THE BRANCH MANAGER NATIONAL INSURANCE CO. LTD. versus SMT. MOUSUMI BHATTACHARJEE & ORS.

Citation: [2019] 5 S.C.R. 46 · Decided: 26-03-2019 · Supreme Court of India · Bench: D.Y. CHANDRACHUD · Disposal: Appeal(s) allowed

cites 2 · see the full citation network in Lexace

Judgment (excerpt)

A
B
C
D
E
F
G
H
46
SUPREME COURT REPORTS
[2019] 5 S.C.R.
THE BRANCH MANAGER NATIONAL INSURANCE CO. LTD.
v.
              SMT. MOUSUMI BHATTACHARJEE & ORS.
(Civil Appeal  No 2614 of 2019)
MARCH 26, 2019
[DR. DHANANJAYA Y CHANDRACHUD AND
HEMANT GUPTA, JJ.]
Consumer Protection Act, 1986 – Insurance policy claim –
Deficiency of service – Whether death due to malaria occasioned
by a mosquito bite in Mozambique constituted a death due to
accident – Insurance policy – Cover against accident – The insured
was working in Assam and thereafter took employment in
Mozambique where he was diagnosed with encephalitis malaria and
died due to multi-organ failure – Claim filed by spouse and father
of the deceased – Plea of insurer was that death due to malaria
caused by a mosquito bite was a result of an infection or disease
and was not an accidental death under the terms of insurance policy
– All the Forums allowed the claim holding that the death was caused
due to accident – On appeal, held: 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 –
Malaria is most commonly transmitted to humans through malaria
virus infested mosquito bites, and when a virus is contracted through
normal means brought about by everyday life, it cannot be deemed
to be an unexpected or unforeseen accident – 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 instant case was caused by
encephalitis malaria – 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,
accounted for 5% of cases of malaria globally – 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
46
      [2019] 5 S.C.R. 46
A
B
C
D
E
F
G
H
47
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 – The interpretation placed on the terms of the
insurance policy by the Forums below was manifestly incorrect.
Allowing the appeal, the Court
HELD: 1. In order to constitute an accident, the event must
be in the nature of an occurrence which is unnatural, unforeseen
or unexpected. The instant case concerned death caused due to
a disease being contracted. Section II of the  insurance policy
covers death caused by accident. Death or injury from accident
caused by insanity or venereal disease has been specifically
excluded and not covered under the policy. [Para 14] [55-B]
Union of India v. Sunil Kumar Ghosh (1984) 4 SCC
246: [1985] 1 SCR  555; Regional Director, ESI
Corporation v. Francis De Costa (1993) 4 Suppl. SCC
100 : [1992] 3 SCR  23; Jyothi Ademma v. Plant
Engineer, Nellore (2006) 5 SCC 513 : [2006] 3 Suppl.
SCR 400; Co-operators Life Insurance  Company v.
Randolph Charles Gibbens 2009 SCC 59 – referred to
Lovelace v. Traveler’s Protective Association 47 Am.
St. Rep. 638;  Sinclair v. Maritime Passengers Assurance
(1861) 3 E&E 478; Fenton v. Thorley & Co. Ltd. (1903)
AC 443; Steel v. Cammel, Laird & Co. (1905) 2 K.B.
232; Gloria Wells v. Minnesota Life Insurance Company
No. 16-20831 (5th Cir. 2018) – referred to
P Ramanatha Aiyar’s Law Lexicon 3rd Edition, 2012; A
W Baker Welford’s The Law Relating to Accident
Insurance 2nd Edition, 1932; Colinvaux’s Law of
Insurance 10th Ed. by Robert Merkin;  P Ramanatha
Aiyar’s Advanced Law Lexicon 3rd Ed. (2005)
– referred to
2.   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
BRANCH MANAGER NATIONAL INSURANCE CO. LTD. v.  MOUSUMI
BHATTACHARJEE.
A
B
C
D
E
F
G
H
48
SUPREME COURT REPORTS
[2019] 5 S.C.R.
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

Excerpt shown. Read the full judgment & AI analysis in Lexace.