Upholding that poisoning by unknown persons in a train is a case of accidental death coverable under the insurance policy, the national consumer disputes redressal commission (NCDRC) directed Life Insurance Corporation of India (LIC) to pay Rs10 lakh with 9% interest and other benefits of the policy to the nominee of the deceased life assured (DLA).
In an order, the NCDRC bench of Dr Inder Jit Singh (presiding member) says, "Final report of the police, based on results of investigation has recorded possible reason of death due to illness because of taking unknown poisonous material. There is nothing on record that will conclusively lead to a finding that it was a case of suicide, as has been contended by the LIC. Most of the documents lead to a conclusion that it was possibly a case of poisoning by unknown persons, hence a case of accidental death coverable under the policy."
Karauli, Rajasthan-based Banwari Lal Gupta had sought an insurance claim for the accidental death of his brother Jugal Kishor from LIC. In December 2009, Jugal Kishore bought life insurance for Rs5 lakh from LIC, which included a double claim benefit in case of accidental death. He made Banwari Lal his nominee for the insurance policy.
On 10 July 2010, while travelling in the Jan Shatabdi train, Jugal Kishore allegedly became a victim of an attempted robbery, where he was administered a poisonous substance. Initially, he was admitted to the Railway Hospital in Gangapur city under the care of his father. However, due to the severity of his condition, he was subsequently transferred to SMS Hospital in Jaipur, where he died on 11 July 2010.
His brother Banwari Lal filed an insurance claim for Rs10 lakh (Rs5 lakh life insurance plus Rs5 lakh accidental death benefit) with LIC. However, the claim was rejected. The complaint filed by Banwari Lal before the district consumer disputes redressal commission was dismissed owing to a deficiency in required documents. He filed a case in the local court, which asked him to submit an application (for claim) and the requisite documents to the local office of LIC.
However, LIC again rejected his claim. Banwari Lal filed a second complaint before the Karauli district consumer disputes redressal commission which was dismissed over jurisdiction. He then filed a third complaint before the Sawai Madhopur district consumer disputes redressal commission.
On 1 January 2019, the district commission dismissed the complaint, saying that Jugal Kishor died by suicide. Banwari Lal contended that death was accidental since some poisonous drink was administered to his brother during the train journey by some unknown persons and he was found unconscious and, after that, died.
Banwari Lal then appealed before the Jaipur bench of the Rajasthan state consumer disputes redressal commission. On 2 August 2019, the state commission set aside the order passed by the district commission and directed LIC to pay Rs10 lakh and other benefits of the insurance policy with 9% interest to Banwari Lal, the nominee of Jugal Kishor.
After considering various facts, the state commission concluded that Jugal Kishor's death was accidental. It duly considered various case laws cited by the LIC. It observed that the viscera (of Jugal Kishor) was also positive for the presence of aluminium phosphide, and the insurance company did not submit any evidence to prove that Jugal Kishor himself had consumed aluminium phosphide.
LIC then approached NCDRC challenging the order passed by the state commission. It contended that the conclusive police final report failed to ascertain any evidence of accidental death resulting from the administration of poison to Jugal Kishor via alcohol. Furthermore, the absence of any reported theft or robbery to law enforcement casts doubt upon the validity of the theory suggesting theft and external poisoning, it says.
The counsel for Banwari Lal argued that the insurance policy's stipulated terms and conditions explicitly guarantee a payout of Rs10 lakh. "The demise of Jugal Kishor occurred as a result of poisoning during train travel, substantiated by medical prescriptions from Railway Hospital, Civil Hospital Gangapur, and SMS Hospital Jaipur, corroborated by police information, an inquiry officer's opinion, and the presence of alcohol and aluminium phosphide in the viscera report. This incident unequivocally qualifies as an accidental death and not a suicide."
"Furthermore, the presence of all these substances does not negate the possibility that they were administered by an unknown third party, thereby discrediting the notion of suicide. The absence of evidence presented by LIC supporting the claim of suicide further strengthens this argument. Additionally, there is no indication that the deceased (Jugal Kishor) faced issues with his job, family, or suffered from alcohol or drug-related problems," the counsel says.
The counsel for LIC countered the contention by asserting that the presence of ethyl alcohol and aluminium phosphide, as indicated in Jugal Kishor's reports, clearly suggests that he was heavily intoxicated by alcohol and had ingested sulphas, thereby committing suicide. "This act would trigger the application of Condition no. 6 and Condition no. 10(b)(1) of the policy, which absolves the insurance company from liability. The State Commission erred both in legal interpretation and factual understanding by allowing the complainant's initial appeal."
Dr Singh from NCDRC observed that the post-mortem report dated 11 July 2010 records that, as per information furnished by the police, and as per the panchnama, the cause of death was due to illness from taking unknown poisonous material. While the report from the medical attendant noted the cause of death as from unknown poisoning, the report from the state forensics laboratory states that on chemical examination of 'viscera', there was the presence of aluminium phosphide and ethyl alcohol.
The bench then ruled that since most documents point towards a case of poisoning by unknown persons, Jugal Kishor's death should be termed as an accidental death. NCDRC then directed LIC to pay Rs10 lakh and other benefits of the policy with 9% interest to Banwari Lal.
(Revision Petition No2513 of 2019 Date: 23 August 2023)
