Compare Expat Health Insurance

GET QUOTES

Section 1
Section 2
Section 3
Section 4
Section 5
Section 6
Section 7
Section 8

 

Case Study – Injury must have been caused by an accident for purposes of personal accident claims

The insured submitted an accident claim for multiple chop wounds sustained during an attack by a gang. According to the insured’s statement made to the police, he went to the scene of a fight with the intention of rescuing his friends from a mob’s assaults. In his rescue mission, the insured was seriously wounded by the assailants who were armed with weapons.

Although the insurer rejected the claim on the grounds that the circumstances of the incident which led to the injury of the insured had violated the law, the Complaints Panel was in no doubt that the insured had deliberately joined the fray himself. The Complaints Panel was of the view that it was an easy matter to foresee that pushing some of the mobsters at the scene of the fight would result in the insured being attacked. As that was what actually happened, the Complaints Panel reached the finding that the insured’s injury was not accidental but was a natural consequence of his own actions. It therefore ruled in favour of the insurer.

Remarks: the insured person’s foreseeability of being attacked as a result of his own deliberate action has taken his injury out of the scope of injury caused by an “accident”.