Supreme Court Says Death Due To Insect Bite Will Not Be Covered Under Accident Insurance

Death due to accident bite: An insurable claim or not?

"In a policy of insurance which covers death due to accident, the peril insured against is an accident: an untoward happening or occurrence which is unforeseen and unexpected in the normal course of human events”

Does difference between risk of death due to an accident on a hilly area as compared to an accident on plain surface makes a difference? The Supreme Court has observed that when a disease or accident is caused by insect bite/virus in the natural course of events, it would not be covered by the definition of an accident. Doesn’t it give a straight forward answer to above question which is to say that if there is a board of accident-prone area ahead and you go in that area and suffer with an accident it shouldn’t be regarded as accident as that could have been foreseen as one could have foreseen death due to insect bite in normal course of events. As the court observed that if in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen, but not an accident if its contact or cause is expected and foreseen. The bench was dealing with an appeal against the National Consumer Commission which rejected the Insurance company's contention that malaria due to mosquito bite is a disease and not an accident. The question to be answered by the bench in Branch Manager, National Insurance Co. Ltd vs. Mousumi Bhattacharjee was whether a death due to malaria occasioned by a mosquito bite in Mozambique, constituted a death due to accident?

1. Background of the Case:

The case concerns the death of a man, Debhashis Bhattacharjee, who died of multiple organ failure after being diagnosed with encephalitis malaria contracted from a mosquito bite he sustained while working in Mozambique in 2012. After his death his spouse filed for insurance claim but the insurance claim denied the claim stating that his insurance policy covered personal accidents. After this spouse has filed litigation before the District Consumer Dispute Redressed Forum praying to pass an order for paying her the insurance amount with outstanding. But the insurance company filed their written argument stating that the death caused due to malicious decease will not be covered under accidental claim, but the plea was rejected by the forum and allowed the petition on the ground that the death due to disease is also an accident hence, the claim can be considered.

2. The Supreme Court's Decision:

The supreme court stated that accident is a term which is used to describe the term wherein the incident was not foreseen and it was not a result of normal circumstances. Thes supreme court stated that a disease which is contrasted in the course of the normal circumstances cannot be termed as accident for the purpose of the accidental insurance. The supreme court observed:

"As the law of insurance has developed, there has been a nuanced understanding of the distinction between an accident and a disease which is contracted in the natural course of human events in determining whether a policy of accident insurance would cover a disease. At one end of the spectrum is the theory that an accident postulates a mishap or an untoward happening, something which is unexpected and unforeseen. This understanding of what is an accident indicates that something which arises in the natural course of things is not an accident. This is the basis for holding that a disease may not fall for classification as an accident, when it is caused by a bodily infirmity or a condition. The court further stated that where a person suffers from flu or a viral fever cannot say that it is an accident.”

Although the court accepted the fact that there is an element of chance or probability in contracting any illness. For Instance, even when viral disease has proliferated in an area, every individual may not suffer from it. Getting a bout of flu or a viral illness may be a matter of chance. But the court said that a person who gets the flu cannot be described as having suffered an accident: the flu was transmitted in the natural course of things.

However, the court contrasting it with a situation where the affiliation or bodily condition is cause due to the unexpected and unforeseen. For instance, in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen, the bench comprising Justice DY Chandrachud and Justice Hemant Gupta observed while dealing with what it called an 'interesting question of law'.

The court stated that being “bitten by a mosquito is an unforeseen eventuality”. But in the present circumstances the mosquito bit Mr. Bhattacharjee in Mozambique, which according to World Health Organization has a population of 29.6 million people and accounts for five per cent of the cases of malaria globally. Malaria is too common in Mozambique. “It is on record that one out of three people in Mozambique is afflicted with malaria. In light of these statistics, the illness of encephalitis malaria through a mosquito bite cannot be considered as anccidentt. It was neither unexpected nor unforeseen. It was not a peril insured against in the policy of accident insurance,” Justice Chandrachud set aside the decisions of the Consumer Disputes Commission.

Setting aside the commission’s order, the bench, on the facts of the case, observed:

“In a policy of insurance which covers death due to accident, the peril insured against is an accident: an untoward happening or occurrence which is unforeseen and unexpected in the normal course of human events. The death of the insured in the present case was caused by encephalitis malaria. The claim under the policy is founded on the hypothesis that there is an element of uncertainty about whether or when a person would be the victim of a mosquito bite which is a carrier of a vector borne disease. The submission is that being bitten by a mosquito is an unforeseen eventuality and should be regarded as an accident. We do not agree with this submission. The insured was based in Mozambique. According to the World Health Organization’s World Malaria Report 2018, Mozambique, with a population of 29.6 million people, accounts for 5% of cases of malaria globally. It is also on record that one out of three people in Mozambique is afflicted with malaria. In light of these statistics, the illness of encephalitis malaria through a mosquito bite cannot be considered as an accident. It was neither unexpected nor unforeseen. It was not a peril insured against in the policy of accident insurance.”

The honourable supreme court thus held in the favour of the insurance company stating insect bite not to be an accident.

3. Interpretation of 'Accidental Death' in Insurance Policies:

Accident is described as An unpleasant event, especially in a vehicle, that happens unexpectedly and causes injury or damage, secondly something that happens unexpectedly and is not planned in advance, which is to say the accident should be one that causes damages/injury which is essential element highlighted in the aforementioned definition and in another view of definition, the scope of the term accident was widened as unforeseen and injurious occurrence due to mistake, negligence, neglect or misconduct, an unanticipated and towards event that cause(s) harm.

The court also gave an instance where a bodily condition from which an individual suffers may be the direct consequence of an accident. A motor car accident, resulting in bodily injuries, the consequence of which is death or disability which may fall within the cover of a policy of accident insurance, it said.

"Hence, it has been postulated that where a disease is caused or transmitted in the natural course of events, it would not be covered by the definition of an accident. However, in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen."

Isn’t it contradictory to one another. As there are equal chances of accident/ death/ accident in driving?

4. Implications for Policyholders and Insurance Industry:

The court made an observation that getting flu or viral illness may be a matter of chance. But a person who gets the flu cannot be described as having suffered an accident. Why? Just because a normal person get flue in normal circumstances. But a normal person can suffer accident in normal circumstances. For instance, a person can suffer accident in normal circumstances while driving a vehicle as there is always a risk on road when you drive. So, if let’s say you are driving in a accident prone area and one person is driving in non-accident prone area both suffer a crash. Would one be considered as an accident and one not? This doesn’t only lack logic but also is discriminatory and against the article-14 and 19 of Indian Constitution.

The court observed that as the United Nation report says with a population of 29.6 million people in the place of Mozambique in an account for 5% of people has caused malaria by a mosquito bite, hence is predictable that there is a chance of mosquito bite if we go there. The above findings of the apex court are completely hilarious in nature, in which the SC says mosquito bite can be predicted as Mozambique is a disease-prone area. We may have a contrary, for example, if we travel in airplane there is chance of an accident, hence if any person dead in-flight crash, it not an accident in comparison to apex court findings? Thus, in my opinion the court failed in its findings.