What Is 'Accidental Death' In The Context Of Insurance Law?

What Is 'Accidental Death' In The Context Of Insurance Law?

 
Accidental death benefit clauses in life insurance policies are very common these days. This gives additional coverage, over and above the usual life insurance sum, if the death of the insured is caused due to an accident. Of course, one has to pay extra premium to avail this benefit.

A standard phrase found in such clauses is "death due to accident caused by violent, visible and external means".

Though sounding morbid, this phrase has been at the heart of fascinating judicial discussions on what exactly is an accident.

Commonly understood, accident is an unforeseen incident which takes place not in the ordinary course of events, leading to unpleasant, tragic or startling results.

In a judgment delivered last month in the case Smt.Alka Shukla vs Life Insurance Corporation of India, the Supreme Court has discussed this aspect in detail.

The question in that case was whether a person who died of heart attack while riding a motor cycle can be said to have suffered 'accidental death'. The insurance company had repudiated the claim on the ground that death was not accidental. Challenging this, the wife of the deceased filed consumer complaint. Though the State Commission allowed the complaint, its decision was overturned by the National Commission in insurer's appeal. After that she approached the Supreme Court.

As per medical records in the case, the cause of death was heart attack, and the fall from the scooter did not contribute to it. There was no no evidence to show that any bodily injuries were suffered due to the fall from the motorcycle or that they led to the assured suffering a heart attack. The bench of Justices D Y Chandrachud and Hemant Gupta found that the fall from the bike, which was taken as the accident in the case, did not contribute to death. Death was attributable to heart attack, which was not treated as an accident caused by 'violent, visible and external means'

Accidental Means and Accidental Results

While reaching its conclusions, the SC discussed the concepts of 'accidental means' and 'accidental results', which are used by Courts all over the world to deal with such situations.

Justice Chandrachud said in the judgment that there was a divergence of opinion between courts across international jurisdictions - including the UK, US, Canada and Singapore- on whether a distinction should be maintained between 'accidental means' and 'accidental result' while deciding accidental insurance claims.

As per the 'accidental means' approach, the mere fact that death was unexpected is not sufficient to classify it as 'accidental death'. It should have been caused by 'accidental means'. This approach draws support from the use of word 'means' in the phrase "violent, visible and external means".

A 1934 judgment of the Supreme Court of the United States in the case Landress v Phoenix Mutual Life Insurance was regarding the claim of a person who died due to sunstroke while playing golf. The majority judgment upheld the repudiation of claim by observing "insurance is not against an accidental result" and that the policy need be honoured only if the accidental death is "effected by means which are external and accidental".

Justice Cordozo however dissented from the majority. According to him, the distinction between 'means' and 'result' was artificial. If the death was an accidental result, it was caused by accidental means, he reasoned.

The Canadian Supreme Court has taken a contrary view from the majority opinion of SCOTUS in Landress. In the case American International Assurance Life Company Ltd and American Life Insurance Company v Dorothy Martin, the insured died due to over dose of medicines injected by him. The insurance company rejected the claim saying that death was not due to violent, external accidental means and was caused by a deliberate act of the insured.

The Canadian Court said that to ascertain whether a given means of death is "accidental", it must be considered whether the consequences were expected.

"We cannot usefully separate off the "means" from the rest of the causal chain and ask whether they were deliberate", the Court observed, applying the reasoning of Justice Cordozo. According to Court, "accidental death" and "death by accidental means" have the same connotation and unintended results should be treated as accidental.

Endorsing the Canadian view, the Singapore Supreme Court held in a case relating to unintended overdose of medicine that 'accidental means' test should not be used to deny insurance coverage to cases where the proximate cause of death was a voluntary act of the deceased, which had produced an unintended result.

When death was caused by external attack

In Kamlawati Devi vs State of Bihar, the Patna High Court was grappled with the issue whether death of an officer while performing election due to attack by armed miscreants can be said to be "resulting solely and directly from accident caused by external violent and any other visible means"

Justice Aftab Alam (later SC judge), who discussed the concepts of "accidental means" and "accidental results" in his judgment, observed that he was inclined to accept the view expressed by Justice Cordozo in Landress case(supra).

Nevertheless, Justice Alam held that the case was covered by the test of "accidental means" as well, as the attack by miscreants was "external, violent and visible". Looked at from both the views, the death was covered by accident benefit clause, held the Court.

In Alka Shukla(supra), the Supreme Court did not venture to conclusively determine which of the approaches is correct. The Apex Court however laid down a test to decide such cases, by saying :"to sustain a claim under the accident benefit cover, it must be established that the assured has sustained a bodily injury which resulted solely and directly from the accident. There must, in other words exist a proximate causal relationship between the accident and the bodily injury. Moreover, the accident must be caused by outward violent and visible means"

Violent, Visible and External- Meaning of the terms

It is important to understand the implications of these words, which qualify the expression 'accidental means' in the accident benefit clause.

'Violent means' does not mean that there should be use of blatant and brute force. Even subtle instances of violence, such as an accidental inhalation of poisonous gas, will be regarded as 'violence'. Any external act, which does violence to the human body by rendering it incapable of functioning will be regarded as 'violent'. The word "violent" is merely used in antithesis to "without any violence at all.(Halsbury's Laws of England, 4th Edition, 2013 (Vol 25))

Halsbury's Laws further explains that 'External means' is used to point the contrast with something internal. Any cause which is not internal must be external, but this does not mean that the injury must be external; there may be, and often is, nothing externally visible to indicate the presence of internal injury at all. The effect of the term is therefore to underline that disorders arising within the human body, without ascertainable reference at all to anything coming from outside, are not covered.

Based on this connotation, the Kerala High Court held that act of a third party or an external agency was not required to characterize an accident as 'violent' (Valsala Devi v Divisional Manager, Kottayam). There, an accident benefit claim was made with respect to death of the insured, which had occurred due to fall from a high-rise building. The claim was repudiated by citing the reason that it was not 'violent'. The insurance company also relied on the medical report which had said that the deceased was suffering from 'diabates and hypertension'. So, the insurer stated that the fall was due to his medical condition, and there was no external cause.

Negating this stand of the insurer, the High Court observed 

"It cannot at all be said that, only an accident caused by a third party would be covered under the said clause. Whether it be induced by a third party or by reason of a mere slip or as in the present case, an accident, a fall would be an accident coming within the coverage of the policy; if it is fatal. Even if the fall were by reason of either Diabetes or Hypertension, then too it would be an accident insofar as the medical condition which caused the fall was not the cause of death. Death was solely due to the fall and was directly occasioned by the injury to the head, caused in the fall. The 'outward, violent and visible cause' is the head injury which injury alone was the cause of the death. The fall and the injury to the head, which occasioned death, is the outward cause, as distinguished from an internal cause like a hemorrhage or hypoglycemia. The injury is visible as also was due to the violence of the fatal fall".

The Gujarat High Court in Ambalal Lallubhai Panchal vs LIC held that death due to dog bite is death due to accidental means. The Court said that 'accident' has to be given a wide meaning to cover all mishaps which happen unexpectedly, and which are not deliberate or voluntary.

"A dog bite is not brought about by any design or intention. It is an unexpected harm. A dog bite is surely something that is outward, violent and visible by which the harm is brought about and the death resulting therefrom would therefore in our opinion be a death resulting from an accident caused by outward, violent and visible means within the meaning of the accident benefit clause of the policy", said the Court.

Disease occurring in natural course of events not an accident

In Branch Manager, National Insurance Co Ltd v Smt Mousumi Bhattacharjee and others, the SC held that death due to Malaria in Mozambique cannot be termed as 'accidental death'. This was so held by the Court based on the fact that the area was Malaria prone and mosquito bite there was not outside the course of natural events. The reports of WHO stated that one out of three persons in Mozambique was afflicted with Malaria.

""Hence, it has been postulated that where a disease is caused or transmitted in the natural course of events, it would not be covered by the definition of an accident. However, in a given case or circumstance, the affliction or bodily condition may be regarded as an accident where its cause or course of transmission is unexpected and unforeseen", the Court said.

Murder an accident

The National Consumer Disputes Redressal Commission (NCDRC) held in Royal Sundaram Alliance Insurance Co Ltd v Pawan Balram Mulchandani that murder can be treated as accidental death.

The Commission referred to the UK Court of Appeal's judgment in Nisbet v Rayne and Burn, in which it was held that murder was an accident from the stand point of the person, who suffered from it.

If the immediate cause of the injury is not the deliberate and wilful act of the insured himself, it would be an accident, the Commission quoted from Halsburys.

"It is reasonable and logical to conclude that a person takes personal accident shield insurance policy to insure himself against accidental injury resulting in death caused by an unexpected and unintentional incident. In this case, there was no immediate deliberate willful act by the insured that led to his murder. Putting himself to risk of injury by immediate wilful deliberate act or carelessness or instigation or aggression etc. is not evident. Death was due to unexpected and unintentional incident i.e. an accident. 'Murder' per se was not specifically excepted in the policy. Hence, in the facts of this case, the death was clearly accidental and was squarely covered by the policy," the Commission said.

In Rita Devi vs New India Assurance Co Ltd, the murder of an autorickshaw driver at the hands of persons who tried to steal the vehicle was treated by the Supreme Court as an accident arising out of use of vehicle for the purposes of third party insurance under Motor Vehicles Act.

The attempt of theft by the passengers was an unforeseen event as far as the driver was concerned, and if the driver gets killed in such attempt, it is an event outside the natural course. It has to be treated as an accident which occurred during duty, reasoned the Court.

When disease is consequent to accident

There could be situations where accident does not lead to immediate death, but will give rise to other health complications, which may lead to death.

In a case where a person died of heart attack three days after an accident, the NCDRC held that it should be treated as death caused by accident.

"...first the accident took place, resulted in injuries and chest pain which ultimately resulted in 'death'. May be, the death in the medical terms be described as 'due to heart-attack, but the main cause for leading to heart-attack was injury caused due to accident. Accident is the basis for Causing chest pain and thereafter heart-attack", concluded the Commission in the case Krishna Wati v LIC

When work-related stress causes death

There are several decisions which hold that if death is established to be caused by work-related stress, it has to be treated as an accident arising in the course of employment, so as to get the protection of insurance coverage. These decisions are rendered in the context of Workmen's Compensation Act.

The Kerala High Court decision in United Indian Insurance Co v C S Gopalakrishnan is a good reference on this point, as it discusses several other High Court judgments, to hold that death due to illness caused by strenuous work is a fatal accident.

In Laxmibai Atmaram v. Chairman and Trustees, Bombay Port Trust , Chagla, C.J., speaking for a Division Bench, said that "if the employment is a contributory cause, or if the employment has accelerated the death, or if it could be said that the death was due not only to the disease but the disease coupled with the employment, then the employer would be liable and it could be said that the death arose out of the employment of the deceased"

Published on: 08/06/2019Source: Live Law