IN THE HIGH COURT AT CALCUTTA
Moushumi Bhattacharya, J.
Chitra Mukherjee – Petitioner
Versus
Union of India & Ors. – Respondents
W.P.A 103 of 2023
Decided On : 10-05-2023
Appeal - Claim for Accident Insurance – Compensation for Rat Bite – Petitioner lodged a claim with respondent United India Insurance Company pursuant to death – Insurance Company refused claim by way of a letter Insurance Company is unable to admit its liability on account of cause of death of petitioner – Insurance Company was of view cause of death was non-accidental and was hence not covered under policy – whether death caused from a mosquito bite would count as an “accident” - Held, Court is also unable to accept contention that Personal Accident Insurance Policy present case was tailor-made for army men in particular petitioner would accordingly be entitled to a more extensive interpretation of clauses comparison of definition of accident Policy of deceased IRDA Norms and for civilians indicates definition is same across board – Court feels petitioner’s pain and Insurance Policy precedents subject do not permit interpreting any disease caused by a mosquito bite as an accident neither fortuitous nor unexpected entirely country city-specific impugned refusal on part of Insurance Company to admit liability particular policy hence cannot be seen as arbitrary or unreasonable – Appeal dismissed.
JUDGMENT :
Moushumi Bhattacharya, J.
1. The petitioner is the mother of one Chayan Mukherjee who was serving in the Indian Army and died on 20.12.2021 in the Command Hospital (Eastern Command), Kolkata. The petitioner’s son was admitted to the hospital on 16.11.2021 after developing certain post-surgical complications arising from a knee injury and was diagnosed with end stage renal disease while undergoing treatment at Command Hospital. The petitioner’s son developed high grade fever with chills on 12.12.2021 and was found to be Dengue NS1 Ag positive. The petitioner’s son succumbed to his illness on 20.12.2021.
2. The petitioner lodged a claim with the respondent no. 4 / United India Insurance Company pursuant to the death of her son. The Insurance Company refused the claim by way of a letter dated 22.9.2022 stating that the Insurance Company is unable to admit its liability on account of the cause of death of the petitioner’s son. The Insurance Company was of the view that the cause of death was “non-accidental” and was hence not covered under the policy.
3. The petitioner has challenged the refusal of the Insurance Company to admit the claim and seeks quashing of the letter of the Insurance Company dated 22.9.2022.
4. Learned Counsel appearing for the petitioner urges that the petitioner’s claim falls within the Insurance Policy which was specifically made for defense personnel and should be distinguished from a policy made for a civilian. Counsel submits that the primary cause of death was entirely accidental as the petitioner’s son could not have foreseen that he would be afflicted with Dengue in the Command Hospital. Counsel relies on the meaning of the word “accident” to submit that the death caused by Dengue was not within the control of the petitioner’s son and was the least expected incident of his admission to the Command Hospital. Counsel urges that the other cause of death namely IgA Nephropathy is a consequence of Dengue. Counsel seeks to draw a distinction between the judgment pronounced by the Supreme Court in Branch Manager, National Insurance Company Limited v. Mousumi Bhattacharjee; (2019) 5 SCC 391 and the facts of the present case to contend that Dengue is not a common disease in India.
5. Learned counsel appearing for the Insurance Company relies on the “Renewal of MOU between IA and SBI Bank” dated 15.12.2021 between the Indian Army and SBI for a period of 3 years. Counsel places clause 5 of the document which deals with “Accident Insurance” to submit that the cause of death in the present case is not an accident as defined under the said clause. Counsel also relies on Schedule-I of the United India Insurance Company Limited Group Personal Accident Insurance Policy and the coverage for claims relating to an accident. It is submitted that the cause of death in the present case is Dengue as well as renal disease as recorded in the Medical Certificate and the Autopsy Report.
6. The point which falls for adjudication is whether death caused from a mosquito bite would count as an “accident”. If yes, it would follow that the Insurance Company should have admitted the petitioner’s claim for accident insurance in terms of the Policy. If no, the impugned decision would not call for interference.
7. The material before the Court would be the best indicator of the answer to the above question. The Medical Certificate recording the cause of death shows that the petitioner’s son died on 20.12.2021 at 16:15 hours at the age of 29 years. The place of death was Command hospital (Eastern Command), Kolkata. The disease/condition directly leading to death is (1) Dengue Hemorrhagic Fever, (2) End Stage Renal Disease – IgA Nephropathy. The antecedent cause of death is shown as “NIL”. The other significant conditions contributing to the death (with “if any”) has been stated as right knee ACL tear repair (post-operated). It is
Branch Manager, National Insurance Company Limited v. Mousumi Bhattacharjee
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