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Case 5 Personal accident policy requires “accidental” bodily injury

After an operation to remove a craniopharyngioma, the woman became blind in the right eye. She considered her blindness an unfortunate accident and submitted a claim under her personal accident policy, which the insurer rejected.  A key issue in the claims dispute was whether the injury of blindness had resulted from an “accident” or not, which was defined in the policy as ‘an unforeseen and involuntary event which causes a bodily injury’. The woman was referred to have the operation because the craniopharyngioma had caused deterioration and visual field defect to both eyes. The insurer believed that the woman should have been informed of the possible risks, including blindness, for undergoing such a complicated operation. In other words, the woman’s blindness should have been a risk known to her, rather than an injury caused by an ‘unforeseen and involuntary event’.

Having considered all available facts, the Complaints Panel agreed that the woman’s blindness was not caused by an accident, but was one of the foreseeable consequences of the surgery. Thus, the insurer’s decision to reject the accident claim was upheld.

Remarks: it is normal for each personal accident policy to specifically define “accident” for the purpose of qualifying the insured bodily injury.