Kerala

StateCommission

A/15/349

manager lic of india - Complainant(s)

Versus

dolly jose - Opp.Party(s)

g s kalkura

28 Oct 2016

ORDER

 

KERALA STATE CONSUMER DISPUTES REDRESSAL

COMMISSION  VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL NO. 349/15

JUDGMENT DATED:28.10.2016

 

PRESENT : 

JUSTICE SHRI. P.Q. BARKATHALI                         :  PRESIDENT

SHRI.V.V. JOSE                                                          : MEMBER

Manager, LIC of India,

Sakthan Thampuram Nagar,

Thrissur.                                                                               : APPELLANT

 

(By Adv: Sri. G.S. Kalkura)

 

            Vs.

 

Dolly Jose, W/o late P.D. Jose,

Pailakkara House, P.O, Chiyyaram,                               : RESPONDENT

Thrissur.

 

(By Adv: Sri. Unnikrishnan .V)

 

JUDGMENT

HON.JUSTICE.P.Q.BARKATHALI : PRESIDENT

 

This is an appeal filed by the opposite party in CC.570/12 on the file of Consumer Disputes Redressal Forum, Thrissur challenging the order of the Forum dated, April 23, 2015 directing the opposite party/Insurance Company to pay to the complainant Rs.10,00,000/- being the amount due under the policy along with a cost of Rs.2500/-.

2.      The case of the complainant as detailed in the complaint before the Forum in brief is this:-

The husband of the complainant was a holder of insurance policy of the opposite party from March 23, 2011.  Her husband, Mr. Jose died in a train accident.  When the complainant submitted her claim before the opposite party only the policy amount of Rs.10,00,000/- was given to him.  Policy is a double accident benefit policy.  Therefore complainant is entitled to Rs.20,00,000/- as per the policy.  Complainant filed the complaint claiming that amount and compensation.

 3.     Opposite party is Manager, LIC of India, Thrissur.  He in his version contended thus before the Forum.  The existence of the policy and payment of basic sum assured Rs.10,00,000/- on June 27, 2011 is admitted.  Complainant is not entitled to double accident benefit of the policy as the deceased was under the influence of alcohol at the time of accident which is exempted as per the clause 11(b)(i) of the policy conditions.  Therefore complaint has to be dismissed.

4.      Complainant filed proof affidavit and Exts.A1 to A3 were marked on her side and on the side of the opposite party Ext.R1 to R4 were marked before the Forum.  On an appreciation of evidence Forum found that complainant is entitled to double accident benefit and directed the opposite party to pay to the complainant Rs.10,00,000/- and a cost of Rs.2500/-.  Opposite party has now come up in appeal challenging the said order of the Forum.

5.      Heard both the counsels.

          6.      The following points arise for consideration:-

1. Whether the complainant is entitled to double accident benefit under the policy?
2. Whether the impugned order of the Forum can be sustained?

 

7.  The counsel for the appellant argued that as the deceased had 135.08mg. of ethyl alcohol in his blood, he has to be treated as a person under the influence of alcohol and that therefore the insurance company is justified in repudiating the policy.  We are unable to agree.  Ext.R3 is the copy of the certificate of chemical analysis.  It shows that there is 135.08 mg of ethyl alcohol in his blood.  But merely on that basis alone we cannot conclude that he was under the influence of alcohol.

8.  That apart the deceased was seen near the railway track on the morning of March 24, 2011 and the cause of death was head injury as seen from Ext.R2 copy of post mortem report.  Opposite party has failed to show that deceased was under the influence of alcohol at the time of accident.  It was also not proved that the consumption of alcohol by the deceased had contributed to the accident.  Therefore the contention of the opposite party that deceased was under the influence of alcohol and that therefore the accident happened cannot be accepted.  It follows that complainant is entitled to double accident benefit under the policy in question.

9.  Forum directed the opposite party to pay to the complainant Rs.10,00,000/- being the double accident benefit under the policy.  Forum has also directed the opposite party to pay cost of Rs.2500/-.  We find no ground to interfere with the said finding of the Forum.

In the result appeal is dismissed with cost of Rs.5000/-.

 

 

JUSTICE P.Q. BARKATHALI       :  PRESIDENT

 

 

V.V. JOSE : MEMBER

 

VL.