Death By Poisoning Has to Be Based On Substantial Evidence: NCDRC

Brief Facts of the Case

The husband of the Complainant obtained an insurance policy from Life India Insurance/insurer. The policy had a sum assured of Rs. 5,00,000 with an additional Rs. 5,00,000 for accidental death benefits, totaling Rs. 10,00,000. He filled out the proposal form, underwent a medical check-up by the insurer's doctors, and paid the premium, leading to the policy issuance. Later, one day, returning home from work, he complained of acidity and vomiting. Despite treatment and being admitted, he passed away. A post-mortem suggested suspected poisoning, leading to an accidental death case, but a subsequent report found no poison. The Complainant's insurance claim was repudiated, citing false information regarding alcohol consumption and suspicion of suicide due to poisoning. Aggrieved, the Complainant filed a complaint with the District Forum. The District Forum partly allowed the complaint and directed the insurer to pay Rs. 5,00,000, along with Rs. 2,000 for mental agony and Rs. 1,000 for litigation costs. Dissatisfied, the Complainant appealed to the State Commission, which directed the insurer to pay Rs. 5,00,000 for accidental death benefit in addition to the sum assured already awarded by the District Forum. Subsequently, the insurer filed a revision petition before the National Commission.

Contentions of the Insurer

The insurer argued that the deceased policyholder was noted to be a chronic alcoholic, as per the medical summary prepared by the treating doctor, and had consumed alcohol shortly before being admitted to the hospital. This contradicted the information provided by the deceased in the proposal form, where he stated he did not consume alcohol, indicating false declarations made at the time of obtaining the policy. The cause of death was reported as organophosphate poisoning in various medical and official reports, suggesting intentional consumption of poison rather than accidental death. Although no poison was detected in the viscera during the post-mortem examination, the insurer argued that certain poisons may not leave detectable signs in such examinations, as held by the Apex Court in Mahabir Mandal and Ors. Vs. State of Bihar. The insurer also cited Clause 6 of the insurance policy, which placed the burden on them to pay the claim amount only if it is deemed valid. Despite this, they complied with the orders of the lower Fora, demonstrating their willingness to fulfill their legal obligation.

Observations by the Commission

The commission observed that the documentary evidence indicated a medicolegal case was initiated due to suspected poisoning. However, the investigating police inspector's final report noted that while vomiting and toilet use were present, there was no proof of poison consumption, pending chemical analysis. The Regional Forensic Science Laboratory of Maharashtra later concluded that no poison was found in the samples tested. The commission further observed that the State Commission's conclusion of death by poisoning was not based on substantial evidence. Despite the deceased's original claim of never consuming alcohol, his medical case summary indicated a history of chronic alcoholism and recent alcohol consumption. This suggested that his condition could have worsened for reasons other than poisoning, as no poison was detected in the chemical analysis report. The commission ruled that the State Commission erred in its conclusion, thus overturning its decision and affirming the original decision of the District Forum. Consequently, the revision petition by the insurer was allowed.

Case Title: Life Insurance Corporation Of India Vs. Rohini Swami

Case Number: R. P. No. 3456/2016