NATIONAL INSURANCE CO. LTD. Vs. STATE OF KERALA

JUDGEMENT

(1.) The writ petition is filed by the National Insurance Company challenging Exhibit P9 award dtd. 3/1/2012 passed by the Insurance Ombudsman, Kochi in complaint No. IO/KCH/GI/11-003- 986/2010-11 under the provisions of the Redressal of Public Grievances Rules, 1998, by which the Ombudsman allowed the complaint and directed the petitioner insurance company to pay an amount of Rs.7,00,000.00 to the 4th respondent, wife of the deceased/insured, within 15 days of receipt of the acceptance letter; and failing which to pay 9% interest from the date of filing of the complaint i.e., 17/3/2011 till payment.

(2.) Brief material facts for the disposal of the writ petition are as follows:

(3.) On the other hand, the petitioner Insurance Company contended that even though an accident occurred during the policy period from 1/1/2009 to 31/12/2009, as per the post mortem report, the stomach contained fluid with spirituous odour, and chemical analysis revealed that the blood sample contained 154.79 mgms of ethyl alcohol per 100 ml of blood and therefore, the death occurred while the deceased was under the influence of intoxicating liquor. Accordingly, based on the exception clause 5(b) contained in Exhibit P1 policy conditions, the claim was repudiated by the petitioner company. Whatever that be, it is an admitted case of the Insurance Company that the policy was issued covering the Government employees and teachers for the period from 1/1/2009 to 31/12/2009. So also, as per the Memorandum of Understanding entered into by and between the Insurance Company and the Government of Kerala, the sum assured in the case of accidental death is Rs.7.00 lakhs.