Death by mosquito bite not covered by accident insurance policy, says HC
A death resulting from a mosquito bite cannot be qualified as an accident and therefore no insurance claim can be made under the ‘accident insurance policy’, as held by the Calcutta High Court.
Chitra Mukherjee’s mother moved to the Supreme Court after the death of her son and army man Qian Mukherjee in the command hospital. He was admitted to the hospital after developing certain complications after surgery stemming from a knee injury and was diagnosed with End Stage Kidney Disease while undergoing treatment there. Later, he developed a high fever with chills and was found to be suffering from dengue. He succumbed to his illness a few days later. The mother contacted the insurance company to obtain a claim, but it was denied on the grounds that the cause of death was “non-accident” and therefore not covered under the policy.
Going through all the facts presented and the arguments presented, one Justice Moushumi Bhattacharya noted that the definition of accidental death includes accidental injuries, but excludes disease. The consensus also tends to rule out death by disease alone without accident.
Moreover, the council said that being bitten by a mosquito in the sterile confines of a hospital could be an unwanted and unwarranted incident at best. It is not fortunate enough to startle the sufferer (sting) as unexpected. After all, an accident is an event that surprises a person when it occurs but does not surprise a person when it does not. There is also violence associated with the incidents – screaming, jingling, destruction usually accompanied by high-level noises. On the other hand, mosquitoes are the silent and deceitful enemies who do their harmful deeds unnoticed.
It highlighted that the IRDA guidance on a standard personal accident insurance product defines an accident as “a sudden, unexpected and involuntary event caused by external, visible and violent means”. The group personal accident insurance policy of United India Insurance Company Limited with State Bank of India, the subject of the claim herein, defines accident with reference to personal accident insurance as follows: “If at any time during the currency of this policy the insured should suffer any bodily injury arising solely and directly from an accident caused by external violent and visible means, then the Company shall pay to the Insured or his legal representative(s) as the case may be the amount or amounts.”
The court said that the document covering the petitioner’s son in this case was intended to cover death and disability subject to death occurring only and directly and as a result of an accident caused by a violent and visible external impact. Coverage specifically includes snake bites and high-altitude sickness as well as altitude pulmonary edema — but excludes other forms of insect bites, Seat added.
“The death of the petitioner’s son is undoubtedly sad and this court is moved by the petitioner’s pain and anguish. However, the insurance policy and subject matter precedent do not permit any illness caused by a mosquito bite to be construed as an accident. It is not accidental or unexpected and is country/city specific The Court concluded and dismissed the petition, The contested refusal on the part of the insurance company to acknowledge liability in a particular policy and therefore cannot be held to be arbitrary or unreasonable.