#LegallySpeaking: Death by mosquito bite is not an accident, ineligible for insurance payment
In an appealing case of 2016, an issue came before the National Commission to decide whether the death of a Policy owner due to Malaria after a mosquito bite can be termed as Accidental Death?
A case study:
The husband of the complainant took the home loan from a bank and along with it, he also availed the facility of Term insurance issued by the National Insurance Co. In case of accidental death, the policy amount was to be paid to the claimants.
During the continuation of the policy, the policyholder died due to Malaria and thus his legal heirs (LRs) applied to the Insurance Company for getting the sum assured. But the Insurance Company turned down the claims on grounds that Malaria itself is a disease and not an accident. Hence the LRs filed the complaint before the District consumer forum, which was allowed in their favor. Hence the Insurance Company filed the appeal in state commission, which was also rejected and the matter came to the National Commission.
The National Commission upheld both the judgments of lower forums and observed that the Policy does not define the term "Accident". It relied upon the definition of Accident given in Oxford dictionary, wherein it is defined as "An Accident is something that happens unexpectedly and not planned in advance and causes injury". Thus stating that no one can predict about the mosquito bite and it can happen anywhere and anytime, like an accident.
It relied upon the earlier judgment of Matbarsingh V/s Oriental Insurance Co. wherein it has been held that Snake-bite, dog-bite, frost-bite are also accidents. As per the above decision, death due to Dengue fever will be covered under accident policies.
Wherein the Hoonourable Supremene Court observed in Civil Appeal No. 2614 of 2019, after thorughly discussing about definition of accident by referring various other dictionaries & case law and finally held that: " illness of encephalitis Malaria through a mosquito bite cannot be considered as an accident. It was neither unexpected nor unforseen.
Source: National Insurance Co. Ltd. V/s Mosumi Bhattacharjee, (R.P. No.1270/2016)
Note: The objective of the #LegallySpeaking initiative is to spread awareness about the medicolegal implications of commonly encountered scenarios in a clinician's daily practice.