File Accident Insurance Claim Even if Death is by Malaria or Dog Bite !

0
346
Print Friendly

accidental insurance claimIn case a person bought an accident insurance plan , it will hardly come to the mind of his /her legal heir to file an accident insuarnce claim if the diseased insured person did not die because of an accident like road or air or train or building collapse etc. More so , the thought of filing an insurance claim will also not come up if he /she dies on account of mosquito bite i.e Malaria or due to Dengue or the dog bite etc. Because , it is quite normal to treat such death as a non-accidental misfortune in our life.

However , law does not take words and conditions for granted. So ,when  one person persevered to know why death due to Malaria can not be covered under accidental insurance , the court has given verdict in favour of her. With that , the gate for many more claim is also now opened up  to file an accident insurance claim even if the death was not  on account of an “accident on road ” or on train or air …..but by some kind of disease that suddenly attacked a person and take away his/her life . 

A ruling by National Consumer Dispute Redressal Commission recently is quite interesting and worth knowing for all buyers of the accident insurance. The issue whether the death of a Policy holder due to Malaria after a mosquito bite can be termed as accidental Death  came up before the National Commission in National Insurance Co. Ltd. V/s Mosumi Bhattacharjee, (R.P. No.1270/2016). The answer of the commission was Yes .

Facts of the case

A person took home loan from Bank of Baroda and also availed facility of term insurance policy by name “Bank of Baroda Loan Suraksha Vima”, issued by the National Insurance Co. under which  the policy amount was to be paid to the claimants on his death by accident. The Policy holder died due to Malaria when the policy was in active.

The Insurance Company rejected the claim filed by the wife of the person on the ground that the death was not account of the accident , but a disease.

The legal heir  filed a complaint before the District consumer forum, which was allowed in their favour.The Insurance Company challenged the order before the state commission, which was  rejected . Then the insurance company approached , National Consumer Dispute Redressal Commission .  But , this also went against the National Insurance.

Excerpt from the Order in Mausomi Bhattacharya Case

The word ‘accident’ is defined as (i) as incident, an unforeseen injurious occurrence, something that does not come in the usual course of event or that cannot be reasonably anticipated, (ii) an unforeseen and injurious occurrence due to mistake, negligence, neglect or misconduct; an unanticipated and untoward event that cause harm, (In Black’s Law Dictionary (Ninth Edition).

6.      It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act or omission on the part of the victim. In Consumer Complaint No. 223 of 2006, Shri Matber Singh Vs. Oriental Insurance Co. Ltd., decided on 05.09.2014, this Commission noted that as per the information available on the website of the Insurance Company, an accident may include events like snake bite, frost bite and dog bite.  Hence, it would be difficult to accept the contention that malaria due to mosquito bite is a disease and not an accident.

 

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
REVISION PETITION NO. 1270 OF 2016
(Against the Order dated 02/02/2016 in Appeal No. 469/2014 of the State Commission West Bengal)
1. BRANCH MANAGER, NATIONAL INSURANCE COMPANY LTD.
THROUGH MANAGER, NATIOAL INSURANCE COMPANY LTD., NATIONAL LEGAL VERTICAL OFFICE OF GENERAL MANAGER-NORTH 2E/9, JHANDEWALAN EXTENSION IIND FLOOR,
NEW DELHI-110055
………..Petitioner(s)
Versus
1. MOUSUMI BHATTACHARJEE & 2 ORS.
W/O LATE DEBASISH BHATTACHARJEE, OMKAR ENCLAVE FLAT NO. 2C, DESPARA CHIRIYAMORE, KAIKHALI, P.S. AIRPORT,KOLKATA-700052
DISTT-NORTH 24 PGS.,
WEST BENGAL
2. SRI SWAGAT BHATTACHARJEE
OMKAR ENCLAVE FLAT NO. 2C, DESPARA CHIRIYAMORE, KAIKHALI, P.S. AIRPORT,KOLKATA-700052
DISTT. NORTH 24 PGS.
WEST BENGAL
3. BRANCH MANAGER, BANK OF BARODA,
TEGHORIA BR. JAMUNOTRI APARTMENT, TEGHORIA, VIP ROAD, OPP. HALDIRAM, P.S. AIRPORT,
KOLKATA-700052
WEST BENGAL
………..Respondent(s)

 

BEFORE:
HON’BLE MR. JUSTICE V.K. JAIN, PRESIDING MEMBER
HON’BLE MR. ANUP K THAKUR, MEMBER

 

For the Petitioner :
Ms. Sakshi Gupta, Advocate
For the Respondent :

Dated : 12 May 2016

ORDER
JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL)

 

The husband of respondent no.1 and father of the respondent no.2, namely Shri Debasish Bhattacharjee took a housing loan from Bank of Baroda for purchase of a house.  He also obtained an insurance policy namely “Bank of Baroda Home Loan Suraksha Bima” issued by the petitioner/National Insurance Co. Ltd. Under the said policy, the sum insured was payable in case of death of the insured inter alia due to accident. Late Shri Debasish Bhattacharjee died at a hospital on 22.1.2012.  On his death, a claim by his legal heirs was submitted to the insurer in order to enable them to liquidate the housing loan taken by the deceased.  The claim, however, was not paid. Being aggrieved they approached the concerned District Forum by way of compliant.

2.      The insurer resisted the claim on the ground that the deceased having died due to mosquito bite, his death was not due to an accident and therefore, the sum assured was not payable to the complainants.  The stand taken by the insurer was that malaria due to mosquito bite was an infection/disease and not an accident.

3.      Vide its order dated 28.2.2014, District Forum allowed the complaint.  Being aggrieved, the insurer approached the concerned State Commission by way of appeal. Vide impugned order dated 2.2.2016, the State Commission dismissed the appeal filed by the insurer. Being still dissatisfied, the insurance company is before us by way of this revision petition.

4.      The insurance policy which the deceased had taken in his life time, to the extent it is relevant, is read as under:-

Section II covers the following perils

  1. Death due to accident
  2. Accidental loss of two limbs, two eyes or one limb and one eye
  3. Permanent total disablement from injuries other than that named above.

 

 

  1. Loss of one limb or one eye
  2. Any accidental injury or loss not mentioned under Section – II above.
  3. Cumulative Bonus
  4. Education fund
  5. Cost of transportation of the dead body
  6. Persons below the age of 18 years at the time of disbursement of loan and above 60 years at the end of repayment period.
  7. People having hysteria
  8. Death or accident resulting from intentional self-injury, suicide or attempted suicide.
  9. Death or injury from accident whilst under the influence of intoxicating liquor or drug
  10. Death or injury from accident caused by insanity or veneral disease.
  11. Death or injury from accident arising or resulting from the insured committing any breach of law with criminal intent
  12. War or was like operations
  13. Lionizing radiations or contamination by radioactivity
  14. Loss by delay, loss of market or any other consequential or indirect loss or damage
  15. Default in repayment of installments and or loan due to any reason whatsoever except due to the occurrence of insured peril.

 

5.      The only question which arises for our consideration in this petition is as to whether the death due to malaria on account of mosquito bite can be said to be a death due to accident or not.  The term “accident” has not been defined in the policy which the deceased had taken and therefore contextual dictionary meaning of the said term has to be taken for the purpose of deciding whether the death of the deceased was due to an accident or not.  An accident is something that happens unexpectedly and is not planned in advance.  It is defined as (i) an unpleasant event, especially in a vehicle, that happens unexpectedly and causes injury or damage, (ii) something that happens unexpectedly and is not planned in advance, in the Oxford Advanced Learner’s Dictionary (New 8th Edition).  The word ‘accident’ is defined as (i) as incident, an unforeseen injurious occurrence, something that does not come in the usual course of event or that cannot be reasonably anticipated, (ii) an unforeseen and injurious occurrence due to mistake, negligence, neglect or misconduct; an unanticipated and untoward event that cause harm, (In Black’s Law Dictionary (Ninth Edition).

6.      It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act or omission on the part of the victim. In Consumer Complaint No. 223 of 2006, Shri Matber Singh Vs. Oriental Insurance Co. Ltd., decided on 05.09.2014, this Commission noted that as per the information available on the website of the Insurance Company, an accident may include events like snake bite, frost bite and dog bite.  Hence, it would be difficult to accept the contention that malaria due to mosquito bite is a disease and not an accident.

7.      In view of the above referred discussion, it is difficult for us to accept that the death due to mosquito bite would not be a death due to an accident.  We therefore, find no merit in the revision petition. It is accordingly dismissed.

………………….J
V.K. JAIN
PRESIDING MEMBER
………………….J
ANUP K THAKUR
MEMBER