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While declining to interfere with the impugned order passed by the National Commission ("NCDRC"), the Supreme Court has recently observed that the insured is not entitled to compensation if, based on facts, it is proved that he was intoxicated and the injury was due to intoxication.

"Only if the insured sustains any bodily injury resulting solely and directly from an 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.", Division Bench of Justice Mohan M. Shantanagoudar & Justice Vineet Saran noted. 

In the present matter, the deceased working as a Daily Wage Chowkidar in Himachal Pradesh State Forest Corporation ("HPSFC") died on the morning of 8.10.1997 due to asphyxia resulting from regurgitation of food articles into the larynx and trachea after consumption of alcohol. The deceased's legal heirs laid a claim before Respondent No 2 (Insurance Policy), which was repudiated by the Insurance Company vide letter dated 17.07.1998. 

Aggrieved, the appellants 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 the part of the Insurance Company and claiming insurance amount of Rs. 2 lakhs along with interest and cost. The District Forum vide 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.

Thereafter, the Insurance Company filed an appeal before the State Commission, which 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. However, relying on The New India Assurance Co. Ltd. v. Smt. Jamuna Devi & Ors., (2002) 3 CPJ 64 (NC), 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 HPSFC and not of the Insurance Company. 

Aggrieved, Respondent No.1-HPSFC 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. Therefore, the Insurance Company had no statutory liability to compensate for the loss of life of the deceased as per the terms of the Insurance Policy. The National Commission observed that Respondent No.1-HPSFC could not avoid liability under the Workmen's Compensation Act, 1923 (‘1923 Act'), which was already presented as a claim before the Commissioner, Workmen's Compensation, Chopal by the Appellants to seek compensation under the 1923 Act. The Commissioner had passed an 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, which HPSFC challenged before Hon'ble High Court of Himachal Pradesh. The Hon'ble Court vide interim order on 6.11.2003 directed stay of operation and execution of the Commissioner's order dated 28.08.2003. Thus the National Commission noted that the matter was sub judice before the Commissioner allowed the Revision Petition. 

Thereafter, aggrieved by the order and judgement of NCDRC dated 24.04.2009 filed by the HPSFC, the appellant approached this Court. 

The Appellant's Counsel submitted 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. It was also submitted that Respondent No 1 (HPSFC) was liable to pay compensation to the appellant for the deceased's death as the deceased was never told about the applicability of the Insurance Policy in case of accidental death. 

On the other hand, HPSFC's Counsel submitted that in case of an insured's accidental death, the Insurance Company would be liable regardless of whether the death took place within the course of employment or not. 

Further, Respondent No. 2 (Insurance Company) submitted that natural death was not covered under the Insurance Policy. To further substantiate, Respondent argued that, 

"The Insurance Policy only covers "bodily injury resulting solely and directly from accidents 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 Post-Mortem Report also shows that no bodily injury was caused to the deceased, the claim is not payable under the said Policy."

The Court concerning Respondent No 1's liability noted that "As for the liability of the Respondent No.1-HPSFC, we are of the opinion that the Respondent No.1-HPSFC 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."

Thus, while dismissing the petition, the Bench upheld the findings of NCDRC & State Commission & further observed that the Insurance Company was not liable to settle the appellant's claim. 

Case Title: Narbada Devi & Ors v. H.P. State Forest Corporation & Anr.