Insurance claim - death- but no accident - natural death not covered- not entitled for claim The probable cause of death as per the Final Opinion 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 accidental. In our considered opinion, the judgment passed by the National Commission in Jamuna Devi (supra) is peculiar to the facts and circumstances of that case. There is nothing on record to show that the deceased in the present case was given to believe that the Insurance Policy covered natural death as well. Therefore, the directions issued in Jamuna Devi would not be applicable to the present case. Provided always that the company shall not be liable under this policy to: 4) Payment of compensation in respect of death, injury or disablement of the insured from (a) intentional (illegible) suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drug (c) or (illegible) by insanity, (d) arising or resulting from the insured committing any breach of the law with criminal intent.” The aforesaid Proviso 4 makes it amply clear that the injured is not entitled to compensation since on facts it is proved that he was intoxicated and that was due to intoxication.

Insurance claim - death- but no accident - natural death not covered- not entitled for claim The probable cause of death as per the Final Opinion 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 accidental. In   our   considered   opinion,   the   judgment   passed   by   the National Commission in Jamuna Devi (supra) is peculiar to the facts and circumstances of that case. 

There is nothing on record to   show  that   the  deceased   in  the  present   case  was   given   to believe that the Insurance Policy covered natural death as well.  

Therefore, the directions issued in  Jamuna  Devi  would not be applicable to the present case.

Provided always that the company shall not be liable under this policy to: 4) Payment of compensation in respect of death, injury   or   disablement   of   the   insured   from   (a) intentional (illegible) suicide or attempted suicide, (b)   whilst   under   the   influence   of   intoxicating liquor   or   drug   (c)   or   (illegible)   by   insanity,   (d) arising or resulting from the insured committing any breach of the law with criminal intent.” The   aforesaid   Proviso   4   makes   it   amply   clear   that   the injured is not entitled to compensation since on facts it is proved that he was intoxicated and that was due to intoxication.

1

NON­REPORTABLE

IN THE SUPREME COURT OF INDIA

CIVIL APPELLATE JURISDICTION

CIVIL APPEAL NO. 6379 OF 2010

NARBADA DEVI AND ORS. …APPELLANT(S) 

VERSUS

H.P. STATE FOREST CORPORATION  …RESPONDENT(S)

& ANR.

J  U  D  G  M  E  N  T

MOHAN M. SHANTANAGOUDAR, J. :

1. This   appeal   arises   out   of   order   and   judgement   of   the

National Consumer Disputes Redressal Commission, New Delhi

(hereinafter ‘National Commission’) dated 24.04.2009 (hereinafter

‘Impugned Order’), allowing Revision Petition No. 331 of 2007

filed by the Respondent No.1 herein, Himachal Pradesh State

Forest Corporation (hereinafter ‘HPSFC’), 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.

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2. The facts leading to this appeal are as follows: Om Prakash

(hereinafter  ‘deceased’)  was  an   employee of   Respondent   No.1­

HPSFC posted as a Chowkidar (daily wages) at their Divisional

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

trapped in it. On the morning of 8.10.1997, on the way to Village

Thundal, the deceased was found in a hapless condition around

9:00   AM,   smelling   of   alcohol.   When   the   Chowkidar,   Mohan

Singh, saw the deceased, he called the Forest Sub­Inspector, and

the deceased was removed to the quarter of Chandermohan. Over

there, he was given hot water bath and massaged. However, he

subsequently died at about 1:00 PM on 8.10.1997. Thereafter,

the forest guard, Chandermohan reached Chopal and lodged FIR

on   9.10.1997   at   about   2:30   P.M.   The   Assistant   Manager   of

Respondent No.1­HPSFC issued a certificate to the effect that the

deceased had died on duty while he was working as a daily­rated

Chowkidar.

3. The Post­Mortem Report dated 10.10.1997 stated that no

injury was seen on any part of the body of the deceased. Further,

3

that the cause of death was probably asphyxia resulting from

regurgitation   of   food   articles   into   larynx   and   trachea   after

consumption of alcohol amounting to about 34.5 mg per 100 ml

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

opinion was also obtained from one Dr. D.S. Puri, M.D. & former

Professor   &   Head   of   Department   of   Medicine,   Indira   Gandhi

Medical College, Shimla. As per his opinion dated 17.08.2002,

“this level of alcohol in blood and urine is sufficient to cause deep

sleep”. 

4. Under   the   Janta   Personal   Accident   Insurance   Scheme

(hereinafter ‘Insurance Scheme’), Respondent No.1­HPSFC had

taken   the   Janta   Personal   Accident   Insurance   Policy   dated

24.05.1996 (hereinafter ‘Insurance Policy’) for its 3008 employees

from   Respondent   No.2­The   New   India   Assurance   Company

Limited (hereinafter ‘Insurance Company’). Under the Insurance

Scheme, there was an insurance coverage of Rs. 1 lakh for all

4

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.,

the Appellants herein laid a claim before the Respondent No.2­

Insurance Company under the Insurance Policy; however, the

Insurance   Company   repudiated   the   claim   vide   letter   dated

17.07.1998 and hence, the claim was not settled.

5. Aggrieved by the Insurance Company’s repudiation of their

claim, the Appellants herein filed a consumer complaint under

Section 12 of the Consumer Protection Act, 1986 (‘Consumer

Protection Act’) before the District Consumer Disputes Redressal

Forum, Shimla (‘District Forum’), alleging deficiency in service on

part of the Insurance Company and claiming insurance amount

of   Rs.   2   lakhs   along   with   interest   and   cost.   By   order   dated

13.09.2004, the District Forum held that the Insurance Company

had   wrongly   repudiated   the   claim   and   was   liable   to   make

payment and indemnification of the insured amount of Rs. 2

lakhs to the Appellants. 

5

5.1 The reasoning given by the District Forum was as follows:

The   Forum  observed   that   the   only  issue   to  be   considered   is

whether the death is natural or accidental. In case of the former,

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.

Narayan Reddy which 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   failure   to   eliminate   CO2),   causing

unconsciousness   or   death.”   The   District   Forum   therefore

concluded that death by asphyxia could not be termed natural

and concluded that the death of the deceased was not natural

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 (supra)

could not be relied on as he had not examined the body of the

deceased. 

6

6. Thereafter, the Respondent No.2­Insurance Company filed

an   appeal  before  the   State   Commission,   which   was  listed  as

Appeal No. 281/2004. The State Commission in its order dated

9.10.2006 observed that the body of the deceased did not have

any external injury or mark of violence, and therefore opined that

the   death   was   not   accidental.   Hence,   the   State   Commission

concluded that the Insurance Company could not be held liable

under   the   Insurance   Policy.   However,   the   State   Commission

modified the District Forum’s order to the extent that the liability

set out in the District Forum’s order would be that of Respondent

No.1­HPSFC and not of the Insurance Company, relying upon the

decision   of   the   National   Commission   in  The New   India

Assurance Co. Ltd. v. Smt. Jamuna Devi & Ors., (2002) 3 CPJ

64 (NC).

7. Aggrieved,   the   Respondent   No.1­HPSFC   approached   the

National   Commission   by   way   of   Revision   Petition   No.   331   of

2007,   which   was   allowed   vide   the   Impugned   Order   dated

24.04.2009. The National Commission observed that the State

Commission had rightly held that the deceased’s death was not

accidental   and   therefore,   the   Insurance   Company   had   no

statutory liability to compensate the loss of life of the deceased as

7

per the terms of the Insurance Policy. Further, that Respondent

No.1­HPSFC cannot be held liable under the Insurance Policy

since it was only acting as a mediator for depositing the premium

of employees with the Insurance Company. However, the National

Commission observed that Respondent No.1­HPSFC could not

avoid   liability   under   the   Workmen’s   Compensation   Act,   1923

(hereinafter,   ‘1923   Act’).   The   Appellants   herein   had   already

presented   a   claim   before   the   Commissioner,   Workmen’s

Compensation,   Chopal   (hereinafter   ‘Commissioner’),   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

@12% p.a. to the Appellants herein. HPSFC had appealed against

the   said   award   before   the   Hon’ble   High   Court   of   Himachal

Pradesh, Shimla and the Hon’ble Court had passed an interim

order on 6.11.2003 directing stay of operation and execution of

the Commissioner’s order dated 28.08.2003. Hence the National

Commission held that the matter was already sub­judice before

the Commissioner and it would not be proper for it to record its

finding. The Revision Petition was accordingly allowed. Aggrieved,

the Appellant has come before this Court.

8

8. Learned counsel for the Appellants has argued that that the

terms   and   conditions   of   the   Insurance   Policy   were   never

communicated to the insured persons nor were they supplied

with a copy of the Insurance Policy. The deceased was not told

that   the  Insurance  Policy  was   applicable   only   in  the   case  of

accidental death and therefore, the Respondent No.1­HPSFC is

liable to pay compensation to the Appellants for the death of the

deceased. 

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

Insurance Policy is available only to those who pay the premium.

Therefore, a claim before the Commissioner under the 1923 Act

cannot preclude a claim under the Insurance Policy.

8.2 Lastly, the Appellants have contended that as per the law

laid down in Jamuna Devi (supra), even if the Insurance Policy is

not applicable, Respondent No.1­HPSFC may be held liable for

paying   compensation   to   the   Appellants   herein.   Further,   that

9

Respondent No.1­HPSFC was acting as a mediator between the

insured/deceased and the Insurance Company and hence there

was a tripartite agreement which entitles the Appellants to file a

case against the Respondent No.1­HPSFC.

9. Per contra, the learned counsel for Respondent No.1­HPSFC

argued that under the Insurance Policy, if the insured died an

accidental death, regardless of whether such death takes place

within the course of employment or not, the Insurance Company

would be liable. However, the Respondent No.1­HPSFC had no

liability under the Insurance Policy whatsoever. If the death does

not arise out of accident, neither the Insurance Company nor

HPSFC would be liable. The State Commission and the National

Commission rightly recorded concurrent findings that the death

was   not   accidental,   however,   the   State   Commission   and   the

District Forum considered the issue on the wrong premise that in

case the death was accidental, the Insurance Company would be

liable and otherwise, Respondent No.1­HPSFC would be liable.

Further, that the deceased was an employee of Respondent No.1­

HPSFC and not a consumer since the definition of “service” under

the Consumer Protection Act excludes from its ambit services

10

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

HPSFC. Lastly, that HPSFC could be held liable only under the

provisions of the 1923 Act and not under the Insurance Scheme

as   it   was   only   a   mediator   for   depositing   the   premium   of

employees with the Insurance Company.

10. Learned   counsel   for   the   Respondent   No.   2­Insurance

Company   contended   that   the   deceased   died   a   natural   death,

which is not covered under the Insurance Policy. The Insurance

Policy only covers “bodily injury resulting solely and directly from

accident caused by outward, violent and visible means (including

sterilization risks)”. Since there is no evidence to show that the

deceased met with any 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.

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

11

influence of intoxicating liquor or drug, claim under the Policy

will not be payable. 

10.2 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.   Therefore,   the   learned   counsel   for   the

Insurance Company submitted that the Appellants’ claim is not

maintainable under the Insurance Policy conditions, particularly

Proviso 4. It was further pointed out that there is neither any

direct evidence nor any bodily injury to prove the Appellants’

claim that the deceased died due to having suffered a fall during

the storm at night. The learned counsel also placed reliance on

the   expert   opinions   of   Dr.   D.J.   Das   Gupta   dated   6.07.1998

(supra) and Dr. D.S. Puri dated 17.08.2002 (supra) to show that

the deceased was in an intoxicated state at the time of death.

Hence,   the   learned   counsel   for   the   Insurance   Company

submitted that the present appeal is liable to be dismissed. 

11. We have heard the learned counsel for the parties at length

and have considered the materials placed on record as well as the

12

findings   of   the   three   consumer   forums.   In   the   facts   and

circumstances of the case, we do not find any reason to interfere

with   the   impugned   order   dated   24.04.2009   passed   by   the

National Commission for the reasons mentioned below.

12. 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

would be liable to indemnify the insured. Therefore, as per the

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

deceased. The probable cause of death as per the Final Opinion

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

accidental. Further, the expert opinions of Dr. D.S. Puri and Dr.

D.J. Das Gupta (supra) also show that the cause of death was

due to consumption of alcohol. In light of the explicit terms of the

Insurance Policy, we find that the National Commission and the

13

State Commission have rightly held that the deceased’s death

was not accidental, and that the Insurance Company would not

be liable to settle the Appellants’ claim. 

13. As for the liability of the Respondent No.1­HPSFC, we are of

the opinion that the Respondent No.1­HPSFC was only acting as

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

Impugned Order. 

14. At   this   stage,   we   consider   it   pertinent   to   deal   with   the

contention raised by the Appellants that Respondent No.1­HPSFC

ought   to   be   directed   to   pay   compensation   in   place   of   the

Insurance Company on the basis of the judgment in  Jamuna

Devi  (supra).   In   the   facts   of  Jamuna   Devi,   the   deceased

employee   in   that   case   was   also   insured   under   the   same

Insurance Scheme. Upon his death, a claim was raised which

was repudiated by the Insurance Company. When the matter

came before the National Commission by way of revision petition,

14

the National Commission held that the death was not accidental

and   therefore,   repudiation   of   the   claim   by   the   Insurance

Company   was   correct.   However,   the   National   Commission

observed from the records that the deceased therein was given to

believe that the policy covered natural death as well. The National

Commission also considered the fact that before the introduction

of   the   Scheme,   a   communication   dated   23.01.1996   was

addressed by the Financial Commissioner­cum­Secretary (PW) to

all Heads of Departments under the Government of Himachal

Pradesh giving details of the Insurance Scheme and the benefits

arising therefrom. The said letter mentioned “death” as one of the

events covered by the insurance scheme, however, it did not

specify   only   accidental   death.   Therefore,   the   National

Commission held that the employer in that case was liable to

make payment of compensation. 

15. In   our   considered   opinion,   the   judgment   passed   by   the

National Commission in Jamuna Devi (supra) is peculiar to the

facts and circumstances of that case. There is nothing on record

to   show  that   the  deceased   in  the  present   case  was   given   to

believe that the Insurance Policy covered natural death as well.

15

Therefore, the directions issued in  Jamuna  Devi  would not be

applicable to the present case.

16. At   this   juncture,   we   may   also   observe   that   in   the

communication   dated   23.01.1996   addressed   by   the   Financial

Commissioner­cum­Secretary   (PW)   (mentioned   supra),   it   was

stated that the Insurance Scheme would cover death due to any

type   of   accident   including   road,   natural   calamities   like

landslides,   floods,   drowning,   tree­falling,   avalanches,   etc.

However, the Appellants have not adduced any evidence to prove

their contention that there was indeed a storm on the night of

7.10.1997 and that the deceased fell to his death as a result, so

as to lend support to their argument that the present case may

be covered in the broader terms of the Insurance Scheme as

envisaged in the letter dated 23.01.1996. 

17. Be   that   as   it   may,   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. The relevant Proviso 4 of the insurance policy reads thus:­

“PROVISOS

16

Provided always that the company shall not be

liable under this policy to:

4) Payment of compensation in respect of death,

injury   or   disablement   of   the   insured   from   (a)

intentional (illegible) suicide or attempted suicide,

(b)   whilst   under   the   influence   of   intoxicating

liquor   or   drug   (c)   or   (illegible)   by   insanity,   (d)

arising or resulting from the insured committing

any breach of the law with criminal intent.”

The   aforesaid   Proviso   4   makes   it   amply   clear   that   the

injured is not entitled to compensation since on facts it is proved

that he was intoxicated and that was due to intoxication.

18. In light of the aforementioned observations, we decline to

interfere   with   the   Impugned   Order   passed   by   the   National

Commission. Accordingly, the Appeal stands dismissed. No order

as to costs.

…..…………................................J.

(MOHAN M. SHANTANAGOUDAR)

.……………………………...............J.

                               (VINEET SARAN)

NEW DELHI,

MARCH 22, 2021