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Baby Apoorva Rai v. New India Assurance Co. Ltd.
Factual and Procedural Background
The complainant is the daughter of the late Surya Kiran, who was employed as a Senior Manager by Tata Consultancy Services Ltd. (opposite party No.2) in Bangalore and a member of the company's Group Insurance Mediclaim Policy issued by New India Assurance Company Ltd. (opposite party No.1). Under the policy, compensation for bodily injury from an accident caused by an external and visible means was payable based on the insured's annual compensation up to a maximum of Rs. one crore, but the insurer was not liable for death while the insured was under the influence of intoxicating liquor or drugs.
The deceased died on September 14, 2003 by drowning in a swimming pool. Post-mortem and laboratory analysis of viscera showed 103.14 mg of ethyl alcohol per 100 ml of blood. Based on the viscera report and the policy exclusion, the insurer rejected the claim. The complainant sought payment of Rs. 1 crore (plus interest), Rs. 1 lakh as compensation, and Rs. 60,000 as litigation costs. The complaint was brought before this Commission; the insurance company resisted the claim primarily on the ground that the deceased was under the influence of intoxicating liquor at the time of death.
Legal Issues Presented
- Whether the presence of 103.14 mg of ethyl alcohol per 100 ml of blood establishes that the deceased was "under the influence of intoxicating liquor" within the meaning of the insurance policy's exclusion clause.
- If the deceased is found to have been under the influence, whether the insurer is thereby absolved of liability under the terms of the Group Insurance Mediclaim Policy.
Arguments of the Parties
Complainant's Arguments
- Counsel for the complainant relied on Modis Medical Jurisprudence and Toxicology (24th Edition) to argue that the presence of 103.14 mg/100 ml blood does not necessarily demonstrate that the deceased was under the influence of intoxicating liquor.
- The complainant's counsel pointed to textual extracts suggesting that alcohol affects individuals differently and that concentrations cited in medical texts are not definitive proof of impairment; the implication was that 103.14 mg/100 ml is not per se conclusive of intoxication.
- The complainant relied on a prior decision of the Commission in LIC of India & Anr. v. Ranjit Kaur III (2011) CPJ 232 (NC), where 86.2 mg/100 ml was found and the Commission observed that presence of alcohol by itself is not adequate proof of intoxication and that a clinical picture and nexus may be relevant.
Insurance Company's Arguments
- The insurance company maintained that the viscera report showing 103.14 mg/100 ml of ethyl alcohol is the sole and decisive evidence that the deceased was under the influence, and thus the policy exclusion applies.
- Counsel relied on an article by W.W. Thornton (Indiana Law Journal, 11.01.1928) emphasizing that legal intoxication can be established by observable impairment of judgment, senses or conduct, although that article does not prescribe a quantitative blood alcohol threshold.
- Counsel also relied on Lyons Medical Jurisprudence and Toxicology and other medical literature indicating that blood alcohol concentrations of 80–100 mg/100 ml constitute being "under the influence" and that 100 mg/100 ml (0.10%) is regarded in some standards as prima facie evidence of alcoholic intoxication; counsel cited a Commission decision (LIC of India & Anr. v. Priyanka Singh) where 109.92 mg/100 ml led to dismissal of the complaint on grounds of intoxication.
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| LIC of India & Anr. v. Ranjit Kaur III (2011) CPJ 232 (NC) | Illustration that presence of alcohol (86.2 mg/100 ml in that case) by itself may not be adequate proof of intoxication; need to consider clinical picture and nexus between drinking and the cause of death. | The court distinguished this decision because the alcohol level there (86.2 mg/100 ml) was lower than in the present case; it also treated the Commission's observation regarding nexus as obiter and not binding, noting it is contrary to the express terms of the policy which does not require a nexus to be shown. |
| LIC of India & Anr. v. Priyanka Singh (First Appeal No.368 of 2014; decision dated 14.10.2005) | Support for the proposition that a blood alcohol level around or above 100 mg/100 ml (109.92 mg in that case) can justify a finding of intoxication and disqualify the insured from policy benefits where the policy excludes death under influence. | The court relied on this precedent to support its view that the present level (103.14 mg/100 ml) is sufficient to conclude the deceased was under the influence and therefore ineligible for policy benefits; Priyanka Singh was cited as persuasive authority. |
Court's Reasoning and Analysis
The court proceeded from the undisputed factual premise that the only direct evidence relating to alcohol consumption was the laboratory viscera report showing 103.14 mg of ethyl alcohol per 100 ml of blood and that there was no direct eyewitness or clinical evidence of visible intoxication at the time of drowning.
It then considered competing medico-legal authorities and prior Commission decisions cited by the parties:
- The complainant relied on Modis Medical Jurisprudence and Toxicology to argue that 103.14 mg/100 ml does not necessarily demonstrate that the deceased was under the influence; Modis set higher thresholds (e.g., 150 mg/100 ml) for moderate intoxication in the excerpt quoted.
- The insurance company relied on:
- The Thornton article, which defines legal intoxication by observable impairment of nerves, judgment or conduct rather than by a fixed numeric threshold; the court noted this article does not specify quantitative limits.
- Lyons Medical Jurisprudence and Toxicology and the American Medical Association / National Safety Council positions indicating that 0.10% (100 mg/100 ml) can be prima facie evidence of alcoholic intoxication and that a blood alcohol concentration of 80–100 mg/100 ml corresponds to being under the influence.
- An AIIMS manual describing functional effects at various blood alcohol concentrations, including that 100 mg/100 ml and above leads to blurred vision, unsteady gait and impaired coordination—effects the court viewed as indicative of influence.
- Weighing these sources, the court stated it was not inclined to accept Modis' more permissive interpretation in light of the AIIMS manual and Lyons, which corroborated each other. The court considered the international and national standards for permissible blood alcohol for driving (noting India permits only 30 mg/100 ml while many countries set limits around 100 mg/100 ml) as relevant by analogy: although this was not a driving case, the underlying purpose of such limits (preventing accidents caused or contributed to by alcohol) is similar to the insurer's rationale for excluding coverage where intoxication contributed to the accident.
- The court emphasized the policy's clear exclusion: the insurer is absolved where the insured was under the influence of intoxicating liquor at the time of the accident; the policy does not require proof of a causal nexus between drinking and the accident.
- Given the viscera report of 103.14 mg/100 ml, which exceeds the 100 mg/100 ml threshold recognized in Lyons and AIIMS material as indicating impairment, and taking Priyanka Singh (109.92 mg/100 ml) as supporting authority, the court found it reasonable to conclude the deceased was under the influence at the time of death.
- The court also noted the absence of any explanation for how the drowning occurred and observed there was a "strong possibility" that alcohol consumption had led or contributed to the drowning, which aligned with the purpose of the policy exclusion.
- Regarding Ranjit Kaur, the court treated the Commission's observation requiring nexus as obiter and not determinative, observing that it conflicts with the express terms of the policy.
Holding and Implications
COMPLAINT DISMISSED.
Holding: The court held that, on the basis of the viscera report showing 103.14 mg of ethyl alcohol per 100 ml of blood and the medical literature it found persuasive (AIIMS manual and Lyons), the deceased was under the influence of intoxicating liquor at the time he got drowned. As a consequence, the insurer was not liable to make any payment under the terms of the policy, which excludes coverage for death while the insured is under the influence of intoxicating liquor.
Direct effect on the parties: The complainant's claim for policy benefits (including the Rs. 1 crore claimed) was dismissed; the insurer (New India Assurance Company Ltd.) is not required to make payment under the policy. The court made no order as to costs.
Broader implications: The opinion applied existing medico-legal thresholds and prior Commission authority to conclude that a blood alcohol level slightly in excess of 100 mg/100 ml is sufficient to establish that the insured was "under the influence" for purposes of a policy exclusion. The opinion does not state that it establishes a new legal precedent beyond this decision.
JUSTICE V.K. JAIN, PRESIDING MEMBER The complainant before us is the daughter of late Surya Kiran, who was working as a Senior Manager with opposite party No.2 Tata Consultancy Services Ltd., at Bangalore. Being an employee of TCS, he was also a member of the Group Insurance Mediclaim Policy taken by the said company from opposite party No.1, New India Assurance Company Ltd. In terms of the aforesaid policy, if an employee was to sustain bodily injury solely and directly from accident caused by an external and visible means, the insurer was liable to pay a compensation based upon the annual compensation of the employee, subject to maximum of Rs. one crore. Late Shri Surya Kiran, who was drawing a gross salary of Rs.1,89,696/- per month in August, 2003, expired on September 14, 2003 when he got drowned in a swimming pool. As per the post-mortem conducted on his body, he died due to asphyxia as a result of drowning and he had consumed alcohol prior to his death. The viscera report in respect of the deceased was analysed by the laboratory and it was reported that he had 103.14 mg of ethyl alcohol in100 ml of his blood. As per the terms of the policy taken by opposite party No.2, the insurer was not liable in case of death while under the influence of intoxicating liquor or drugs. In view of the finding in the viscera report, the claim lodged with the insurance company was rejected on the ground that he was under influence of intoxicating liquor at the time he died. Being aggrieved, the complainant is before us, seeking payment of a sum of Rupees one crore, along with interest and the compensation quantified at Rupees one lac, besides Rs.60,000/- as the cost of litigation.
2. The complaint has been resisted by the insurance company, primarily on the ground that the deceased was under the influence of intoxicating liquor at the time he died and therefore, the insurance company was not liable to pay any amount to his legal heirs.
3. There is no direct evidence of the deceased being under influence of intoxicating liquor at the time he got drowned in the swimming pool. The only evidence relied upon the insurance company to substantiate the plea that he was under the influence of intoxicating liquor at the time he died, is the report of the laboratory reporting presence of 103.14 mg of ethyl alcohol per 100 ml of the blood of the deceased.
4. Relying upon Modis Medical Jurisprudence and Toxicology, 24 Edition, the learnedth counsel for the complainants submitted that the presence of 103.14 mg/100 ml of the blood does not lead to the conclusion that the deceased was under the influence of intoxicating liquor. He relied upon the following extract from the above-referred text book: It is generally believed that a person with a concentration of 0.1 per cent alcohol in the blood appears to be gay and vivacious, and those with a concentration of 0.15 per cent alcohol in the blood are regarded as fit to drive a motor vehicle. This concentration of alcohol in the blood is regarded as a presumptive limit of safety, and may result from the rapid consumption of 8 ounces of whisky of 4 to 5 pints of beer. Alcohol acts differently on different individuals and also on the same individual at different times. The action depends mostly on the environment and temperature of the individuals and upon the degree of dilution of the alcohol consumed. The habitual drinker usually shows fewer effects from the same dose of alcohol. Barbiturates, benzodiazepines, antihistamines, tranquillizers, chlorpromazine and insulin, potentiate the action of alcohol, while epileptics or persons who have suffered from a head injury may show an increased effect to a small quantity of alcohol. It would thus be seen that in the opinion of the Author, the percentage of alcohol in the blood would be 0.2% in case, the quantity of alcohol per 100 ml of blood is 200 mg. Thus, a person who has 200 mg alcohol per 100 ml. of his blood can be said to be moderate intoxicated, if we go by the above referred opinion. A person with a concentration of 0.15% alcohol in the blood is regarded to be fit to drive a motor vehicle. 0.15% of alcohol in the blood comes only if he has
150 mg of alcohol per 100 ml. of his blood.
5. The learned counsel for the insurance company, however, relied upon an Article titled While Under the Influence of Intoxicating Liquor written by W.W. Thornton and published on 11.01.1928 in Indiana Law Journal. The question considered in the above referred Article was as to what condition must a driver of a motor vehicle be in to be under the influence of intoxicating liquor or narcotic drugs? The Author extracted the following observations from the judicial pronouncements considered by him: A person is drunk in legal sense when he is so far under the influence of intoxicating liquors that his nerves are visibly excited or his judgment impaired by the liquor. Intoxicated condition means that if the person were in such a state that he was incapable of giving the attention to what he was doing, which a man of prudent and reasonable intelligence would give. When it appears that a person is under the influence of liquor, or when his manner is unusual or abnormal, and his inhibited condition is reflected in his walk or conversation, when his ordinary judgment and common sense are disturbed, or his usual will power is temporarily suspended, when they or similar symptoms result from the use of liquors and are manifest, then the person is intoxicated. It is not necessary that the person would be so-called dead-drunk or hopelessly intoxicated. It is enough that his sense are obviously destroyed or distracted by the use of intoxicating liquors within the meaning of the statute authorizing recovery of damages against a saloon keeper who sells liquors to an intoxicated person. Under the law a man is intoxicated whenever he is so much under the influence of spirituous or intoxicating liquors that it so operates upon him, that it so affects his acts, or conduct or movement, that the public or parties coming in contact with him could readily see and know that it was affecting him in that respect. A man to that extent under the influence of liquor that parties coming in contact with him, or seeing him, would readily know that he was under the influence of liquor, by his conduct or his words or his movements, would be sufficient to show that such party was intoxicated. Whenever a man is under the influence of liquor so as not to be entirely at himself, he is intoxicated; although he can walk straight although he may attend to his business, and may not give any outward and visible signs to the casual observer that he is drunk, yet if he is under the influence of liquor so as not to be at himself, so as to be excited from it, and not to possess that clearness of intellect and that control of himself that he otherwise would have, he is intoxicated. It would thus be seen that the Article relied upon by the learned counsel for the opposite party is not based on the quantity of the alcohol found in the blood of a person. This Article does not go into the question as to how much quantity of the ethyl alcohol in the blood of a person can lead to the inference that he was under influence of intoxicating liquor.
6. The learned counsel for the opposite party has also relied upon the following information in Lyons Medical Jurisprudence and Toxicology: The American Medical Association and the National Safety Council of USA have adopted the following policy statement with regard to intoxication Blood alcohol of 0.10% can be accepted as prima facie evidence of alcoholic intoxication, recognizing that many individuals are under the influence in the 0.05 to 0.10% range. The Uniform Vehicle Code of USA 1962 has as its standards: Blood alcohol of 0.05% or less raises a presumption that the subject was not under the influence of alcoholic beverage; blood alcohol in excess of 0.05% but less than 0.10% raises no presumption of intoxication or soberness; blood alcohol of 0.10% or more raises the presumption that the subject was under the influence of alcoholic beverage. In different countries the prescribed limit for permissible blood alcohol is as follows: India - 30 mg% USA - 100 mg% Australia - 40 mg% Terminologies used in medico-legal context: The following terminologies are employed in medico-legal cases. Their exact meaning should be understood. Sober blood alcohol concentration of less than 10 mg% Drinking Blood alcohol concentration of 20-70 mg% Under the influence of alcohol blood alcohol concentration of 80-100 mg% Drunk or intoxicated blood alcohol concentration of 150-300 mg% Coma and death blood alcohol concentration in excess of 400 mg%. As per the above referred text book, a person is under the influence of alcohol when the blood alcohol concentration is 80-100mg/100 ml of the blood. The above referred text book also shows that the USA, which is most liberal, as far as the quantity of alcohol which a person can consume at the time of driving also allows only upto 100 mg alcohol/100 ml of the blood. It further shows that if the alcohol content is .1%, it would be the prima facie evidence of alcoholic intoxication. Blood alcohol percentage of .1% comes when the quantity of ethyl alcohol in the blood is 100 mg/100 ml of the blood. Thus, if we go by the text book of Modi, a person, who has consumed less than 150 mg of alcohol per 100 ml. of his blood, cannot be said to be under influence of intoxication, whereas as per the text book of Lyons, a person having 100 mg or more per 100 ml of blood will be said to be under influence of alcohol.
7. In a Manual for Physicians in National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi the effects of alcohol has been stated as under: BAC mg/dl Effects
80 Euphoria, feeling of relaxation and talking freely, clumsy movement ofhands and legs, reduced alertness but believes himself to be alert. 100-200 Noisy, moody, impaired judgement, impaired driving ability Electroencephalographic changes begin to appear, Blurred vision, unsteady gait, gross motor in-coordination, slurred speech, aggressive, quarrelsome, talking loudly. 200-300 Amnesia for the experience blackout. 300-350 Coma 355-600 May cause or contribute to death It would thus be seen that in terms of the above referred compilation issued by the AIIMS, if the quantity of alcohol in the blood is 100 or more mg. /dl (100 ml), it leads to vision getting blurred, the gait become unsteady and the coordination gets affected. These changes, in our opinion, can occur only when someone is already under the influence of alcohol by that time. The judgment of the drinker as well as his driving ability gets affected even where the quantity of alcohol in the blood is 80 mg or more per 100 ml of the blood.
8. The learned counsel for the complainant has relied upon the decision of this Commission in where the quantity of alcoholLIC of India & Anr. Vs. Ranjit Kaur III (2011) CPJ 232 (NC), in the blood was found to be 86.2 mg./100 ml of blood. Ruling in favour of the complainant, this Commission inter-alia observed as under: It has also come in evidence that this by itself is not adequate proof that the deceased was intoxicated at the time of his death. As rightly observed by the learned Fora below, the specific clinical picture of alcohol intoxication also depends on the quantity and frequency of consumption and duration of drinking at that level and, therefore, mere presence of alcohol even above the usually prescribed limits is not a conclusive proof of intoxication. Apart from this, there is also no evidence that there was a nexus between the death caused by electric shock and consumption of liquor.
9. The learned counsel for the opposite party, on the other hand has relied upon the decision of this Commission in LIC of India & Anr. Vs. Priyanka Singh First Appeal No.368 of 2014 In the above referred case, 109.92 mg of ethyl alcohol per 100 ml ofdecided on 14.10.2005. blood was found in the body of the insured. Dismissing the complaint, this Commission, inter-alia observed and held as under: As per the medical literature, HWV COX Medical Jurisprudence and Toxicology, Seventh Edition PC Dikshit brought on record, there are three stages of alcoholic intoxication, which reads as follows: Stage of Excitement (50 to 150 mg percent) Feeling of well-being slight excitement, increased confidence, lack of self-control are usually seen. There is a heightened sexual desire, but performance is reduced. The visual acuity is reduced. It also alters time and space orientation. There is poor judgment and mental concentration is retarded. The learned counsel for the complainant/respondent in the above referred case relied upon the text book of Biochemistry as per which quantity of 50-150 mg was described as Pre-intoxication in which there are signs of instability, decreased neuromuscular coordination and the judgment and control required for quick responses such as car driving are impaired. Whereas in intoxicating stage (150-300 mg/dl) speech is impaired and motor skills are incoordinated. However, relying upon the Medical Literature produced by the appellant Corporation, this Commission held that the deceased was under intoxication as a result of consumption of alcohol found in his blood sample, making him ineligible to the benefits of double accident policy. It would be pertinent to note that in the above referred case, no amount was payable in case the insured was under influence of intoxicating liquor drug or narcotics.
10. Considering the opinion expressed in the Manual issued by All India Institute of Medical Sciences, which is the premier most medical Institution in this Country, we are not inclined to accept the opinion expressed in Modis Medical Jurisprudence and Toxicology, particularly when the opinion of AIIMS also find corroboration from the opinion expressed in Lyons Medical Jurisprudence and Toxicology. Though, this is not a case of the death while driving after consuming alcohol, the maximum quantity of alcohol permitted by various countries for a person to drive a motor vehicle cannot be said to be an altogether irrelevant since the purpose of prohibiting driving after consuming liquor beyond the prescribed quantity is to ensure that the driver does not commit an accident on account of the effect of liquor on him. The purpose of the insurer behind excluding the cases of accident when the insured is under influence of intoxicating liquor is to ensure that the consumption of the liquor does not lead or contribute to happening of the accident in which the insured dies or injured. Therefore, consumption of liquor beyond a safe limit must necessarily disqualify the insured from getting the benefits of the insurance policy taken by him. The quantity of alcohol allowed to the driver of a motor vehicle is not more than
100 mg/100 ml of the blood in any country, including USA though, in our country it is only 30 mg/100 ml of blood. Therefore, in our opinion, if a person is found to have consumed more than 103.14 mg of alcohol/100 ml of his blood, which is position in the case before us, it would be reasonable to say that he was under the influence of the intoxicating liquor at the time he died or got injured. We are fortified in taking this view from the decision of this Commission in Priyanka Singh (supra). As far as the decision of this Commission in Ranjit Kaur (supra) is concerned, we find that the quantity of alcohol in the blood of the insured in that case was of 86.2 mg, which was much less than quantity of the alcohol found in the blood of the deceased Surya Kiran. Though in Ranjit Kaur (supra), this Commission, inter-alia observed that there was no nexus between the death caused by electric shock in consumption of liquor, the aforesaid observation is only an obiter and does not constitute the of the case. In fact, the aforesaid obiterratio decidendi is contrary to the express terms of the insurance policy which absolves the insurer of its obligation under the policy, in case the insured was under the influence of the intoxicating liquor at the time of the accident and the policy does not require any nexus to be shown between the case of accident and the consumption of liquor.
11. Yet another aspect of this case is that the deceased died due to drowning in the swimming pool. This is not the case of the complainant that the deceased had entered the swimming pool without knowing how to swim. There is no explanation in the complaint as to how the deceased got drowned in the swimming pool. Considering the quantity of liquor found in his blood, there is a strong possibility of the consumption of liquor having led or contributed to his getting drowned in the swimming pool.
12. For the reasons stated hereinabove, we are of the considered view that since the deceased was under influence of intoxicating liquor at the time he got drowned in the swimming pool, the respondent company is not liable to make any payment to the complainant, in terms of the policy taken by the deceased. The complaint is therefore, dismissed. No order as costs. ......................J
V.K. JAIN PRESIDING MEMBER ...................... DR. B.C. GUPTA MEMBER
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