Punjab

StateCommission

FA/12/849

LIC of India - Complainant(s)

Versus

Manjeet Kaur - Opp.Party(s)

Rajesh K. Sharma

29 Jan 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION, PUNJAB     SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                                      First Appeal No.849 of 2012.

 

                                                          Date of Institution:    21.06.2012.

                                                          Date of Decision:              29.01.2015.

 

1.      Life Insurance Corporation of India, Head Office, Jeevan        Prakash Building, 3^rd Floor, next to Canara Bank, Corporation   Circle, J.C. Road, Bangalore-560002, through its Chairman.

 

2.      Life Insurance Corporation of India, Divisional Office, Sector-  17, Chandigarh, through its Senior Divisional Manager.

 

3.      Life Insurance Corporation of India, Sangrur, through its          District Manager.

 

4.      Life Insurance Corporation of India, Branch Office, Nabha,      Patiala, Bye-pass Road, Nabha, Tehsil Patiala, through its         Branch Manager.

 

          (All all appellants through Authorized Officer Smt. P. Kwatra,   Manager (Legal & HPF), Life Insurance Corporation of India,     Divisional Office, ‘Jeevan Parkash’, Sector 17-B, Chandigarh.

 

                                                          …..Appellants/OPs

         

                                      Versus

 

Manjeet Kaur W/o late Sh. Satnam Singh S/o Daya Singh, R/o Village Tolewal, Post Office Amargarh, Tehsil Malerkotla, District Sangrur.

 

                                                          ….Respondent/Complainant.

         

 

First Appeal against order dated 08.05.2012 passed by the District Consumer Disputes Redressal Forum, Sangrur.

Quorum:-

 

                    Shri Baldev Singh Sekhon, Presiding Member.

                    Shri Harcharan Singh Guram, Member.     

Present:-

 

          For the appellants:      Sh. R.C. Aggarwal, Advocate.

          For the respondent:     Sh. Harshit Jain, Advocate.

          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

BALDEV SINGH SEKHON, PRESIDING MEMBER:-

                                     

                   This appeal has been filed by the appellants/OPs against the order dated 08.05.2012 passed by the District Consumer Disputes Redressal Forum (in short, “the District Forum”), Sangrur, vide which the complaint filed by the respondent/complainant against the appellants/OPs was allowed and they were directed to pay to the complainant (a) accidental death benefits of Rs.2 lacs, along with interest @ 9% p.a. from the date of death of Sh. Satnam Singh till realization; (b) to pay to the complainant a sum of Rs.11,000/- as litigation expenses.

2.           Briefly stated, the facts of the case are that husband of the complainant, namely Sh. Satnam Singh, was holder of Jiwan Sanchar Plan (without profits) policy bearing No.162137445 dated 11.11.2001. At the time of insurance, he was told by the representative of the OPs that in case of his death in accident, his kin would also be entitled to get accidental benefits. On 31.10.2010, Satnam Singh died in a motorcycle accident near petrol pump on Malerkotla-Nabha Road, Amargarh, Tehsil Malerkotla, regarding which FIR No.15 dated 31.10.2010 U/s 304-A/279/427 IPC was registered at P.S. Amargarh. Thereafter, complainant, being the nominee of deceased Satnam Singh, filed application for getting accidental benefits, but OP-2 rejected her claim, vide letter No.Nil dated 15.06.2011 on the ground that the deceased was under the influence of alcohol at the time of accident and, therefore, her claim was not payable. It was pleaded that the repudiation of the claim was illegal and OPs have mis-interpreted the clauses of the policy contract. Alleging deficiency in service on the part of the OPs, the complainant filed the complaint before the District Forum, seeking directions to pay her accidental benefits amounting to Rs.2 lacs, along with interest @ 18% p.a. from the date of death, besides Rs.31,000/- on account of harassment and litigation expenses.
3.           Upon notice, the OPs filed joint written reply, pleading therein that the complainant had not come to the Forum with clean hands. She had already been paid Rs.3.26 lacs on 23.02.2011 i.e. the benefits, she was eligible as per the policy and same was accepted by her without any protest as full and final settlement. It was further pleaded that accidental benefits were denied in the light of report of Chemical Examiner of Govt. of Punjab, as per policy terms and conditions and rules and regulations of the Corporation. It was admitted that in case of accidental death of the life assured, an  amount equal to the basic sum assured was payable subject to the terms and conditions of the policy. The claim of the complainant for the basic sum assured was settled by the OPs. Denying all other allegations, dismissal of the complaint was prayed.
4.           Parties led their evidence by way of affidavits and documents before the District Forum, which after going through the same, allowed the complaint, in aforesaid terms.
5.           Aggrieved by this order, the OPs have come up in the appeal on the grounds that the learned District Forum has failed to appreciate that the parties are bound by the terms and conditions of the insurance policy and as per clause 10.2 under head “Conditions and Privileges within Referred To”, deals with the accidental benefits and is reproduced below:-

10.2: Accident Benefit—If at any time when this Policy is in force for full sum assured, the life assured before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the life assured is 70 (whichever is earlier), is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of-

a) Disability to the life assured- (i) to pay in monthly instalments spread over 10 years an additional sum equal to the sum assured under this policy. If the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid along with the claim; (ii) to waive the payment of future premiums.

The maximum aggregate limit of assurance under all policies issued on the same life to which benefits (i) and (ii) above apply shall not in any event excess Rs.25,000,00/-. If there be more policies than one and if the total assurance exceeds Rs.25,000,00/-, the benefit shall apply to the first Rs. 25,000,00/- sum assured in order of the date of the Policy issued.

The waiver of all premiums shall extinguish all options under this policy and also the benefits covered by para (b) of the clause except as to such assurances. if any, as exceeds the maximum aggregate limit of Rs.25,000,00/- and which have been kept in force by payment of premiums.

(b) Death of the life assured- to pay an additional sum equal to the sum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury within 180 days of its occurrence solely, directly and independent of all other causes result in death of the Life Assured. However such additional sum payable in respect of this policy, together with any such additional sums payable in respect of other policies on the life of Life Assured shall not exceed Rs.25,000,00/-.

The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the disability or the death of life assured:-

(i) be caused by intentional self injury, attempted suicide, insanity or immorality or whilst the life Assured is under the influence of intoxicating liquor, drug or narcotic; or

 

6.                Thus, it was clear that the accidental benefit was not payable when the death of the life assured had taken place, committing any breach of law. Learned District Forum further failed to appreciate that the deceased had also committed breach of section 185 of Motor Vehicles Act, that provides as under:-

 

“185: Driving by a drunken person or by a person under the influence or drugs;- Whoever, while driving, or attempting to drive, a motor vehicle-

(a)     Has, in his blood, alcohol exceeding 30 mg. per 100 ml. of blood detected in a test by a breath analyzer, or

(b)     Is under the influence of a drug to such an extent as to be incapable of exercising proper control over the vehicle.

Shall be punishable for the first offence with imprisonment for a term which may extent to six months, or with fine which may extent to two thousand rupees, or with both; and for a second or subsequent offence, if committed within three years of the commission of the previous similar offence, with imprisonment for a term which may extent to two years, or with fine which may three thousand rupees, or with both.”

 

                   Acceptance of the appeal and setting aside of the impugned order was prayed.

7.           Learned counsel for the complainant prayed that there is no merit in the appeal and the same be dismissed.
8.           We have gone through the pleadings of the parties and have carefully perused the evidence proved on record.
9.           Admittedly, the deceased life assured (hereinafter referred to as “DLA”) Satnam Singh, husband of the complainant, died during the subsistence of the policy and the basic sum assured on the life of the husband of the complainant was paid by the appellants/OPs. However, the accidental benefit to the tune of Rs.2 lacs was declined on account of the fact that the DLA, at the time of said accident was driving the vehicle under the influence of liquour, which was not only in violation of section 185 of the Motor Vehicles Act, but also of the Condition No.10.2 (b) (ii) of the insurance policy, which stipulates that in case, the death is occurred while driving the vehicle, under the influence of intoxicant liquour, drug or narcotic, the claim was not payable. It is evident from the documents proved on record that accident took place on 30.01.2010. Immediately after the accident, FIR No.15 dated 31.10.2010 was registered, which has been proved as Ex.C-2, In this FIR,  Vir Singh S/o Bachan Singh, the cousin of the DLA has stated that he and DLA were returning from Nabha on their respective vehicles and that DLA was going ahead of him on his motorcycle Hero Honda bearing No.PB-10-AG-4478.  At about 7.00 P.M., when they were near Petrol Pump, Amargarh, suddenly, a truck coming from the backside hit the motorcycle of DLA, while overtaking his motorcycle, and DLA died at the spot in the accident and that he reported the matter to the police . After the death of the DLA, postmortem was conducted on his body at Civil Hospital, Malerkotla, which is proved on record as Ex.R-6. The doctor, who conducted the postmortem, opined as under:-

 

“In my opinion, the cause of death in this case is due to injuries as described above, which caused hemorrhage and shock. Injury No.1 and 2 is fatal in nature, which caused death in ordinary course of nature. All the injuries are antimortem in nature. Regarding blood in alcohol, estimation opinion will be given after Chemical Examiner’s report of the Govt. of Punjab, Kharar.”

 

 

10.           The Chemical Analysis report dated 31.10.2010 is also proved on record as Ex.R-5, in which the following observations were made:-

 

“Ethyl alcohol detected in the contents of Ex.II, III, IV and V. No poison, no alcohol detected in the contents of Ex.I. The blood alcohol concentration was estimated to be 74.75 mg per 100 ml.”

 

 

11.           It is, thus, evident that blood alcohol concentration of the DLA at the time of accident was even more than double as prescribed in Section 185 of Motor Vehicle Act, i.e. 30 mg. per 100 ml of blood. Thus, DLA was under the influence of liquor at the time of accident, which took place on 30.10.2010, while he was driving his motorcycle. It is, thus, concluded that the DLA not only violated the section 185 of the Motor Vehicles Act, but the accident fell under the exclusion clause 10.2 (b) (i) of the policy (Ex.R-3), referred above. Learned District Forum has wrongly held that the Chemical Exmainer has not opined that DLA was under the influence of liquor. When the contents of Ethyle Alcohol was found to be 75.74 mg. per 100 ml. of blood, which was even more than the permissible limit, DLA was definitely under the influence of liquour as provided in section 185 of MV Act. District Forum has wrongly relied upon the judgment of Hon’ble National Commission passed in Revision Petition No.2433 of 2007 decided on 11.07.2011 (Life Insurance Corporation of India Vs. Ranjit Kaur) as the facts of the case in this judgment were altogether different. Hon’ble Supreme Court has held in “General Assurance Society Ltd. Vs. Chandumull Jain and another”, AIR 1966 SC 1644, that terms and conditions of the policy are to be strictly construed. It does not matter, who was responsible for the accident when it is proved that DLA himself was under the influence of liquor at the time of accident. Accordingly, the complainant was not entitled to the accidental death claim as per condition no.10.2 (b) of the policy and the OPs have rightly repudiated the claim of the complainant.
12.           In view of above discussion, the appeal filed by the appellant is accepted, the order of the District Forum is set aside and the complaint filed by the complainant is dismissed.
13.           The appellants had deposited the amount of Rs.25,000/- with this Commission at the time of filing the appeal. This amount with interest accrued thereon, if any, be remitted by the registry to the Manager (Legal & HPF), Life Insurance Corporation of India, Divisional Office, ‘Jeevan Parkash’, Sector 17-B, Chandigarh by way of a crossed cheque/demand draft after the expiry of 45 days.
14.           Arguments in this appeal were heard on 19.01.2015 and the order was reserved. Now the order be communicated to the parties.

 

15.           The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

 

                                                               (BALDEV SINGH SEKHON)

                                                                    PRESIDING MEMBER

 

                       

                                                          (HARCHARAN SINGH GURAM)

                                                                              MEMBER

 

January 29, 2015.                                                               

(Gurmeet S)