To maintain a claim underneath the coincidence benefit cover, it should be installed that the assured has sustained a bodily injury which resulted solely and without delay from the accident. There ought to exist a proximate causal dating between the accident and the physical injury. Moreover, the twist of fate needs to be caused by the outward violent and seen approach.
Accidental dying advantage clauses in lifestyle insurance guidelines are very commonplace in recent times. This gives extra insurance, over and above the standard existence insurance sum, if the insured’s loss of life is brought about due to an accident. Of path, one has to pay more top rate to avail of this benefit.
A fashionable word located in such clauses is “demise due to a twist of fate caused by violent, seen and external approach.”
Though sounding morbid, this word has been at the coronary heart of fascinating judicial discussions on what exactly is a twist of fate.
Commonly understood, an accident is an unexpected incident that takes location no longer in the normal direction of activities, leading to ugly, tragic, or startling results.
In a judgment introduced ultimate month within the case Smt.Alka Shukla vs. Life Insurance Corporation of India, the Supreme Court has mentioned this aspect in detail.
If so, the question turned into whether or not a person who died of heart assault while riding a motorcycle can be said to have suffered ‘unintended loss of life.’ The insurance employer had repudiated the declare on the ground that loss of life was no longer unintended. It is challenging this, the wife of the deceased filed a client grievance. Though the State Commission allowed the criticism, its decision was overturned through the National Commission in insurer’s attraction. After that, she approached the Supreme Court.
As in keeping with scientific records within the case, the motive of loss of life was a heart attack, and the fall from the scooter did no longer contribute to it. There changed into no evidence to expose that any physical accidents had been suffered because of the autumn from the bike or that they brought about the assured suffering a heart assault. The bench of Justices D Y Chandrachud and Hemant Gupta located that the fall from the motorcycle, which became taken because of the twist of fate in the case, did no longer contribute to death. Death becomes attributable to coronary heart attack, which changed into no longer treated as a twist of fate because of ‘violent, visible and external method.’
Accidental Means and Accidental Results
While achieving its conclusions, the SC mentioned the standards of ‘unintended method’ and ‘unintended consequences’ used by Courts all over the world to address such conditions.
Justice Chandrachud stated in the judgment that there had been a divergence of opinion between courts throughout international jurisdictions – such as the UK, US, Canada, and Singapore- on whether or not a difference has to be maintained between ‘unintended means’ and ‘unintended result’ at the same time as determining unintended coverage claims.
According to the ‘unintended means’ method, the mere truth that loss of life turned into surprising is not sufficient to categorize it as ‘unintended death.’ It needs to have been resulting from an ‘unintentional manner.’ This approach draws help from using the phrase ‘way’ inside the word “violent, seen and outside method.”
A 1934 judgment of the Supreme Court of the US in the case Landress v Phoenix Mutual Life Insurance was concerning the declare of someone who died because of sunstroke even as playing golf. The majority judgment upheld the repudiation of declaring by looking at “coverage isn’t always towards an unintentional result” and that the policy want is honored only if the unintentional loss of life is “effected through means that are outside and unintentional.”
Justice Cardozo but dissented from the majority. According to him, the distinction between ‘manner’ and ‘result’ become synthetic. If the dying changed into an accidental result, it turned into due to unintentional means, he reasoned.
The Canadian Supreme Court has taken an opposite view from most people’s opinion of SCOTUS in Landress. In American International Assurance Life Company Ltd and American Life Insurance Company v Dorothy Martin, the insured died because of an overdose of medicines injected by him. The coverage organization rejected the claim pronouncing that loss of life became now not because of violent, outside unintentional way and was caused by a planned act of the insured.
The Canadian Court said that to check whether or not a given means of dying is “accidental,” it must consider whether or not the effects had been predicted.
“We can’t usefully separate off the “means” from the relaxation of the causal chain and ask whether or not they were planned,” the Court discovered, applying the reasoning of Justice Cardozo. According to Court, “accidental death” and “dying by using unintentional method” have the same connotation, and accidental results have to be treated as unintentional.
Endorsing the Canadian view, the Singapore Supreme Court held in a case referring to an accidental overdose of medication that the ‘unintentional means’ test ought to be now not used to disclaim coverage to cases wherein the proximate motive of demise becomes a voluntary act of the deceased, which had produced an unintentional result.
When loss of life changed into caused by external attack
In Kamlawati Devi vs. the State of Bihar, the Patna High Court was grappled with the problem of whether or not loss of life of an officer even as appearing election due to attack by armed miscreants can be stated to be “resulting totally and immediately from the accident as a result of outside violent and some other seen method.”
Justice Aftab Alam (later SC judge), who discussed the ideas of “unintentional manner” and “unintended outcomes” in his judgment, determined that he became inclined to accept the view expressed via Justice Cardozo in the Landress case(supra).
Nevertheless, Justice Alam held that the case changed into included by using the take a look at “unintentional manner” as nicely, as the assault via miscreants becomes “external, violent and seen.” Looked at from both views, the loss of life became blanketed with the aid of accident gain clause, held by the Court.
In Alka Shukla(supra), the Supreme Court did not project to decide which methods are accurate conclusively. The Apex Court but laid down a check to decide such cases, by way of announcing :
Violent, Visible and External- Meaning of the terms
It is vital to understand the implications of those words, which qualify the expression ‘accidental approach’ within the twist of fate gain clause.
‘Violent method’ does now not mean that there should be the use of blatant and brute force. Even diffused times of violence, which includes an unintended inhalation of poisonous gas, maybe appeared as ‘violence.’ Any outside activities, which does violence to the human frame using rendering it incapable of functioning, maybe seemed as ‘violent.’ The phrase “violent” is merely utilized in antithesis to “without any violence at all. (Halsbury’s Laws of England, 4th Edition, 2013 (Vol 25))
Halsbury’s Laws also explains that the ‘External way’ is used to contrast with something inner. Any purpose which isn’t inner needs to be external; however, this doesn’t imply that the damage ought to be outside; there may be, and frequently is, not anything externally visible to suggest the presence of inner harm in any respect. The period’s effect is consequently to underline that issues springing up within the human frame, without ascertainable reference in any respect to anything coming from out of doors, aren’t protected.
Based on this connotation, the Kerala High Court held that a third birthday celebration or an external employer was not required to represent a twist of fate as ‘violent’ (Valsala Devi v Divisional Manager, Kottayam). A twist of fate gain declares became made concerning the death of the insured, which had occurred because of fall from a high-upward thrust constructing. The claim changed into repudiated via citing the motive that it changed into no longer ‘violent.’ The coverage business enterprise also relied on the scientific file, which had stated that the deceased was affected by ‘diabetes and high blood pressure.’ So, the insurer said that the autumn was because of his medical circumstance, and there has been no external motive.
Negating this stand of the insurer, the High Court discovered :
“It can’t at all be said that handiest an accident as a result of a 3rd party might be included under the stated clause. Whether or not it’s precipitated by way of a third birthday celebration or using the cause of a trifling slip or as within the gift case, a coincidence, a fall might be a twist of fate coming in the coverage of the coverage; if it is fatal. Even if the fall has been with the aid of purpose of either Diabetes or Hypertension, then so it’d be an accident insofar because the scientific situation which induced the autumn was no longer the motive of death. Death became completely due to the autumn and changed into at once occasioned by way of the harm to the head, brought on inside the fall. The ‘outward, violent and seen cause’ is the top harm which injury alone was the demise’s motive. The fall and the injury to the pinnacle, which occasioned death, is the outward cause, as outstanding from an internal cause like a hemorrhage or hypoglycemia. The injury is seen as additionally turned into because of the violence of the fatal fall”.
The Gujarat High Court in Ambalal Lallubhai Panchal vs. LIC held that demise due to canine chunk is death due to unintentional means. The Court said that the ‘twist of fate’ has to be given an extended meaning to cowl all mishthathich happen abruptly are not deliberate or voluntary.
“A dog chew isn’t always added about using any design or purpose. It is sudden damage. A dog chew is undoubtedly outward, violent, and visible by way of which the damage is added about. The loss of life resulting therefrom could consequently, in our opinion, be a loss of life on account of a twist of fate because of outward, violent and seen way inside the meaning of the accident advantage clause of the policy”, stated the Court.
A disease occurring in the herbal route of activities no longer a twist of fate
In Branch Manager, National Insurance Co Ltd v Smt Mousumi Bhattacharjee and others, the SC held that loss of life due to Malaria in Mozambique could not be termed as ‘unintended dying.’ This became so held via the Court based on the reality that the vicinity turned into Malaria susceptible and mosquito chew there was now not outside the direction of natural events. The reviews of WHO said that one out of three men and women in Mozambique was stricken with Malaria.
“Hence, it has been postulated that in which an ailment is prompted or transmitted inside the natural route of activities, it would now not be covered by the definition of a coincidence. However, in a given case or circumstance, the anguish or bodily situation may appear as an accident wherein its reason or path of transmission is unexpected and unforeseen”, the Court said.