2019 Supreme(SC) 356

SUPREME COURT OF INDIA
DR. DHANANJAYA Y. CHANDRACHUD, HEMANT GUPTA, JJ.
The Branch Manager National Insurance Co. Ltd. – Appellant
Versus
Smt. Mousumi Bhattacharjee And Ors. – Respondents
Civil Appeal No 2614 of 2019 (@SLP(C) No. 4297 of 2017)
Decided On : 26-03-2019

IMPORTANT POINTS
(1) In a policy of insurance which covers death due to accident, peril insured against is an accident: an untoward happening or occurrence which is unforeseen and unexpected in normal course of human events.
(2) Illness of encephalitis malaria through a mosquito bite cannot be considered as an accident.

Headnote:(A) Torts – Accidental Death – Death due to malaria occasioned by a mosquito bite – Scope of award of compensation – In order to constitute accident, event must be in nature of an occurrence which is unnatural, unforeseen or unexpected – Present case concerns death caused due to a disease being contracted – Section II of 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 – There is a fine distinction between occurrence of a disease which may be considered as an accident and a disease which occurs in natural course of events – As law of insurance has developed, there has been a nuanced understanding of distinction between an accident and a disease which is contracted in natural course of human events in determining whether a policy of accident insurance would cover a disease – 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 – 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 flu cannot be described as having suffered an accident – Where a disease is caused or transmitted in natural course of events, it would not be covered by definition of an accident – However, in a given case or circumstance, affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen. (Paras 14, 15 and 18)

       (B) Consumer Protection Act, 1986 – Sections 14(1)(d) and 23 – Insurance – Death due to malaria occasioned by mosquito bite in a foreign country (Mozambique) – Malaria is most commonly transmitted to humans through malaria virus infested mosquito bites – 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, peril insured against is an accident: an untoward happening or occurrence which is unforeseen and unexpected in normal course of human events – Death of insured in present case was caused by encephalitis malaria – Claim under policy is founded on hypothesis that there is an element of uncertainty about whether or when a person would be victim of a mosquito bite which is a carrier of a vector borne disease – One out of three people in Mozambique is afflicted with malaria – 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 policy of accident insurance – Impugned judgment and order of National Commission set aside – However, no recoveries shall be made. (Paras 19 to 23)

       Facts of Case:

       Whether death due to malaria occasioned by mosquito bite in Mozambique, constituted death due to accident. Appeal by the insurer has been filed against judgment of National Consumer Disputes Redressal Commission1, which upheld decision of State Consumer Disputes Redressal Commission. State Commission, in first appeal, had upheld award of claim under insurance policy.

       Findings of Court:

       Interpretation placed on terms of insurance policy was manifestly incorrect. Impugned order of National Commission is unsustainable.

       Result : Appeal allowed.