Consumer Protection Act, 1986 – Insurance policy claim – Deficiency of service – Whether death due to malaria occasioned by a mosquito bite in Mozambique constituted a death due to accident – Insurance policy – Cover against accident – The insured was working in Assam and thereafter took employment in Mozambique where he was diagnosed with encephalitis malaria and died due to multi-organ failure – Claim filed by spouse and father of the deceased – Plea of insurer was that death due to malaria caused by a mosquito bite was a result of an infection or disease and was not an accidental death under the terms of insurance policy – All the Forums allowed the claim holding that the death was caused due to accident – On appeal, held: To be bitten by a mosquito and be imbued with a malarial parasite does involve an element of chance – But the disease which is caused as a result of the insect bite in the natural course of events cannot be regarded as an accident – Malaria is most commonly transmitted to humans through malaria virus infested mosquito bites, and when a virus is contracted through normal means brought about by everyday life, it cannot be deemed to be an unexpected or unforeseen accident – 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 instant case was caused by encephalitis malaria – 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, accounted for 5% of cases of malaria globally – 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 interpretation placed on the terms of the insurance policy by the Forums below was manifestly incorrect.
Allowing the appeal, the Court
HELD: 1. In order to constitute an accident, the event must be in the nature of an occurrence which is unnatural, unforeseen or unexpected. The instant case concerned death caused due to a disease being contracted. Section II of the insurance policy covers death caused by accident. Death or injury from accident caused by insanity or venereal disease has been specifically excluded and not covered under the policy. [Para 14] [55-B] Union of India v. Sunil Kumar Ghosh (1984) 4 SCC 246: [1985] 1 SCR 555; Regional Director, ESI Corporation v. Francis De Costa (1993) 4 Suppl. SCC
100 : [1992] 3 SCR 23; Jyothi Ademma v. Plant Engineer, Nellore (2006) 5 SCC 513 : [2006] 3 Suppl. SCR 400; Co-operators Life Insurance Company v. Randolph Charles Gibbens 2009 SCC 59 – referred to Lovelace v. Traveler’s Protective Association 47 Am. St. Rep. 638; Sinclair v. Maritime Passengers Assurance (1861) 3 E&E 478; Fenton v. Thorley & Co. Ltd. (1903) AC 443; Steel v. Cammel, Laird & Co. (1905) 2 K.B. 232; Gloria Wells v. Minnesota Life Insurance Company No. 16-20831 (5th Cir. 2018) – referred to
P Ramanatha Aiyar’s Law Lexicon 3rd Edition, 2012; A W Baker Welford’s The Law Relating to Accident Insurance 2 nd Edition, 1932; Colinvaux’s Law of Insurance 10th Ed. by Robert Merkin; P Ramanatha Aiyar’s Advanced Law Lexicon 3 rd Ed. (2005)
– referred to
2. 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. A person who suffers from flu or a viral fever cannot say that it is an accident. Of course, there is an element of chance or probability in contracting any illness. 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 a person who gets the flu cannot be described as having suffered an accident: the flu was transmitted in the natural course of things. [Para 18] [58-G-H; 59-A-C]
3. The death of the insured in the instant 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 cannot be accepted. 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. [Para 20] [60-B-D]
As published in the Supreme Court Reports, Supreme Court of India. Text from the Indian Supreme Court Judgments open data set (Dattam Labs), CC BY 4.0.
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