Case Note & Summary
The case involves an appeal by the National Insurance Co. Ltd. against a judgment of the National Consumer Disputes Redressal Commission which upheld the award of a claim under an insurance policy. The insured, Debashis Bhattacharjee, had taken a housing loan from Bank of Baroda and availed of an insurance scheme called 'National Insurance Home Loan Suraksha Bima'. The policy covered death due to accident under Section II. The insured worked as a Manager in a Tea Factory in Mozambique, where he contracted encephalitis malaria and died due to multi-organ failure. His heirs filed a complaint under the Consumer Protection Act, 1986, alleging deficiency of service for non-settlement of the claim. The District Forum allowed the claim, and the State Commission and National Commission affirmed. The insurer appealed to the Supreme Court, arguing that death due to malaria is a disease, not an accident. The Supreme Court analyzed the meaning of 'accident' as an unforeseen and unexpected event, relying on precedents such as Union of India v. Sunil Kumar Ghosh and Regional Director, ESI Corporation v. Francis De Costa. The court noted that malaria is a common occurrence in Mozambique, and a mosquito bite leading to disease is not an accident but a natural event. The court held that death due to disease, even if caused by an external factor, is not covered under 'death due to accident' unless the policy specifically includes it. The Supreme Court allowed the appeal, setting aside the orders of the consumer forums and dismissing the complaint.
Headnote
A) Insurance Law - Interpretation of 'Accident' - Death due to disease - The court considered whether death from malaria caused by a mosquito bite is an 'accident' under Section II of the insurance policy. The court held that death due to a disease, even if caused by an external event like a mosquito bite, is not an accident unless the policy specifically covers disease. The event must be unnatural, unforeseen, or unexpected, and disease is a natural occurrence. (Paras 1, 14-15) B) Insurance Law - Policy Interpretation - Exclusion of Disease - The policy covered death due to accident but excluded certain diseases like venereal disease. The court reasoned that death from malaria, being a disease, is not covered under 'accident' as it is not an unforeseen event in a malaria-endemic region. (Paras 10, 14-15) C) Consumer Protection Act, 1986 - Deficiency of Service - Insurance Claim - The National Consumer Disputes Redressal Commission had upheld the claim, but the Supreme Court reversed, holding that the insurer did not commit a deficiency by denying the claim as death due to malaria was not accidental. (Paras 5-6, 15)
Issue of Consideration
Whether death due to malaria occasioned by a mosquito bite in Mozambique constitutes a death due to accident under an insurance policy.
Final Decision
The Supreme Court allowed the appeal, set aside the orders of the National Commission, State Commission, and District Forum, and dismissed the complaint.
Law Points
- Interpretation of 'accident' in insurance policy
- Death due to disease not covered as accident
- Consumer Protection Act
- 1986
