Insurance claims are known to be a troublesome and difficult process. It is also very common for the insurance companies to deny the insurer’s claims. Have you ever known anybody to compensate for a mosquito bite? Sounds a bit strange but there has been a case that came up with a landmark rule in which malaria death was called as an accident and the insurance company was forced to pay the claim to the heirs.
A Case Study:
In an appealing case of National Insurance Co. Ltd. V/s Mosumi Bhattacharjee, (R.P. No.1270/2016), an issue came before the National Commission to decide whether the death of a Policy owner due to Malaria after a mosquito bite can be termed as Accidental Death?
In this case, Late Mr. Debashish Bhatacharjee, the husband of the Complainant took the home loan from Bank of Baroda and along with it, he also availed the facility of Term insurance-like policy by the name “Bank of Baroda Loan Suraksha Vima”, issued by the National Insurance Co. In case of an accidental death, the policy amount was to be paid to the claimants.
During the continuation of the Policy, the Policyholder died due to Malaria and thus his legal heirs (LRs) applied to the Insurance Company for getting the sum assured. But the Insurance Company turned down the claims on grounds that Malaria itself is a disease and not an accident. Hence the LRs filed the complaint before the District consumer forum, which was allowed in their favor. Hence the Insurance Company filed the appeal in state commission, which was also rejected and the matter came to the National Commission.
The National Commission upheld both the judgments of lower foras and observed that the Policy does not define the term “Accident”. It relied upon the definition of Accident given in Oxford dictionary, wherein it is defined as “An Accident is something that happens unexpectedly and not planned in advance and causes injury”. Thus stating that no one can predict about the mosquito bite and it can happen anywhere and anytime, like an accident.
It relied upon the earlier judgment of Matbarsingh V/s Oriental Insurance Co. wherein it has been held that Snake-bite, dog-bite, frost-bite are also accidents. It rejected the argument of the National Insurance Company that Malaria itself is a disease and not an accident.
This judgment will have an important impact on the people whose family members died accidentally due to diseases, like dengue, malaria, chikungunya etc. According to the World Health Organization, these diseases account for 17% of the estimated global infectious diseases.
Such incidence also calls for the need for term insurance plans. These plans are the most affordable form of insurance which provides death benefits to the family of the insured person for a defined period of time. It is very crucial for everyone, especially the guardian of the family.