Disease Caused By Insect Bite In The Natural Course Of Events Not Covered Under 'Accident' Insurance: SC [Read Judgment]

But, in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen, the bench comprising Justice DY Chandrachud and Justice Hemant Gupta observed while dealing with what it called an 'interesting question of law'.

The question to be answered by the bench in Branch Manager, National Insurance Co. Ltd vs. Mousumi Bhattacharjee was whether a death due to malaria occasioned by a mosquito bite in Mozambique, constituted a death due to accident.

The bench was dealing with an appeal against the National Consumer Commission which rejected the Insurance company's contention that malaria due to mosquito bite is a disease and not an accident. After a conspicuous reference to many judgments, mostly of foreign jurisdictions, the bench observed:

"As the law of insurance has developed, there has been a nuanced understanding of the distinction between an accident and a disease which is contracted in the natural course of human events in determining whether a policy of accident insurance would cover a disease. At one end of the spectrum is the theory that an accident postulates a mishap or an untoward happening, something which is unexpected and unforeseen. This understanding of what is an accident indicates that something which arises in the natural course of things is not an accident. This is the basis for holding that a disease may not fall for classification as an accident, when it is caused by a bodily infirmity or a condition. A person who suffers from flu or a viral fever cannot say that it is an accident. Of course, there is an element of chance or probability in contracting any illness. Even when viral disease has proliferated in an area, every individual may not suffer from it. Getting a bout of flu or a viral illness may be a matter of chance. But a person who gets the flu cannot be described as having suffered an accident: the flu was transmitted in the natural course of things. To be bitten by a mosquito and be imbued with a malarial parasite does involve an element of chance. But the disease which is caused as a result of the insect bite in the natural course of events cannot be regarded as an accident. Particularly, when the disease is caused in an area which is malaria prone. "

The court also gave an instance where a bodily condition from which an individual suffers may be the direct consequence of an accident. A motor car accident, resulting in bodily injuries, the consequence of which is death or disability which may fall within the cover of a policy of accident insurance, it said.

"Hence, it has been postulated that where a disease is caused or transmitted in the natural course of events, it would not be covered by the definition of an accident. However, in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen."

Setting aside the commission's order, the bench, on the facts of the case, observed:

"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. The death of the insured in the present case was caused by encephalitis malaria. The claim under the policy is founded on the hypothesis that there is an element of uncertainty about whether or when a person would be the victim of a mosquito bite which is a carrier of a vectorborne disease. The submission is that being bitten by a mosquito is an unforeseen eventuality and should be regarded as an accident. We do not agree with this submission. The insured was based in Mozambique. According to the World Health Organization's World Malaria Report 2018, Mozambique, with a population of 29.6 million people, accounts for 5% of cases of malaria globally. It is also on record that one out of three people in Mozambique is afflicted with malaria. In light of these statistics, the illness of encephalitis malaria through a mosquito bite cannot be considered as an accident. It was neither unexpected nor unforeseen. It was not a peril insured against in the policy of accident insurance."