Calcutta High Court: While dismissing a writ petition filled to challenge the refusal to admit insurance claim, Moushumi Bhattacharya*, J., held that death due to mosquito bite cannot be termed as an ‘accident' and therefore the same will not be covered as an insurable claim under ‘accident insurance'.
In the instant matter, the petitioner filed an insurance claim before the respondent 4 – United India Insurance Company (Insurance Company) after her son, Chayan Mukherjee died at Command Hospital, Kolkata. The Insurance Company vide letter dated 22-09-2022, rejected the insurance claim as the cause of death was dengue, a disease not covered under its policy. Aggrieved by the decision of the Insurance Company, the petitioner filed a writ petition before this Court, challenging the letter of the Insurance Company which refused to admit the claim of petitioner.
The petitioner contended that the primary cause of death was purely accidental as petitioner's son had no idea that he would be afflicted with dengue in the hospital. On the hand, the Insurance Company contended that the cause of death in the present case is Dengue as well as renal disease as recorded in the Medical Certificate and the Autopsy Report and the same is not an accident as defined under clause 5 of the document which deals with ‘Accident Insurance'.
Whether death caused from a mosquito bite would count as an ‘accident'?
The Court observed that (1) the petitioner can claim the benefit of the Policy as the registered nominee of the account, (2) the conditions directly resulted in death of the petitioner's son as recorded in Autopsy Report and medical certificate is both “Dengue” and “End-stage renal disease – IgA Nephropathy”.
The Court further observed that it is clear from the clinical history of the patient, that the death cannot be attributed solely to Dengue or seen as the sole and direct contributory factor resulting in the death of the petitioner's son, therefore, substantially diluting the argument that the cause of death was accidental since the mosquito bite was an unexpected “accident”.
The Court noted that the Personal Accident Insurance Policy must be interpreted in the factual context of the definition of accident, i.e. “Death or Disability must result solely and directly from an accident caused by an external, violent and visible means. The causation must necessarily involve: Accident → death” and the insurance policy makes it clear that death caused by a disease is not covered.
The Court observed that accident does not include disease and implies the intervention of an external cause which is fortuitous and happens by chance. The Court stated that “the definition of accidental death includes accidental injuries, but excludes illness. The consensus also tilts towards the exclusion of death by disease alone, not accompanied by an accident.”
The Court remarked that “…an accident is an event which startles a person when it takes place but does not startle one when it does not take place. There is also a violence attached to accidents — a screech, a thud, usually destruction accompanied by high-level noise. Mosquitoes, on the other hand, are the silent, insidious enemies who go about their harmful business unnoticed.”
The Court held that though the petitioner's son is undoubtedly sad, but the Court cannot interpret any disease caused by a mosquito bite as an accident and therefore, the Insurance Company's refusal to admit liability in the policy cannot be seen as arbitrary or unreasonable.
While dismissing the present petition, the Court held that the Court does not see any reason to quash the impugned letter dated 22-09-2022 by the Insurance Company.
[Chitra Mukherjee v. Union of India, 2023 SCC OnLine Cal 1118, order dated 10-05-2023]
*Judgment by Justice Moushumi Bhattacharya
Advocates who appeared in this case :
Mr. Rahul Karmakar, Mr. Jibantaraj Das Roy, Mr. Rittick Chowdhury and Ms. Champa Pal, Counsel for the Appellant
Mr. Sukumar Bhattacharyya and Mr. Somnath Adhikari, Counsel for the Union of India
Mr. Debashis Saha, Counsel for the Bank
Mr. Guddu Singh, Counsel for the Insurance Company