Case Title: Branch Manager, National Insurance Co. Ltd vs. Mousumi Bhattacharjee
According to the Supreme Court, an illness that is caused or spread by an insect bite or virus in the normal run of things would not fall under the concept of an accident. The bench made this observation while addressing what it called an "interesting legal topic," noting that in a particular situation or setting, the illness or physiological condition may be viewed as an accident if its source or path of transmission is unanticipated and unforeseeable.
In this instance, the bench had to decide whether a malaria fatality brought on by a tick bite in Mozambique qualified as an accident death. The National Consumer Commission denied the Insurance Company's argument that malaria caused by a mosquito bite is an illness and not an accident, and the bench was considering an appeal against that decision. The bench observed after drawing attention to numerous judgements such as Steel v. Cammel, Laird & Co. (1905) 2 K.B. 232, Co-Operators Life Insurance Company v. Randolph Charles Gibbens 2009 SCC 59 etc., most of which came from foreign countries that when deciding whether an illness would be covered by an accident insurance policy, it has become more complex to recognise the difference between an accident and a disease that is acquired in the normal course of human events. The view that an accident presupposes a mishap or an unfavourable occurring, that is unexpected and unforeseeable, is one crucial consideration. According to this definition of an accident, something that occurs naturally is not a result of a mistake. This is the rationale behind the belief that when a sickness is brought on by a physical defect or condition, it cannot be classified as an accident. It is impossible for someone who had flu or a viral fever to claim that it was an accident. Naturally, any illness has a certain degree of chance or likelihood associated with it. Even if viral disease has spread throughout an area, not every person may be affected. It may be a matter of luck whether you contract the flu or some other viral infection. A person who contracts the flu, however, cannot be said to have been injured accidentally because the virus spread naturally.
The court also provided an example of how a physical ailment that a person experiences could be a direct result of an accident. It suggested that a motor vehicle accident that causes bodily injuries and death or disability, may be covered by an accident insurance policy. Therefore, it has been hypothesised that a disease would not be included by the definition of an accident if it is caused or spread in the course of natural events. However, the illness or body condition may be viewed as an accident in a particular case or setting if its source or mode of transmission is unanticipated and unforeseeable.
The bench overturned the commission's decision after observing the case's facts and noting that an accident—"an unfavourable incident that is unforeseeable and unanticipated in the regular course of human affairs"—is a hazard covered in an insurance policy in cases of death due to accident. In the particular situation, encephalitis malaria was the direct cause of the insured person's death. The argument was that getting stung by a mosquito is an accident and should be treated as such because it was unforeseeable. However, the Court held that such disease does not fall under the purview of accident and insurance amount cannot be claimed.