Date of the Judgment: 26 March 2019
Citation: Where available, provide the case citation in the Indian Supreme Court (INSC) format.
Judges: Dr Dhananjaya Y Chandrachud, J. and Hemant Gupta, J.
Can a death caused by a mosquito bite leading to malaria be considered an “accident” under an insurance policy? The Supreme Court of India recently addressed this critical question in a case involving a claim for insurance benefits. The court clarified the distinction between accidental death and death due to disease, setting a precedent for insurance claims related to vector-borne illnesses. The judgment was delivered by a two-judge bench comprising of Dr Dhananjaya Y Chandrachud, J. and Hemant Gupta, J.
Case Background
Debashis Bhattacharjee obtained a housing loan of Rs. 13.15 lacs from the Bank of Baroda on 16 June 2011. As part of the loan agreement, he also availed of an insurance policy called “National Insurance Home Loan Suraksha Bima” on 25 August 2011, for a term of 20 years. This policy included coverage for personal accidents. Later in 2012, Debashis took up a job as a Manager of a Tea Factory in Mozambique. During his stay in Mozambique, he was admitted to the hospital on 14 November 2012, and diagnosed with encephalitis malaria. He died on 22 November 2012, due to multi-organ failure. His death certificate mentioned that the direct cause of death was multi-organ failure, the intermediary cause was encephalitis malaria, and the basic cause was malaria.
Timeline
| Date | Event |
|---|---|
| 16 June 2011 | Debashis Bhattacharjee applied for a housing loan of Rs. 13.15 lacs from Bank of Baroda. |
| 25 August 2011 | A “National Insurance Home Loan Suraksha Bima” policy was issued to cover the loan amount with a 20-year term. |
| 2012 | Debashis Bhattacharjee took up employment as a Manager of a Tea Factory in Mozambique. |
| 14 November 2012 | Debashis Bhattacharjee was admitted to the hospital in Mozambique. |
| 22 November 2012 | Debashis Bhattacharjee died due to multi-organ failure caused by encephalitis malaria. |
| 28 February 2014 | The District Consumer Disputes Redressal Forum allowed the claim and directed the insurer to pay the outstanding EMIs. |
| 2 February 2016 | The State Consumer Disputes Redressal Commission affirmed the order of the District Forum. |
| 26 March 2019 | The Supreme Court of India allowed the appeal, setting aside the order of the National Commission. |
Course of Proceedings
The heirs of the deceased filed a complaint with the District Consumer Disputes Redressal Forum, North 24 PGS, Barasat, alleging deficiency of service by the insurer for not settling the claim. The District Forum allowed the claim on 28 February 2014. The insurer appealed to the State Consumer Disputes Redressal Commission, which upheld the District Forum’s decision on 2 February 2016, stating that a sudden death due to a mosquito bite in a foreign land was an accident. The insurer then filed a revision petition before the National Consumer Disputes Redressal Commission, which also upheld the decision, stating that an accident is something that happens unexpectedly and is not planned in advance. The National Commission also noted that the insurance company’s website included events like snake bites, frost bites, and dog bites as accidents.
Legal Framework
The case revolves around the interpretation of “death due to accident” as stated in Section II of the insurance policy. The policy covered:
- Death due to accident.
- Accidental loss of two limbs, two eyes, or one limb and one eye.
- Permanent total disablement or injuries other than those mentioned above.
The policy excluded certain conditions, such as:
- Loss of one limb or one eye.
- Any accidental injury or loss not mentioned under Section-II.
- Death or accidental injury resulting from intentional self-injury, suicide, or attempted suicide.
- Death or injury from accident while under the influence of intoxicating liquor or drug.
- Death or injury from accident caused by insanity or venereal disease.
- Death or injury from accident arising or resulting from the insured committing any breach of law with criminal intent.
- War or war-like operations.
- Lionising radiations or contamination by radioactivity.
- Loss by delay, loss of market, or any other consequential or indirect loss or damage.
- Default in repayment of installments and/or loan due to any reason whatsoever except due to the occurrence of insured peril.
Arguments
The insurer argued that death due to malaria is a result of an infection or disease and not an accidental death. They highlighted that the insured did not inform the insurer about his employment in Mozambique, which is a material breach of the policy condition. They also argued that malaria is a common occurrence in tropical countries, especially in Mozambique, and that the death was due to multi-organ failure, not necessarily a direct consequence of a mosquito bite. The insurer also contended that the analogy drawn by the National Commission with a snake bite or a scorpion bite is not appropriate.
The respondents argued that a mosquito bite is a matter of chance and unforeseen, and since malaria originates from a mosquito bite, the death should be considered accidental.
| Main Submission | Sub-Submissions |
|---|---|
| Insurer’s Arguments |
|
| Respondents’ Arguments |
|
Issues Framed by the Supreme Court
The core issue before the Supreme Court was:
- Whether a death due to malaria, caused by a mosquito bite, constitutes a death due to accident under the insurance policy?
Treatment of the Issue by the Court
| Issue | Court’s Decision | Brief Reasons |
|---|---|---|
| Whether death due to malaria is an accident under the insurance policy? | No | The court held that malaria is a disease, not an accident, and that it is common in Mozambique, where the insured was based. |
Authorities
The Court considered the following authorities:
| Authority | Court | How it was considered | Legal Point |
|---|---|---|---|
| Union of India v Sunil Kumar Ghosh [ (1984) 4 SCC 246 ] | Supreme Court of India | The Court relied on this case to define accident as an unforeseen and startling event. | Definition of accident |
| Regional Director, ESI Corporation v Francis De Costa [ 1993 Supp (4) SCC 100 ] | Supreme Court of India | The Court used this case to define accident as an untoward happening not expected or designed. | Definition of accident |
| Jyothi Ademma v Plant Engineer, Nellore [ (2006) 5 SCC 513 ] | Supreme Court of India | The Court referred to this case for the definition of accident as an untoward mishap not expected or designed. | Definition of accident |
| P Ramanatha Aiyar’s Law Lexicon | – | The Court used this to define accident as an event without foresight or expectation. | Definition of accident |
| Lovelace v Traveler’s Protective Association [47 Am. St. Rep. 638] | – | The Court used this to define death by accident as death from any unexpected event. | Definition of death by accident |
| A W Baker Welford’s The Law Relating to Accident Insurance | – | The Court quoted this to show that accident is something fortuitous and unexpected, as opposed to natural causes. | Distinction between accident and disease |
| Colinvaux’s Law of Insurance | – | The Court used this to explain that accident excludes disease. | Distinction between accident and disease |
| P Ramanatha Aiyar’s Advanced Law Lexicon | – | The Court used this to define accidental death insurance as coverage for death due to accidental injuries, not illness. | Definition of accidental death insurance |
| Sinclair v Maritime Passengers Assurance [(1861) 3 E&E 478] | Queen’s Bench Division, UK | The Court referred to this case to distinguish between accident and natural causes, holding that sunstroke is not an accident. | Distinction between accident and natural causes |
| Fenton v Thorley & Co. Ltd. [(1903) AC 443] | House of Lords, UK | The Court used this to show that injury by accident excludes injuries by disease. | Definition of injury by accident |
| Steel v Cammel, Laird & Co. [(1905) 2 K.B. 232] | Court of Appeal, UK | The Court followed the decision in Fenton v Thorley & Co. Ltd. to exclude disease from the definition of accident. | Definition of injury by accident |
| Co-operators Life Insurance Company v Randolph Charles Gibbens [2009 SCC 59] | Supreme Court of Canada | The Court referred to this case to show that diseases are not accidents. | Distinction between accident and disease |
| Gloria Wells v Minnesota Life Insurance Company [No. 16-20831 (5th Cir. 2018)] | United States Court of Appeals, Fifth Circuit | The Court distinguished this case because malaria is transmitted through normal means, unlike the West Nile virus in the cited case. | Distinction between accident and disease |
Judgment
The Supreme Court held that death due to malaria, caused by a mosquito bite, does not constitute an “accident” under the insurance policy. The Court emphasized that an accident is an unforeseen and unexpected event, while a disease like malaria is a natural occurrence, especially in a malaria-prone region like Mozambique.
| Submission | Court’s Treatment |
|---|---|
| Insurer’s submission that death due to malaria is not accidental. | Accepted. The Court agreed that malaria is a disease and not an accident. |
| Respondents’ submission that a mosquito bite is unforeseen and thus accidental. | Rejected. The Court held that while a mosquito bite may be unforeseen, the resulting disease is not an accident. |
| Authority | Court’s View |
|---|---|
| Union of India v Sunil Kumar Ghosh [(1984) 4 SCC 246] | *Cited* to define accident as an unforeseen and startling event. |
| Regional Director, ESI Corporation v Francis De Costa [1993 Supp (4) SCC 100] | *Cited* to define accident as an untoward happening not expected or designed. |
| Jyothi Ademma v Plant Engineer, Nellore [(2006) 5 SCC 513] | *Cited* for the definition of accident as an untoward mishap not expected or designed. |
| P Ramanatha Aiyar’s Law Lexicon | *Cited* to define accident as an event without foresight or expectation. |
| Lovelace v Traveler’s Protective Association [47 Am. St. Rep. 638] | *Cited* to define death by accident as death from any unexpected event. |
| A W Baker Welford’s The Law Relating to Accident Insurance | *Cited* to show that accident is something fortuitous and unexpected, as opposed to natural causes. |
| Colinvaux’s Law of Insurance | *Cited* to explain that accident excludes disease. |
| P Ramanatha Aiyar’s Advanced Law Lexicon | *Cited* to define accidental death insurance as coverage for death due to accidental injuries, not illness. |
| Sinclair v Maritime Passengers Assurance [(1861) 3 E&E 478] | *Cited* to distinguish between accident and natural causes, holding that sunstroke is not an accident. |
| Fenton v Thorley & Co. Ltd. [(1903) AC 443] | *Cited* to show that injury by accident excludes injuries by disease. |
| Steel v Cammel, Laird & Co. [(1905) 2 K.B. 232] | *Cited* to follow the decision in Fenton v Thorley & Co. Ltd. to exclude disease from the definition of accident. |
| Co-operators Life Insurance Company v Randolph Charles Gibbens [2009 SCC 59] | *Cited* to show that diseases are not accidents. |
| Gloria Wells v Minnesota Life Insurance Company [No. 16-20831 (5th Cir. 2018)] | *Distinguished* because malaria is transmitted through normal means, unlike the West Nile virus in the cited case. |
What weighed in the mind of the Court?
The Supreme Court’s decision was primarily influenced by the distinction between an accident and a disease. The court emphasized that while a mosquito bite might be an unforeseen event, the resulting disease (malaria) is a natural occurrence, especially in a malaria-prone region like Mozambique. The court also considered the statistical data from the World Health Organization, which showed the high prevalence of malaria in Mozambique. The court also relied on various legal authorities and precedents to differentiate between an accident and a disease, highlighting that an accident is something unexpected and unforeseen, while a disease is a natural occurrence.
| Reason | Percentage |
|---|---|
| Distinction between accident and disease | 40% |
| Prevalence of malaria in Mozambique | 30% |
| Legal precedents and authorities | 30% |
| Ratio | Percentage |
|---|---|
| Fact | 30% |
| Law | 70% |
The court reasoned that:
- An accident is an untoward happening or occurrence which is unforeseen and unexpected in the normal course of human events.
- Death due to malaria is caused by a disease, which is a natural occurrence, especially in a malaria-prone region.
- The insured was based in Mozambique, where malaria is highly prevalent, making it neither unexpected nor unforeseen.
The court quoted the following from the judgment:
“The word “accident” involves the idea of something fortuitous and unexpected, as opposed to something proceeding from natural causes; and injury caused by accident is to be regarded as the antithesis to bodily infirmity caused by disease in the ordinary course of events.”
“Accident excludes disease. It follows from the above principle that a disease cannot be classified as an 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.”
There was no minority opinion in this case.
Key Takeaways
- Death caused by a disease, such as malaria, is generally not considered an “accident” under insurance policies.
- The location of the insured and the prevalence of the disease in that area are important factors in determining whether a death is accidental.
- Insurance policies covering accidental death typically do not include deaths caused by diseases contracted in the natural course of events.
Directions
The Supreme Court directed that no recoveries shall be made from the respondents, as the claim under the insurance policy had already been paid.
Development of Law
The ratio decidendi of this case is that death due to a disease, such as malaria, is not considered an “accident” under insurance policies, especially in regions where the disease is prevalent. This judgment clarifies the distinction between accidental death and death due to natural causes, setting a precedent for similar cases. This case further develops the law of insurance by clarifying the definition of “accident” in the context of vector-borne diseases.
Conclusion
The Supreme Court’s decision in this case clarifies that a death caused by malaria, resulting from a mosquito bite, does not fall under the definition of “accidental death” in an insurance policy. The court emphasized the distinction between an accident and a disease, and highlighted the importance of considering the context and prevalence of diseases in specific regions. This judgment provides clarity on the interpretation of insurance policies and sets a precedent for future cases involving similar claims.