Seven years after a dairy farmer died in a road accident in Telangana’s Khammam district, a consumer court has faulted an insurer for rejecting his widow’s claim. In addition to the claim amount of Rs 2 lakh with 9 per cent interest from February 2022, Ponnam Padma will also get Rs 20,000 in compensation for mental agony caused and Rs 10,000 towards costs.
Ponnam Muthaiah, a milk vendor with the Heritage Milk Collection Centre at Narayanapuram, was insured with United India Insurance Co Ltd under the group personal accident coverage of Rs 2 lakh provided by Heritage Milk Products Pvt Ltd to each of its vendors. On 5 September 2016, Muthaiah fell from his TVS moped while returning to the village in the evening and succumbed to severe injuries at a private hospital on September 12.
While the Bonakal police registered an FIR and referred to the case in their final report as one of “accidental death” due to a fall from a TVS moped, the insurance company rejected Muthaiah’s settlement claim six months later, in June 2017, citing “false reason” and claimed that the 50-year-old was under the influence of alcohol at the time of his death.
The manager of Heritage Milk Products Pvt Ltd informed the court that the claim was rejected by the insurance company as per the conditions in the policy. The corporate cell of United India Insurance Co Ltd said the policy coverage was subject to terms, conditions, limitations, definitions, exceptions etc.
The insurer submitted copies of the FIR, outpatient card and the postmortem examination report and cited medical records from the hospital to state that “P Muthaiah fell from the bike due to ‘influence of alcohol’ on 05/09/2016” and hence the company was not liable to pay the compensation.
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The District Consumer Disputes Redressal Commission at Nalgonda, comprising president Mamidi Christopher and members S Sandhya Rani and K Venkateshwarlu, heard the plea of Padma, Muthaiah’s widow. Referring to earlier judgments on accidental deaths, the court recalled that it cannot be concluded that he was under alcoholic influence merely because the case history reveals the factum of alcohol influence without any supporting evidence.
Noting that Muthaiah, according to the periodic medical examination report, died due to a head injury leading to cardio-respiratory failure, the court found no basis in the claim, other than a mention of the history of the deceased in the outpatient card, that he was under the influence of alcohol at the time of the accident.
“There is no proof or mention of any intoxicating substance in the entire exhibits filed by opposite party No.3 (United India Insurance Co Ltd) in support of their contention. Opposite parties No.2 (Heritage Milk Products Pvt Ltd) and 3 have failed to establish that the deceased had died due to intoxicating liquor at the time of the accident. Opposite party No.3 in order to escape from their liability had repudiated the genuine claim of the complainant. Therefore, there is a deficiency in service and negligence on the part of Opposite party No.3 in repudiating the claim of the complainant,” the court said.
