Navsari Consumer Commission Rules Dinner with Liquor Does Not Prove Drunkenness
In a landmark decision, the Navsari Consumer Disputes Redressal Commission has delivered a significant ruling that merely attending a dinner where liquor was ordered cannot be automatically construed as being drunk. This judgment came in response to a case involving a woman whose medical claim was rejected by an insurance company on the grounds of alleged intoxication.
Commission Directs Insurer to Honour Medical Claim and Pay Compensation
The commission has directed The Oriental Insurance Company Ltd to honour a medical claim exceeding Rs 3 lakh filed by the woman, who required surgery after a fall. Additionally, the insurer has been ordered to pay an extra Rs 5,000 as compensation for the harassment caused to the claimant during the claims process.
Details of the Incident and Claim Rejection
The incident occurred in 2024 when the woman visited a cafe in Mumbai for dinner with friends. After the meal, she suffered a fall that resulted in a serious leg injury, necessitating treatment at Breach Candy Hospital. Subsequently, she filed a claim with The Oriental Insurance Company Ltd under a policy providing coverage of Rs 8 lakh.
However, on May 19, 2025, the insurer rejected the claim, arguing that the woman had consumed alcohol and fallen while inebriated. This rejection was based on the premise that her presence at a dinner where liquor was ordered implied drunkenness.
Commission's Rationale and Legal Implications
The Navsari Consumer Commission firmly rejected the insurer's argument, stating that the mere fact of attending a social gathering where alcohol is served does not provide sufficient evidence to prove intoxication. The commission emphasized that such an assumption lacks legal merit and fails to consider individual circumstances.
This ruling underscores the importance of concrete evidence in insurance disputes and sets a precedent for similar cases where claims are denied based on speculative grounds. It reinforces consumer rights and highlights the need for insurers to base decisions on factual proof rather than presumptions.
Impact on Insurance Practices and Consumer Protection
The decision is expected to influence how insurance companies handle claims involving allegations of alcohol consumption. It serves as a reminder that rejections must be supported by clear and convincing evidence, such as medical reports or witness testimonies confirming intoxication.
For consumers, this ruling provides added protection against arbitrary claim denials and promotes fairness in the insurance sector. It also encourages insurers to adopt more transparent and evidence-based practices when assessing claims.
Reported by Vishal Patadiya, this case highlights the evolving landscape of consumer law in India and the critical role of redressal commissions in upholding justice.
