Insurer should prove insured was under influence of alcohol to deny accident claim: Kerala HC

Kochi: High court, in a significant judgment, held that an insurer cannot repudiate an accident benefit claim solely on the basis of a toxicology report indicating the presence of alcohol without proving that the insured was under the influence of alcohol.Justice Harisankar V Menon issued the ruling while upholding an order of the permanent lok adalat, Thiruvananthapuram, awarding Rs 15 lakh to the legal heirs of Babu of Vilappilsala, Thiruvananthapuram, who met with an accident while riding a motorcycle on Nov 30, 2020. Babu was found unconscious on the roadside and was rushed to a hospital by ambulance. He underwent treatment but succumbed to his injuries on Dec 1.

As he was covered under a motorcycle package policy, his legal heirs, including his wife and two daughters, filed a claim before the permanent lok adalat. The adalat allowed the claim and awarded Rs 15 lakh, prompting the insurance company to challenge the order before HC.In the appeal, the insurance company contended that Babu’s toxicology report tested positive for alcohol and that the postmortem report stated the cause of death as ‘occlusive coronary artery disease.’

It also relied on the FIR, which stated that the death was not attributed to the accident. Referring to the toxicology report, HC considered whether the mere consumption of alcohol was sufficient to conclude that the deceased was under the “influence of alcohol”.

HC found that, despite the toxicology report, there was no evidence on record to establish that the deceased was under the influence of alcohol at the time of accident.

Accordingly, it held that the insurer could not repudiate the claim merely because the deceased had consumed alcohol without proving that he was under its influence.HC further noted that the deceased had sustained seven injuries in the accident and that the postmortem report clearly stated that “the death was due to occlusive coronary artery disease and injuries could have accelerated or precipitated death.” Similarly, it observed that the mere fact that the FIR did not attribute the death to the accident could not, by itself, be a ground to deny the insurance claim. Accordingly, the appeal was dismissed.