NATIONAL INSURANCE CO LTD Vs. SOMA DEVI

JUDGEMENT

(1.) This revision petition filed by National Insurance Company Ltd. (hereinafter referred to as the 'Petitioner') challenges the order of the State Consumer Disputes Redressal Commission, Himachal Pradesh (here in after referred to as the 'State Commission') which had dismissed its appeal in favour of Smt. Soma and others, Respondents herein, who were the original complainants before the District Forum. The facts of the case are that late Kishan Chand (here in after referred to as the 'insuree'), husband of Respondent No. 1 and father of Respondent Nos. 2 and 3, was employed with the Home Guards and had obtained Group Insurance Personal Accident Policy from Petitioner/Insurance Company for which premium was deducted from his salary. On 9.10.1993, the insuree who was on night patrolling duty was found dead under Lathiana Bridge. Respondent filed an insurance claim with the Petitioner/Insurance Company through Commandant, Home Guards, Una which was repudiated on the ground that the death of the insuree was due to an accident when he was under alcoholic intoxication which resulted in head trauma as per an enquiry conducted by the police. Since this was not factually correct, being aggrieved, Respondent filed a complaint before the District Forum on grounds of deficiency in service and requested that Petitioners be directed to make the payment of the entire amount of Rs. 2 lakh with interest @ 18% till realization, Rs. 10,000 for mental agony and harassment and Rs. 1,500 towards litigation cost.

(2.) The above contentions were denied by the Petitioner/Insurance Company who while admitting that the deceased had taken a Group Personal Accidental Policy from Petitioner/Insurance Company stated that since his death had taken place in unnatural circumstances, an Investigator was appointed to investigate the cause of death. According to the Investigator, the insuree had died due to a fall from the bridge because he was in an inebriated condition. The same was also confirmed as per the report of the Police. Since as per Section 5 of the Insurance Policy, the Petitioner/Insurance Company would not liable for payment of compensation in respect of death, injury or disablement of the insured whilst under influence of intoxicating liquor or drugs, the claim was rightly repudiated.

(3.) The District Forum after hearing both parties and considering evidence on record allowed the complaint by observing that the contradictory findings in the post-mortem report filed by the Police wherein in one place it has been stated that no intoxicants were found in the blood and urine of the deceased and stating at the back of the same report that this was a typing mistake and alcohol was found in the insuree's system makes the entire report suspicious. Also no evidence has been submitted to prove the contents of this report. The District Forum also reached a finding that neither the insuree nor the Respondents had been made aware of the terms and conditions of the insurance policy and, therefore, Petitioner is liable to pay insurance amount of Rs. 2 lakh with interest @ 9% per annum from the date of complaint till realization, Rs. 2,000 as compensation and Rs. 1,000 litigation cost.