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The Branch Manager, National Insurance Co. Ltd. v. Smt. Mousumi Bhattacharjee & Ors.

Civil Appeal · 2019 INSC 403Decided 26 Mar 2019
Civil Appeal No. 2614 of 2019
Dr. Justice D.Y. Chandrachud · Justice Hemant Gupta

Background

A man working in Mozambique died of encephalitis malaria after being bitten by a mosquito; his family sought to claim the outstanding home loan amount under a "Home Loan Suraksha Bima" insurance policy that covered death due to accident. The insurer refused the claim, arguing that death from a disease like malaria was not an "accident." The District Forum, State Consumer Commission, and National Consumer Disputes Redressal Commission (NCDRC) all ruled in the family's favour, treating the mosquito bite as an unforeseen, accidental event, and the insurer appealed to the Supreme Court.

Decision Breakdown

The Supreme Court undertook a detailed review of Indian and international case law distinguishing "accidents" from "diseases," concluding that an event occurring in the ordinary and foreseeable course of nature, even if the exact timing is a matter of chance, is not an accident. Since Mozambique has an extremely high incidence of malaria (around one in three people affected, per WHO data), the Court held that contracting malaria there through a mosquito bite was a foreseeable, natural-course occurrence, not an unexpected "accident" as required by the policy, and that the NCDRC's interpretation was therefore incorrect. However, since the Court was informed the insurer had already paid out the claim during the litigation, it directed under Article 142 that no recovery of the paid amount be made from the family, even while setting aside the NCDRC's order and allowing the appeal on the legal question.

Lesson Learnt

For insurance purposes, a death caused by a disease that is common and foreseeable in the place where it occurs (like malaria in a high-prevalence region) is generally not treated as an "accident," even though the exact moment of infection is a matter of chance: policyholders should check whether their accident cover is broad enough to include disease-related risks if that protection is wanted.

Official source (sci.gov.in)View Judgment (PDF)

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