Page 28 - Insurance Times July 2019

the flu was transmitted in the natural course of things. To the insurance regulatory authority to cover deaths relating
be bitten by a mosquito and be imbued with a malarial to dengue, malaria and chikungunia under accident policies
parasite does involve an element of chance. But the disease and many insurance companies have come up with the
which is caused as a result of the insect bite in the natural policies covering death caused by these diseases after the
course of events cannot be regarded as an accident National Commission ruling.
particularly, when the disease is caused in an area which is
malaria prone. The National Commission upholding both the judgments of
lower courts observed that the policy did not define the
Finally the Court held that in the present case the insured term "accident" and relied upon the definition of 'accident'
was based in Mozambique. According to the World Health given in the Oxford dictionary, wherein it is defined as "an
Organization's World Malaria Report 2018, Mozambique, accident is something that happens unexpectedly and not
with a population of 29.6 million people, accounts for 5% planned in advance and causes injury".
of cases of malaria globally. It is also on record that one out
of three people in Mozambique is afflicted with malaria. In "It is difficult for us to accept that the death due to a
light of these statistics, the illness of encephalitis malaria mosquito bite would not be a death due to an accident,"
through a mosquito bite cannot be considered as an Justice V K Jain said.
accident. It was neither unexpected nor unforeseen.
Another veteran consumer activist Shirish Deshpande
Effect of NCDRC Ruling: welcoming the decision, however, had already sounded a
note of caution. "The commission has equated the
Earlier welcoming the decision of the National Consumer
mosquito bite with dog bite and snake bite. But malaria is
Disputes Redressal Commission in the same case in January
endemic in nature. The judgment needs to be tested finally
2017, Dr Narsing Reddy, then president of Telangana IMA,
by the Supreme Court as it may open the floodgates for
said, "The case of malarial death was considered on the
such claims."
ground that it was something that happened unexpectedly
to the patient. As a mosquito bite can't be predicted, it is
to be seen as an accident. No one expects a bite to happen; Conclusion:
and when there's accident coverage, the insurance claim of The Apex Court decision though has far reaching
the victim or his family can't be rejected." consequences in dealing with accidental claims and will
certainly open the floodgates of accidental claims litigations
After the ruling the Indian Medical Association has asked but its applicability seems to be restricted as Court has heavily
relied on the statistics on malaria prevalent in Mozambique
while reaching to the conclusion that malaria inflicted by
mosquito bite is not an accident. It is also not in dispute in
this case that malaria is not in the exclusion list.

Hence, the ruling cannot be taken as laying down a thumb
rule that all such cases are not covered as 'accident'. Its
applicability in a given case has to be tested in the
background of disease's spread and rate of incidence in that
area in a given case and other attaining circumstances
including policy wordings, especially coverage and exclusions.
The discussion and inferences drawn on distinction between
'disease' and 'accident' has shed some light on the complex
issues of 'accident' and 'disease', and when a disease induced
by a disease becomes an accident.

28 The Insurance Times, July 2019