The Branch Manager, National Insurance Co. Ltd.

v.
Mousumi Bhattacharjee and Ors.

Insurance on Death Caused by Accident

 FACTS

• Debashis Bhattacharjee applies for housing loan of amount 13.15Lakhs from Bank of Baroda.
Repayable in 113 monthly instalments at Rs. 19,105/-.

• With which, he availed the facility of insurance scheme, “National Insurance Home Loan Suraksha
Bima.”

• The insurance policy provided for two applicable section as the subject matter of this case. Section I
provided for house against fire and allied perils. And Section II provides for borrower against
personal accidents.

• However, the term ‘accident’ was not defined in the insurance policy.
 • Debashis worked as a Manager of a Tea Estate in Assam. Then in
2012, took employment in Cha-De-Magoma district of
Mozambique without informing his insurance company.

• On 14 November 2012, he was admitted to the hospital and

diagnosed with encephalitis malaria and died on 22 November
due to multi-organ failure.

FACTS • The heirs claimed against the insurance company for deficiency of
service on their interpretation of the occurrence of death of Mr.
Bhattarcharjee as an accident. Which was covered under
Section II of the insurance policy.

• The insurer claimed that death due to mosquito bite causing malaria
cannot be deemed as death by accident.
Whether a death due to malaria occasioned by a
mosquito bite in Mozambique, constituted a death due
to accident

- Getting bitten by a mosquito

Issue
- In Mozambique

- Death caused due to multiple failure organ sourced from

Malaria
 PROCEDURAL HISTORY
• District Forum allowed the appeal and called upon the insurer to pay the entire outstanding EMI.

• The State Commission affirmed District Forum’s decision and called “sudden death due to mosquito
bite in a foreign land” an accident.

• The National Commission expounded upon term ‘accident’ and referencing multiple definitions and
stated that, “ (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 advanced.”

• Further, the National Commission stated that a mosquito bite is not something one expects and that
the information available by the insurance company stated frost bite and dog and snake bite to be
accident as well. On such basis claiming mosquito bite causing a disease would be an accident.
 PROCEDURAL HISTORY

• LIFE INSURANCE
v.
PERSONAL ACCIDENT INSUARNCE

Allowance of the insured’s claim against deficiency of service

under Consumer Protection Act
 Appellant’s Contentions Respondent’s Contentions

Policy explicitly stated 'death due to Nature of mosquito bite=unforeseen

accident

Moot Points Clause 3(A) of the conditions: Notice Section II of the Policy
of any change in business or
occupation

No intimation of job taken in

Mozambique
• Court emphasised on a Chain
of Events Malaria=common occurrence in Exclusions to Section II of the Policy
tropical countries

'accident' does not include disease Unexpected and undesirable course of

and other natural causes events

Cause of Death= Multiple failure organ Origin of Malaria= the Mosquito bite
 INTERNATIONAL RATIONALE FOR
‘ACCIDENTS’
• The court considered the judgements of the US, UK and Canada.
• There have been drawn a narrow distinction regarding an ‘accident’ and
natural course of events.
• Claiming in a judgement by Justice Cockburn, “We cannot think disease
produced by the action of a known cause can be considered as accidental.”
 Decision & Reasoning
• In our view, it would be appropriate to
approach the issue which has been raised in
the present case as a matter of interpreting the
conditions contained in the insurance policy.
Decision & Reasoning: meaning of ‘accident’
• Union of India v. Sunil Kumar Ghosh: ...An accident is an occurrence or an event which is unforeseen and
startles one when it takes place but does not startle one when it does not take place

• Regional Director, ESI Corporation v. Francis De Costa: It must be regarded as an accident, from the
point of view of the workman who suffers from it, that its occurrence is unexpected and without design on
his part, although either intentionally caused by the author of the act or otherwise.

• In order to constitute an accident, the event must be in the nature of an occurrence which is unnatural,
unforeseen or unexpected.
ANALYSIS

• In the present case the death is caused by a disease which was contracted by the deceased.

• Section II of the 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.

• Whether a disease which is not specifically excluded under the policy is to be covered by it or no.

• Whether a disease can be covered under the ambit of the expression accident.

• Chain of events that preceded the insured’s death could not be regarded as an antithesis to bodily infirmity caused by
disease in the ordinary course of events.
 DECISION
• SC allowed the appeal by the Insurance Company declaring the impugned
order of the National Commission unsustainable

• Relying on the interpretation placed on the terms of the Insurance Policy

• We have been informed during the course of the hearing that the claim under the
insurance policy has been paid by the insurer. We direct in exercise of our jurisdiction
Under Article 142 of the Constitution that no recoveries shall be made.
 ILLUSTRATION

If X were to claim for an ‘accident’ on venereal disease such as

malaria.

The material factors that the court considered on the basis of the
present case is the ‘Expectancy’ of the event.

Let’s take the case of the Zika Virus. A virus that is also transmitted
by mosquito bites.

According to Center of Disease Control, 22 July, 2022.
https://wwwnc.cdc.gov/travel/files/zika-areas-of-risk.pdf
What if?
•What if the mosquito bite occurred in Canada? A Country
that is stated to be having no zika virus mosquitos.
•However, your luck has played you and you contract the
Zika Virus.
•It is the information available that dictates that there would
be no ‘Expectancy’ of the Zika Virus with the territory of
Canada.
•Which, according to the court’s interpretation, should cause
the following.
•(i) Unexpected event causing harm.
•(ii) Should not be in the natural course of events.
•Due to the heavy reliance by the court on the Expectancy of
the event transpiring, contracting the Zika virus would be
considered as an “Accident.”
 PERSONAL ANALYSIS
• Justice Chandrachud, focuses on the subjectivity of the insurance claim to be where and when for
venereal disease is contracted is too broad and requires a narrower definition.
• The court has not mentioned on the onus of the insured to inform the insurer on the change of location
of his work and if said information relay is material to the claim that is covered under the policy.
• Further, the onus of the insurer to inform the insured regarding the heath risks that could be covered in
the new location.
• Furthermore, the court should have emphasized more stringently on the definition of an ‘Accident’ to
be covered in policies that provide for such accidental insurance that are covered. It would ease the
process of the court in the interpretation of ‘accident’ that the policy is willing or not willing to cover.
But has failed to do so.
• THANK YOU :)