Introduction

Accidental Death
Typically, accidental death covers exceptional circumstances, such as exposure to the elements,
traffic accidents, homicide, falls, drowning, and accidents involving heavy equipment. 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 exist a proximate
causal relationship between the accident and the bodily injury. Moreover, the accident must be
caused by outward violent and visible means

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'

When adding an AD&D rider, also known as a “double indemnity” rider, to a life insurance
policy, the designated beneficiaries receive benefits from both in the event the insured dies
accidentally. Benefits typically cannot exceed a certain amount. Most insurers cap the amount
payable under these circumstances. As most AD&D insurance payments usually mirror the face
value of the original life insurance policy, the beneficiary receives a benefit twice the amount of
the life insurance policy’s face value upon the accidental death of the insured.
Accidental Means and Accidental Results

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"
Conclusion
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".