Vineeta Rai, Member ORDER
Vineeta Rai, Member
1. The Life Insurance Corporation of India and Anr. (hereinafter referred to as the 'Petitioner') have filed the present revision petition against the order of the State Consumer Disputes Redressal Commission, Punjab (hereinafter referred to as the 'State Commission') which had rejected Petitioners' appeal in favour of Smt. Ranjit Kaur (hereinafter referred to as the 'Respondent').
2. The facts of the case according to the Respondent are that her husband, Malkiat Singh had taken a Double Accident Benefit policy on 28.09.2001 from the Petitioner/Insurance Corporation for a sum of Rs. 1 lakh. As per the provisions of this policy, in case the insuree dies in an accident then the Insurance Corporation is liable to pay double the amount plus bonus on the amount of insurance taken. On 18.07.2004, Malkiat Singh died due to electric shock while working in the field and necessary information regarding this accident was conveyed both to the Police as well as to the Petitioner/Insurance Corporation. Since the death of the insuree was accidental and this was also confirmed as per inquiry and the post-mortem reports, Respondent being the nominee lodged a claim with the Petitioner/Insurance Corporation for payment of the sum assured as per the provisions of the policy and after several visits the Petitioner/Insurance Corporation settled the claimed at Rs. 1,14,000/- i.e. Rs. 1 lakh being the insured amount and Rs. 14,00/- as bonus but repudiated the double accidental benefit part of the claim.
3. Aggrieved by this repudiation, Respondent filed a complaint before the District Forum on grounds of deficiency in service and negligence on the part of the Petitioner and requested that Petitioner be directed to pay the full amount under the double accident benefit policy along with all benefits as well as interest @ 24% on this amount from the date of death of the insuree till realization. Rs. 25,000/- was sought on account of mental agony and Rs. 25,000/-as litigation cost. The Petitioner/Insurance Corporation while accepting that the insuree died due to electrocution while operating the motor, justified repudiation of payment of the accidental benefit amount on the grounds that the viscera report confirmed that alcohol beyond the permissible was found in the deceased blood thus proving that the insuree was under the influence of alcohol at the time of his death. As per the policy, the Insurance Corporation is not liable to pay the additional accidental benefit amount in case the life assured is under the influence of any intoxicating drug or narcotics at the time of death. Further, the insuree had not indicated in his personal history on the proposal form that he was in the habit of taking alcohol and this amounted to willful suppression of material facts with intention to defraud the Petitioner/Insurance Corporation. The District Forum after hearing both parties and considering the evidence on record accepted the complaint, inter alia, on the grounds that the Petitioner was not able to place any document of verifiable nature on record that there was direct nexus between the alcohol consumed by the insuree and his death. The report of the Chemical Examiner did indicate that there was alcohol concentration in the blood/viscera to the extent of 86.25 mg /100 ml. of blood but this could not be treated as conclusive proof that the insuree was intoxicated at the time of death because it has also come in evidence that the specific clinical picture of alcohol intoxication also depends on other factors such as quantity and frequency of consumption etc.
4. Regarding the contention of the Petitioner that the case is covered under the exclusion clause of the Policy, the District Forum observed as follows:
Even otherwise, it may be noticed that the corporation wants to take the benefit of exclusion clause which is embedded in the policy Ex.R-2. We have not been able to lay our hands on any document whether the life assured had any knowledge of the said clause or such terms and conditions of the policy disentitling the life assured to the benefit were conveyed to him. The Apex Court in Moder........