No compensation on insurance policy in case of intoxication: Supreme Court of India

This appeal arises out of order and judgement of the ‘Impugned Order’) allowing Revision Petition No. 331 of 2007 filed by the Respondent No.1 herein Himachal Pradesh State 9.10.2006 passed by the Himachal Pradesh State Consumer Disputes Redressal Commission Shimla was an employee of Respondent No.1­ Office Chopal. On the night of 7.10.1997 the deceased was coming from Banal Depot to Thundal along with one Chandermohan the forest guard. On the said night there was heavy rain and storm therefore the deceased might have been 9:00 AM smelling of alcohol. When the Chowkidar Mohan Singh saw the deceased he called the Forest Sub­Inspector and there he was given hot water bath and massaged. However he subsequently died at about 1:00 PM on 8.10.1997. Thereafter on 9.10.1997 at about 2:30 P.M. The Assistant Manager of The Post­Mortem Report dated 10.10.1997 stated that no that the cause of death was probably asphyxia resulting from regurgitation of food articles into larynx and trachea after of urine which was calculated as per the chemical examiner’s report. Expert opinion dated 6.07.1998 was obtained from one Dr. D.J. Das Gupta M.D. & Former Professor & Head of Department of Medicine and Principal Indira Gandhi Medical College Shimla which stated that the cause of death is due to alcohol ingestion and regurgitation of food into larynx. Medical Professor & Head of Department of Medicine Indira Gandhi Medical College Shimla. As per his opinion dated 17.08.2002 Under the Janta Personal Accident Insurance Scheme hereinafter ‘Insurance Scheme’) Respondent No.1­HPSFC had taken the Janta Personal Accident Insurance Policy dated from Respondent No.2­The New India Assurance Company Scheme there was an insurance coverage of Rs. 1 lakh for all employees who were willing to opt for the said Scheme Respondent No.1­HPSFC had been depositing premium for its employees including the deceased under the Insurance Policy which was effective during the period from 22.01.1997 to 21.01.1998. Consequently the legal heirs of the deceased i.e. Insurance Company under the Insurance Policy however the Insurance Company repudiated the claim vide letter dated claim the Appellants herein filed a consumer complaint under Section 12 of the Consumer Protection Act 1986 alleging deficiency in service on of Rs. 2 lakhs along with interest and cost. By order dated had wrongly repudiated the claim and was liable to make payment and indemnification of the insured amount of Rs. 2 The Forum observed that the only issue to be considered is Respondent No.1­HPSFC would be liable for compensating the Appellants and in case of the latter the Insurance Company would be liable. The District Forum then considered the definition of asphyxia in the Medicolegal Manual by Dr. K.S by interference with respiration or due to lack of oxygen in respired due to which the organs and tissues are deprived of oxygen causing unconsciousness or death.” The District Forum therefore but accidental. The District Forum further observed that the quantity of alcohol found in the deceased’s body was not sufficient to cause death in the normal course and that the opinion dated 6.07.1998 given by Dr. D.J. Das Gupta seeking compensation under the 1923 Act and the Commissioner had passed award dated 28.08.2003 directing Respondent No.1­ HPSFC to pay a sum of Rs. 1 52 887.50 ­ along with interest the said award before the Hon’ble High Court of Himachal terms and conditions of the Insurance Policy were never communicated to the insured persons nor were they supplied that the Insurance Policy was applicable only in the case of accidental death and therefore the Respondent No.1­HPSFC is 8.1 The learned counsel for the Appellants further contended that the Insurance Scheme is in addition to the Appellants’ entitlement to compensation under the 1923 Act and while all employees of Respondent No.1­HPSFC are entitled to compensation under the 1923 Act compensation under the 8.2 Lastly the Appellants have contended that as per the law not applicable Respondent No.1­HPSFC may be held liable for paying compensation to the Appellants herein. Further that would be liable. However the Respondent No.1­HPSFC had no not arise out of accident neither the Insurance Company nor was not accidental however the State Commission and the liable and otherwise Respondent No.1­HPSFC would be liable the Consumer Protection Act excludes from its ambit services rendered under the contract of employment between employer and employee and hence the complaint was not maintainable under the Consumer Protection Act qua the Respondent No.1­ as it was only a mediator for depositing the premium of 10. Learned counsel for the Respondent No. 2­Insurance Company contended that the deceased died a natural death shows that no bodily injury was caused to the deceased the 10.1 It was additionally pointed out that Proviso 4 to the Insurance Policy contains an exclusion clause whereby it is clearly provided that if the insured dies whilst under the influence of intoxicating liquor or drug claim under the Policy his death the deceased was heavily drunk and had gone and excessive drinking and cold weather asphyxia is the final medical complication. Therefore the learned counsel for the Proviso 4. It was further pointed out that there is neither any direct evidence nor any bodily injury to prove the Appellants’ the expert opinions of Dr. D.J. Das Gupta dated 6.07.1998 the deceased was in an intoxicated state at the time of death Hence the learned counsel for the Insurance Company findings of the three consumer forums. In the facts and with the impugned order dated 24.04.2009 passed by the From a bare perusal of the Insurance Policy as quoted supra it is clear that only if the insured sustains any bodily injury resulting solely and directly from accident caused by outward violent and visible means the Insurance Company Insurance Policy only accidental death of the insured shall be indemnified. As noted above the Post­Mortem Report clearly indicates that there were no injuries found on the body of the in the Post­Mortem Report is asphyxiation caused by alcohol consumption and regurgitation of food into larynx. As such we find it difficult to conclude that the deceased’s death was State Commission have rightly held that the deceased’s death 13. As for the liability of the Respondent No.1­HPSFC we are of a mediator for depositing the premium of employees with the Insurance Company and had no liability as such under the Insurance Policy. The liability of Respondent No.1­HPSFC if any would be under the 1923 Act proceedings under which have already been settled by the Commissioner as recorded in the 14. At this stage we consider it pertinent to deal with the ought to be directed to pay compensation in place of the Insurance Company on the basis of the judgment in Jamuna Devi is peculiar to the to show that the deceased in the present case was given to Therefore the directions issued in Jamuna Devi would not be 16. At this juncture we may also observe that in the communication dated 23.01.1996 addressed by the Financial Commissioner­cum­Secretary (mentioned supra) it was type of accident including road natural calamities like landslides floods drowning tree­falling avalanches etc be covered in the broader terms of the Insurance Scheme as 17. Be that as it may the Provisos of insurance policy Provided always that the company shall not be injury or disablement of the insured from whilst under the influence of intoxicating liquor or drug or by insanity (d The aforesaid Proviso 4 makes it amply clear that the In light of the aforementioned observations we decline to interfere with the Impugned Order passed by the National

Summary: The Provisos of insurance policy specifically disclose that compensation will not be paid in respect of injury of the injured if he is under the influence of intoxicating liquor and the injured was not entitled to compensation since on facts it was proved that he was intoxicated and that was due to intoxication. This judgment was passed by the Hon’ble Justice MOHAN M. SHANTANAGOUDAR of the Supreme Court in the matter of NARBADA DEVI AND ORS.  Vs. H.P. STATE FOREST CORPORATION &amp; ANR. [CIVIL APPEAL NO. 6379 OF 2010]. This appeal arose out of order and judgement of the National Consumer Disputes Redressal Commission, New Delhi allowing Revision Petition filed by the Respondent, against the order dated 9.10.2006   passed by the   Himachal   Pradesh   State   Consumer Disputes   Redressal   Commission,   Shimla   (hereinafter   ‘State Commission’) in Appeal No. 281/2004.  The factual data revealed that the deceased was returning from Banal   Depot to   Thundal along with one Chandermohan, the forest guard, on a stormy night where he was trapped and later recovered in a hapless condition around 9:00   AM, smelling of alcohol.  After being recovered, he was given a hot water bath but he could not survive. Later the forest guard filed an FIR and the respondent issued a certificate that stated that the deceased died on duty during his working tenure.  The post mortem reported asphyxia because of a choked food pipe due to intoxication. The deceased was enrolled in the Janta personal accident insurance scheme hence the decedents of the deceased were liable for the compensation from the scheme but the insurance company rejected to settle the compensation. The court relied on the definition of asphyxia in the Medicolegal Manual by Dr K.S. Narayan Reddy states that “Asphyxia is a condition caused by   interference   with   respiration,   or   due   to   lack   of   oxygen   in respired due to which  the  organs  and tissues are deprived  of oxygen   (together   with the failure   to   eliminate   CO2),   causing unconsciousness   or   death.”   The court held that “The Insurance Policy only covers ‘bodily injury resulting solely and directly from an accident caused by outward, violent and visible means (including sterilization risks)’. Since there is no evidence to show that the deceased met with an accident and the Post­Mortem Report also shows that no bodily injury was caused to the deceased, the claim is not payable under the said Policy.” The court pointed   out   that   Proviso   4   to   the Insurance   Policy   contains   an   exclusion   clause and stated that “whereby   it   is clearly   provided   that   if   the   insured   dies   whilst   under   the influence of intoxicating liquor or drug, claim under the Policy will not be payable.” The appellants’ claim was not maintainable on the grounds stating that “The facts of the present case show that on the night before his death, the deceased was heavily drunk, and had gone and slept outside on a cold, rainy October night in Chopal. In case of excessive drinking and cold weather, asphyxia is the final medical complication”.