The illness of encephalitis malaria through a mosquito bite cannot be considered as an accident for the purpose of claiming insurance under Personal Accident Policy- Supreme Court

Death occurred due to Malaria on account of mosquito bite cannot entitle  the legal heirs of the Policyholder from claiming insured amount in respect of personal accident Insurance Policy, the Supreme Court lays down the law. According to the Supreme Court, encephalitis malaria through a mosquito bite cannot be treated as an accident by relying upon the various definitions  and  legal propositions settled down by the various courts all over the world.

In the case on hand, the Insured was working as a Manager of a Tea Estate in Assam. He thereafter took up employment in 2012 as a Manager of a Tea Factory at  Cha-DeMagoma, District Gurue, Province-Zambezia, Republic of Mozambique. During his stay in Mozambique, the insured was admitted to the hospital on 14 November 2012. He was diagnosed with encephalitis malaria and died on 22 November 2012 due to multi-organ failure. He had taken a policy against personal accident. Upon his death, his legal heirs claimed the insured amount, which had been refused by the Insurance Company. So, they filed a complaint before the District Consumer Disputes Redressal Forum and the same had been allowed and the State Commission as well as the National Commission had also concurred with the decision of the District forum. Upon hearing, the Supreme Court reversed the decision of the National Commission by holding that “insured was based in Mozambique. According to the World Health Organization’s World Malaria Report 2018, Mozambique, with a population of 29.6 million people, accounts for 5% of cases of malaria globally. It is also on record that one out of three people in Mozambique is afflicted with malaria. In light of these statistics, the 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 the policy of accident insurance”

The Apex Court had also observed that “Malaria is most commonly transmitted to humans through malaria virus infested mosquito bites, and when a virus is contracted through normal means brought about by everyday life it cannot be deemed to be an unexpected or unforeseen accident”.

Though the Supreme Court settles the position of Law in the above manner as against the Claimants, still, by invoking article 142 of the Constitution of India, it directed the insurance company not to recover any amount from the claimants, which had already been paid as per the direction of National Commission.

(Case Law: The Branch Manager National Insurance Co. Ltd Versus Smt. Mousumi Bhattacharjee & Ors- Date of Decision of SC -26-03-2019)