LIC told to pay Rs 1.80L to Chandigarh woman whose ‘drunk’ husband died after slipping on floor

Pinki stated that even though the LIC was supposed to pay double the amount of the sum assured — which is Rs 1.50 lakh with premium, the insurance company had disbursed only Rs 1,74,948, which is ordinary claim of the sum assured with other benefits.

The medical record of her husband showed cause of death as “cerebral damage consequent to blunt trauma to head” and “chronic alcoholism”, and alcoholism was not the cause of death as such the claim for double accident benefit of Rs 1.50 lakh was to be paid to her, which was rejected. Pinki thus filed a case at the forum on November 26, 2018.

LIC’s Panchkula branch and its manager, submitted in reply that Harish Kumar had a fell on the floor after slipping in the bathroom which had caused severe head injury. However, Kumar had died due to slipping on the floor after consumption of alcohol. “It is clear violation of the terms and conditions of the policy and he had given answer in negative with regard to the consumption of alcohol. As such, it could not have been categorized as an accidental death, therefore, ordinary claim of the sum of Rs.1,50,000 was disbursed to the complainant’s widow and nominee and not double claim as it was not classified as an accidental death.”

The forum after hearing to the arguments held that “…medical certificate of cause of death also shows the alleged history of fall from height. It is not the case, at the time of initial admission or say treatment conducted, deceased was found to have consumed alcohol…it was nowhere recorded by the doctor, any disease i.e. chronic alcoholism or say which causes liver cirrhosis and had died of the same. There is no record to this effect, but, the primary cause was severe head injury with a fall.”

The forum, in the judgment released on October 4, held that “…if a person consumes alcohol, it does not mean that he has to suffer a fall or it is also not the case, liquor was consumed in excess so he had lost his balance of mind as a result of which he fell on the floor and had suffered injuries… Merely drawing assumptions and presumptions that he used to consume alcohol or say he had a fall in a fit of intoxication of alcohol cannot take place of a proof…”

Thus holding that the death of Kumar was accidental, the forum directed LIC to pay Rs 1.50 lakh to the complainant along with an interest at 9 percent per annum from January 9, 2018 till realisation, along with it Rs 20,000 as compensation and Rs 10,000 as cost of litigation