The Chandigarh District Consumer Disputes Redressal Commission has directed an insurance company and a bank to pay ₹60 lakh to the widow of a Chandigarh Police head constable, holding that a hospital record referring to a history of alcohol consumption was not enough to establish that he was intoxicated when he met with a fatal road accident.
A bench comprising Commission president Pawanjit Singh and member Mohan Sharma held that the insurer had wrongly rejected the accidental death insurance claim. It also awarded the widow ₹20,000 towards compensation for mental agony and harassment and litigation expenses.
The order was passed on September 22.
Hospital Record Did Not Establish Intoxication
The Commission noted that the hospital summary recorded a history of alcohol consumption but did not state that the deceased was under the influence of liquor at the time of the accident.
It observed that a history of alcohol consumption and being intoxicated at a particular time were not the same.
Relying on precedents of the National Consumer Disputes Redressal Commission, the Commission held that alcohol consumption mentioned in medical records, without supporting scientific or medical evidence such as a blood-alcohol test or breathalyser test, could not by itself prove intoxication.
It therefore found that the insurer was not justified in invoking the policy exclusion on that basis.
Head Constable Was Covered Under Accidental Death Policy
The deceased was serving as a head constable with Chandigarh Police and maintained his salary account with a private bank.
Under a Memorandum of Understanding dated October 30, 2021, Chandigarh Police personnel holding salary accounts with the bank were covered by a personal accidental death insurance policy.
On July 2, 2022, the head constable met with a road accident while travelling on his scooter and suffered serious injuries. He was initially taken to SPS Hospital in Ludhiana and was later referred to GMCH-32 in Chandigarh.
He died from his injuries on July 18, 2022.
His widow subsequently sought payment of the accidental death insurance benefit available under the MoU.
Insurer Rejected Claim Citing Alcohol
In October 2022, the insurance company repudiated the claim on the ground that hospital records showed that the deceased was under the influence of alcohol at the time of the accident.
The widow then approached the District Consumer Commission, alleging deficiency in service and unfair trade practice.
The insurer opposed the complaint and raised objections relating to maintainability, locus standi, concealment of facts and cause of action.
While admitting that the deceased was insured, the company argued that the policy was governed by its terms and conditions. It also contended that the head constable was not on duty at the time of the accident and that the claim fell within a policy exclusion because he was allegedly drunk.
The bank, meanwhile, maintained that its role under the MoU was limited to facilitating and forwarding the required documents to the insurer, which alone was responsible for deciding the claim.
Claim Rejection Amounted To Deficiency In Service
The Commission found that the deceased was covered by the personal accidental death insurance policy under the MoU and that his death following the July 2 accident was not disputed.
It held that the insurer had failed to establish through credible medical or scientific evidence that he was intoxicated when the accident took place.
The Commission consequently concluded that repudiation of the claim was unjustified and amounted to deficiency in service and unfair trade practice.
It directed the insurance company and the bank to pay ₹60 lakh to the widow along with ₹20,000 towards compensation for mental agony, harassment and litigation costs.
