal of the complaint as there was no deficiency in rendering service. The complainant filed rejoinder and contended that the deceased died as was given potasium cyanide by somebody.

Both the parties led their evidence on affidavits and documents which resulted in passing the impugned order. We have gone through the records and heard the arguments of learned Counsels for both the parties on facts and on the legal propositions.

THE learned Counsel for the appellant Mr. B.J. Singh argued that the relevant terms and conditions of the policy do not permit any additional sum referred to in Clause 10(b). THE insured Mr. Vikram Sharma was under the influence of liquor at the time of his death, as per post-mortem examination report made by the Medical Officer, Civil Hospital, Ludhiana. THE affidavit by way of evidence of Sham Singh, Manager (P&IR Legal) is also on record, testifying that the life assured/deceased had consumed excess alcohol at the time of accident and he had died on 6.1.1996 due to consumption of excess alcohol, so he was not entitled for accident benefits as per Clause 10(b)(i) of Insurance Policy. THE case of death is not accidental. He himself having taken excess alcohol made a cause for his death. THE deceased is responsible for the cause of own his death and the Insurance Company is not liable to pay under rules. To support his arguments, he referred the F.I.R. in the present case and a letter No. E488/36 dated 31.3.1996 from Civil Hospital, Ludhiana to the S.H.O., Police Station, Focal Point, Ludhiana (from page 24 to 35 of Record File). He further asserted that the sum of Rs. 55,062/- was paid in full and final settlement of the claim on 31.3.1998. The relevant portion of the policy is reproduced below was referred : "10. 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 on which the age nearer birthday of 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,

xxx xxx xxx xxx (b) Death of 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 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) if the disability or the death of the Life Assured shall, (i) be 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; or

THE main submission of the Counsel for the complainant is that Sh. Vikram Sharma died an unnatural death and the post-mortem revealed death by poisoning meaning thereby it was a death by accident and not a natural death. THE F.I.R. was lodged with Police Station, Dhandari Kalan, but investigation remains incomplete so far. Post-mortem report placed on the file shows that potasium cynide with alcohol was detected in the sample sent and death is due to consumption of alcohol mixed with potasium cynide. While scanning the record on the file, we noticed the following remarks in the post-mortem report (page 30) : "Cause of death kept pending till the report of Chem. Exam is received on page 35 (Letter No. 488/98 dated 31.3.1996)." "Cyanide equivalent to 52.08 mg. (of potassiuym cyanide and alcohol were detected in the contents of exhibit No. 1 and their presence was confirmed in the contents of exhibit Nos. II, III and IV. Blood alcohol concentration was estimated to be as 80.25 mg. /100 mg. of blood. No position was detected in the contents of exhibit No. V."

We are satisfied from the evidence produced before us that the plea taken by the Life Insurance Corporation of India to justify the non-payment of an additional sum equal to the sum assured under the policy to the complainant is correct. The deceased may have died with diluted poisonous substance but was under the influence of liquor at the time for his death which violated the terms of insurance policy for the payment of claim as reproduced above. It was not a case of death by accident. Even if investigation is not complete at the police level, that does not debar L.I.C. from deciding the claim. For the L.I.C. claim purpose, post-mortem report is enough to establish whether the insured deceased was under the influence of intoxicating liquor or not. In the present case the post-mortem report (Ex. A-5) as sent by the Medical Officer, Civil Hospital, Ludhiana to the S.H.O., Police Station, Focal Point, Ludhiana vide letter No. E 488/96 dated 31.3.1996 shows that alcohol coupled with potasium cyanide were detected in the contents as referred to above.'' This case is fully covered by New India Assurance Company v. Smt. Paramjit Kaur, 1998 (2) CPC 373, in which it is held as under : "The deceased was under the influence of intoxicating liquor which violated the term of Insurance Policy for payment of claims. On that account, he himself fell down from the stationary truck. It was not a case of death by accident involving the vehicle from which he was not responsible."

For the reasons recorded above, we allow the appeal; set aside the order of the District Forum and dismiss the complaint with no order as to costs. Stay granted vide order dated 23.7.1998 is hereby vacated. Appeal allowed.