08/10/2018
"Death of Policyholder 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.
Article in Maharashtra Times.
