Insurer denies claim calling husband ‘drunk’ in accident, widow wins Rs 4 lakh

“The insurer failed to establish with sufficient evidence that the deceased was under the influence of alcohol. A mere mention in the post-mortem report that alcohol smell was present, without chemical analysis or any scientific examination, cannot be made the basis for rejecting an accidental death claim,” the commission said on July 7.

The dispute stemmed from a road accident that claimed the life of the complainant’s husband in December 2013. Although the family pursued the insurance claim for years, SBI General Insurance rejected it only in September 2023, citing delayed intimation and alleged drunken driving. The commission, however, held that the cause of action arose from the rejection of the claim and not from the date of the accident, making the complaint filed in March 2025 well within the limitation period.

Claim rejected

According to the complaint, Shakuntala Devi’s husband, Prahlad Rai, had purchased a personal accident insurance policy through the SBI branch at Kurasia Colliery. The policy was valid from October 30, 2013 to October 29, 2014, with Shakuntala Devi named as the nominee.

On December 24, 2013, Prahlad Rai was riding his scooter when he met with an accident at around 5.30 pm. He sustained fatal injuries and later died. A police case was registered and post-mortem was conducted. After the accident, the widow informed the insurer, completed the formalities and submitted the documents sought from time to time, including through the company’s online claim process.

However, despite repeated follow-ups, the insurance company rejected the claim through a letter dated September 22, 2023. Aggrieved, she approached the consumer commission in March 2025, alleging deficiency in service.

Insurer cited delay, alleged drunken driving

SBI General Insurance opposed the complaint, arguing that the accident had occurred in December 2013 but the claim was intimated almost ten years later, making it liable to be rejected.

The insurer also relied on the post-mortem report, contending that alcohol was found in the deceased’s stomach and that he had been driving under the influence of liquor, violating the terms of the personal accident policy. It further argued that the consumer complaint itself was barred by limitation since the accident had taken place more than a decade earlier.

Commission rejects limitation objection

The commission first dealt with the issue of limitation and rejected the insurer’s contention.

It observed that under the Consumer Protection Act, 2019, the relevant date was September 22, 2023—the day on which the insurance company formally repudiated the claim. Since the complaint was instituted on March 11, 2025, it had been filed within the prescribed two-year period and was therefore maintainable.

Mere smell of alcohol not enough

• Examining the insurer’s allegation of drunken driving, the commission found significant gaps in the evidence.
• It noted that the post-mortem report merely recorded the smell or presence of alcohol in the stomach contents. However, the doctor neither quantified the alcohol concentration nor advised any chemical or forensic examination to determine intoxication.
• There was also no laboratory report confirming the alcohol level in the blood or body, and no independent witness or material was produced to establish that the deceased was driving under the influence of alcohol.
• The commission further observed that the doctor conducting the post-mortem had specifically opined that the death resulted from head injuries and internal injuries sustained in the road accident.
• In these circumstances, it held that the insurance company had failed to discharge its burden of proving that the policy exclusion relating to intoxication was attracted.
• Holding that the repudiation lacked a proper factual and scientific basis, the commission concluded that the insurer had committed deficiency in service by denying the legitimate claim.

Relief

Allowing the complaint, the commission directed SBI General Insurance Company to pay the insured sum of Rs 4 lakh to Shakuntala Devi.

It also ordered the insurer to pay interest at the rate of 6 per cent per annum from March 11, 2025, the date on which the consumer complaint was filed, until the date of actual payment. In addition, the insurer has been directed to pay Rs 3,500 towards litigation costs.

The commission ordered that the payment be made within 60 days. If the insurer fails to comply within the stipulated period, the awarded amount will carry interest at 9 per cent per annum for the delayed period. The complaint against the State Bank of India branch was dismissed.

Significance

The ruling reinforces that an insurer cannot deny an accidental death claim merely because a post-mortem notes the smell of alcohol. Such an allegation must be backed by reliable medical or scientific evidence proving intoxication

For consumer-related grievances, individuals may contact the consumer helpline in their respective states or call the National Consumer Helpline at 1915 or 1800-233-3663 for assistance.