PERSONAL ACCIDENT INSURANCE

I was reading through two different policies.

One defined accident as 'injury suffered caused solely by an accident and not by sickness, disease or gradual physical or mental deformity or infirmity'.

Another defined accident as 'shall mean a sudden, unintentional, unexpected, unusual, and specific event that occurs at an identifiable time and place which shall, independently of any other cause, be the sole cause of bodily injury'.

Let us look at this accident : A man was driving home after work when a dog dashed across the road. He swerved to avoid the dog and crashed into a tree. He suffered injury and was unconscious. A minute or two later, the car burst into flame and he was burned to death.

The first policy will be liable as death was caused solely by an 'accident' as defined. The second policy would present a problem. Death was not the result of the initial collision but by fire which was another cause. The two phrases, 'independently of any other cause' and 'be the sole cause of bodily injury', make liability under the policy uncertain. We need to show 'sole cause' and it must be 'independent' of any other cause. The claim could be denied.

I would want to have the first policy if I desire to effect a policy. What comments do members have?

• Buchizya Martin Mtonga Kondolo i thnk we shud consider the proximate cause of the death of the driver and apply the suitable defination of the accident,

  
  
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  Goh Yong Huat The insurance principle of Proximate cause would definitely be applicable in this case

  
  
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  Raymond Huang We all know that the principle of 'proximate cause' must be used to determine whether the cause was the most direct, effective, dominant and efficient one covered by the policy or otherwise. The principle may be modified to limit its operation like including 'indirectly, traceable, attributable' and the phase 'independent of any other cause'.

  
  
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  Chan Kee Kem I think hhh meant is avoiding the dog which the first cause which the diver survived. But the 2nd cause which the car caught fire, the policy wording would not respond as ' independent of any other cause ' would apply so policy will not pay. Policy wording should be simple to understand. Why make it so difficult.

  
  
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  Raymond Huang CKK - Very good comment. Death of the insured arose out of one event - car accident - but the second policy talks about sole cause of injury/death and will not respond when it is not 'independent of any other cause'. I agree policy wording should be simple. The second policy's definition carries an 'escape from liability' proviso. No good in my opinion.

  
  
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  Damian Tuan sadly there is 1 thousand and one different wording ..and i believe many insurers staff even at higher position is not aware or could confidently say they know the different policy wording....in addition to "proximate cause" mention by Goh Yong Huat...and other insurance principles which are equally well verse of it...i think the "Spirit & intention " must be determine at the point of purchase ...equally insured or agent must not expect " a cover which covers the sky or moon" at the friction of the "market price" ...so the moral here...... is 1) the insurer needs to be fair in their claims and not "look" for excuses not to pay ....2) intention must be ascertain at the point of purchase 3) the agent needs to be well verse Technically on the cover , claims and all other related subjects and lastly...... 4) the agents needs to have a "good reputation" with the insurer ...if all the above fails !!! as end of the day , if you have a good policy, correctly insured or covered ...but at the end day as the INSURER is the paying party ...you need them or you will not get your compensation...or you will be dragged into a long & lenghty legal process ...

  
  
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  William Ho The driver was burnt to death subsequent to the car hitting a tree. Both causes of the car accidentally hitting the tree and catching fire are insured perils. I see no reason why the death is not covered unless it can be proved an uninsured peril was in play.

  
  
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  William Ho Or being accidentally burnt to death is an exclusion in the policy.

  
  
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  Raymond Huang WH - What you said is correct but why include 'independent of any other cause' to complicate matters. Your valuable input would be appreciated.

  
  
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  Damian Tuan all though the policy must comply with the condition that ...it's independently of any other cause" , although the death was not caused by the collusion but the FIRE ... don't all PA policy cover FIRE perils or elements ??? i believe the intention to requires an '' independence " is to ensure there is "no abnormal or unexplained" causes but as long it's a insured perils/situation and NOT a Clear cut exclusion..it should be payable...

  
  
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  Wong Woon Hock My view is that the policy wording should be simple and transparent and not meant to create excuses to repudiate liability so long as death or injury is accidental in nature, excluding sickness, mental disorder, suicide and self-inflicted injury. Nowadays many PA policy even cover medical expenses or funeral expenses for certain amount on death due to dengue fever, etc.

  
  
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  Yam Lim Song The definition of an accident in the first policy is more straight forward and palatable. This is the common version used by most insurers in the industry. I will opt for the first policy.

  
  
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  Wong Woon Hock Yes, I too will prefer the 1st policy.

  
  
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  William Ho RH. I am also of the view the wording of the first policy is clear. I cannot guess the reasons why the drafter of the wording of the second policy found the need define "accident" in such manner. The actual circumstances of the incident will determine whether it is an accident and whether the accident was the proximate cause of the injury/death. As I mentioned in a previous post I believe less is more when it comes to wordings.

  
  
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  Raymond Huang WH - Excellent comment. Thanks.

  
  
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  Andrew Cheng Unfortunately , my own PA policy wording belongs to the 2nd policy .

  

  August 3 at 4:17pm · Like
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  Raymond Huang Andrew Cheng - Don't worry. You are well covered unless the circumstances of the accident are complicating.

  
  
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  Raymond Huang 'Independent of any other cause' means that the injury or death must arise from a sole cause without the intervention of a new cause (causa interveniens). If there is an intervening cause, the policy will not pay the claim. Look at this case. A man went horse riding in the hills alone>the horse tripped and he fell on the ground injuring his back>unable to move>could not summon help>lying on the ground and exposed to the elements>contracted pneumonia and died. The insurer refused the claim saying death was due to sickness. The court ruled that the proximate cause of the death was the injury from the fall and not the sickness. The chain of events from the fall until the death of the insured was unbroken and therefore the fall remained the proximate cause. There was no intervening cause to break the chain of events. I do not like the phrase 'independent of any other cause' in my policy. It may cause complications in a claim.

  
  
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  William Ho Although worded differently the two policies provide the same cover. The first one covers "accident" and relies on the principle of proximate cause to determine whether the incident is an accident as insured. The second more wordy one includes the principle of proximate cause into the insuring clause. Both policy will cover an accident if the proximate cause is insured.

  
  
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  Raymond Huang WH - A lay person would prefer a simple wording. Cannot understand the need for the long definition. Thanks for your comforting assurance.

  
  
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  Chan Kee Kem No need to employ a person who studied in Oxford to draft an insurance policy whereby a layman will not able to understand. Remember kiss, keep in simply simple so everybody can understand.