"Death of Policyholder patient due to Malaria after Mosquito Bite is an accidental death and hence Insurance Company is liable to pay the sum assured."
In an interesting Case
of National Insurance Co. Ltd. V/s Mosumi Bhattacharjee, (R.P.
No.1270/2016), a question came before the National Commission to decide whether death of a Policy
holder due to Malaria after a mosquito bite can be termed as accidental Death ?
Facts in short.
1. Late Mr. Debashish
Bhatacharjee, the husband of the Complainant took the home loan from Bank of
Baroda and along with it, he also availed facility of Term insurance like
policy by name "Bank of Baroda Loan Suraksha Vima", issued by the
National Insurance Co. Incase of an accidental death, the policy amount was to
be paid to the claimants
2. During the
subsistence of the Policy, the Policy holder died due to Malaria and hence his
legal heirs (LRs) applied to the Insurance Company fir getting the sum assured.
3. But the Insurance
Company turned down the claim on the ground 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 favour. Hence the Insurance Company
filed the appeal in state commission, which was also rejected and hence the
matter came to national Commission.
Held :
1. The National
Commission upheld both the judgments of lower foras 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".
2. Thus 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. It rejected the argument of the National Insurance company
that Malaria itself is a disease and not an accident.
A) I feel this is an
important judgment. Few days back, at least a person in every family was
suffering from Dengue / chikungunya and Malaria. Few patients were succumbed to
death due to such diseases.This judgment may be helpful to such families. Obviously terms of Policy, if any,
will play an important role.
B) This decision also
underlines the importance of having Term Insurance like policies. Consult an
expert in this field.