Sushila Chauhan vs NATIONAL INSURANCE CO LTD

LATE B.S.Chauhan, husband of the Revision Petitioner was an employee of Cimmco Birla India Ltd. and as such, covered under a Group Personal Insurance Policy taken by the Company. As seen from the record, on 17.9.1997 during night hours, Shri Chauhan fell down the stairs and suffered head injuries. At about 10:55 PM he was shifted to Government Hospital Bharatpur and expired there, soon after at 11:50 PM. Respondent/National Insurance Company Ltd. repudiated the claim on 28.3.1998, on the ground that as per the post -mortem report, the deceased was under alcoholic intoxication.

DISTRICT Forum, Bharatpur, allowed the Consumer Complaint filed against repudiation of the claim and the insurance company was directed to pay the claim amount of Rs.2,28,816/ - with 9% interest from the date of repudiation. The Complaint, to the extent it related to the employer, was dismissed.

WHILE allowing the complaint, the District Forum has noted that as per the report of the surveyor/investigator appointed by the Insurance Company, Shri Chauhan had died of head injury sustained in the fall. It was therefore incumbent upon the Insurance Company to obtain the viscera examination report and to take it into consideration. This was not done. The Complaint was rejected on the ground of post -mortem report only which had noted smell of alcohol. The District Forum held that it cannot be the basis for rejecting the claim under the policy. In appeal against the above order, the State Commission has also referred to the proceedings under Section 174 Cr.P.C, initiated by the local Police, wherein it was stated that the deceased had died due to consumption of alcohol. It has also referred to the Post -Mortem report of 18.9.1997 and the Viscera Examination report of 31.1.1998. The Commission relied upon the decision of the National Commission in LIC Vs. Smt. Priyanka Singh (FA No.368 of 2004) in which it was observed that there are three stages of alcohol intoxication - (i) Stage of excitement (ii) Stage of in -coordination and (iii) Stage of coma. It held that "The instant case is covered under the first category. In this category the visual acuity is reduced. It also alters time and space orientation. It further says that there is poor judgment and mental concentration is retarded. If these observations are seen in context with the sequence of events one can easily say that the deceased was under the influence of liquor. The marg report goes to show that he was brought in hospital in a state of alcohol intoxication and immediately thereafter he expired. Even the statements of the complainant were recorded, which state that her husband had slipped from the stairs and sustained grievous injuries as a result thereof.

Blood alcohol reaches all the organs mainly the brain and interferes with the normal brain functions like judgment and coordination of muscular movements. The blood alcohol level influences the behaviour of the person. In this particular case the brain was so much affected that the deceased could not control himself and slipped from the stairs. The accident took place whilst the deceased was under the influence intoxicating liquor the policy says that the company is riot liable to pay compensation in case of death or injury of the insured person whilst under the influence of intoxicating liquor or drugs. There is no force in the submission made by the learned Counsel for the respondent that the policy conditions were not supplied by the Insurance Company. When the cover note was issued, it was mentioned specifically that policy was also attached and this policy was made a part of contract."

WE have carefully considered the records as submitted in the Revision Petition and heard the two sides. Medical literature relied upon by the two sides has also been perused.

ONE of the grounds in the Revision Petition filed by the Complainant is that the claim was repudiated without obtaining the Viscera Examination Report. However, there is no explanation as to what material impact it would have had on the outcome. A perusal of the Viscera Examination Report shows that presence of alcohol in the blood sample of the deceased was of the level of 92 mg/100 ml. The revision petition makes a feeble and unconvincing attempt to contrast it with the Post Mortem report to claim that only smell of alcohol was found which should not have been made the basis for denial of claim under the policy. We find no substance in this claim. While ''smell'' may be indicative only, existence of high alcohol in the blood (as determined in the Viscera Examination Report) is more specific and determinate. Therefore, the State Commission was right in basing its finding on this Report.

IN the result, we find no merit in this Revision Petition. It is therefore dismissed and the order of Rajasthan State Consumer Disputes Redressal Commission in Appeal No. 386/2003 is confirmed. No orders as to costs.