Oriental Insurance Co. Ltd. vs SATPATHI BAI

THIS appeal, under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 27.3.2002 in Complaint No. 218/2001 by District Consumer Disputes Redressal Forum, Durg (hereinafter called the ''District Forum'' for short) directing the appellant/insurer to pay to the complainant Rs. 5.00 lacs as also cost of the complaint.

THE relevant undisputed facts stated in brief are that Kriparam Bahadur, husband of complainant Smt. Satwati Bai, had been covered by the appellant/insurer under Group Janta Personal Accident Policy (hereinafter called the ''Janta Policy'' for short) as the said insured Kriparam Bahadur was a member of INTUC and employee of Bhilai Steel Plant. THE coverage of risk under the said policy was from 9.11.1999 to 8.1.2011. Under the terms of the said policy, in case of death of the insured in an accident during the above period, Rs. 5.00 lacs were payable to the nominee. It is also not in dispute that on 3.12.1999 the insured Kriparam Bahadur met with a road accident and was injured. He succumbed to injuries on 5.12.1999 during his treatment at Pt. J.L.N. Hospital, Bhilai. THE complainant laid claim under the policy which was however, repudiated by the appellant/insurer. Feeling aggrieved the complainant approached the District Forum and filed the complaint. The complaint was resisted by the appellant/insurer mainly on the ground that the deceased was under the influence of liquor and was intoxicated which resulted in the accident. It was further averred that in view of the above circumstances, the complainant was not entitled to any benefit under the policy.

District Forum in the impugned order, held that the appellant/insurer has not placed any material on record to show that at the time of accident the deceased was in a state of intoxication. Accordingly, the defence version as above of the appellant/insurer was rejected by the District Forum and the complaint of the complainant was allowed.

IN this appeal, learned Counsel for the appellant/insurer reiterated the stand that since the deceased was intoxicated at the time of accident, the amount assured under the policy was not payable in view of 4th proviso of the policy which inter alia provides that the insurer is not liable to make payment under the policy, in case death occurs on account of intoxication. None appeared for the complainant/respondent, during the time of hearing in the appeal.

IN view of the contentions as above, the only question that arises for consideration is; as to whether the appellant/insurer has proved that the deceased was under the influence of drug or was intoxicated? In the above regard, we find that no reliable material has been placed on record. A letter dated 3.1.2001 of Dr. S.M. Sharma of Bhilai Steel Plant is placed on record, which states that as per their records there was smell of alcohol in the breath of the deceased Kriparam Bahadur. However, the said hospital record has not been produced, on the basis of which the above letter was written by Dr. S.M. Sharma. There is yet another letter of investigator M.P. Tiwari addressed to Branch Manager of appellant/insurer, according to which the deceased was driving the motor vehicle under intoxication. The conclusion as above appears to be based on his investigation. However, the relevant record referred to by the investigator as above has not been produced by the appellant/insurer. Similarly, one Dr. Ritu Raj Tangia addressed a letter dated 2.1.2001 to the Regional Manager of appellant/insurer and has stated that on the basis of material placed before him, the accident appears to have taken place on account of consumption of alcohol by the deceased. However, the said letter of Dr. Ritu Raj Tangia has not been duly supported by his affidavit. The hospital record which Dr. Tangia has referred to in his letter is not enclosed with the said letter. As a result of above, it is clear that appellant/insurer has not placed on record the basis on which Dr. S.M. Sharma and Dr. Ritu Raj Tangia and investigator M.P. Tiwari had expressed their opinion or based their conclusion. In the circumstances, the letters and reports as above by themselves, would not be sufficient proof to show that the deceased was under the state of intoxication causing accident. It was for the appellant/insurer to have proved the above fact as the repudiation by them was on the basis of breach of terms of policy. They have failed to do so and failed to produce satisfactory material in that regard. Consequently, the finding of the District Forum as above based on due appreciation of material placed on record, was justified. The same does not call for any interference and are accordingly affirmed.

THIS appeal has no substance. It is accordingly dismissed. Appeal dismissed.