Ricky has a personal accident policy that covers death by accident but excludes death by disease. He falls from his horse and suffers leg injuries. He is admitted to hospital but his leg wound turns septic and one week l

CS Professional · Insurance - Law and Practice · PYQS · December 2017
Ricky has a personal accident policy that covers death by accident but excludes death by disease. He falls from his horse and suffers leg injuries. He is admitted to hospital but his leg wound turns septic and one week later he dies as a result of the disease septicaemia. Explain whether the personal accident insurers are liable under the policy referring to relevant case law in support of your answer.

Answer & Explanation:

The issue here is causation - the insurers would need to establish whether original accident was the proximate cause of Ricky's death or was his death as result of septicaemia. Where there is a 'chain of events', the insurers are liable where the loss flows in an unbroken chain directly from an insured peril. Equally, there is no liability if the loss flows from an excluded peril. Etherington v Lancashire and Yorkshire Accident Insurance Company (1909) The insured fell from the horse and suffered some injuries that force him to lie in cold and damp conditions so that he contracted pneumonia, of which he eventually died. It was held that the proximate cause of his death was the original 'accident' if the fall from the horse and not the disease that ultimately killed him (which was excluded). Mardof v Accident Insurance Co.(1903) The insured scratched his leg with his thumb nail while removing his socks. Six days later the wound turned septic, on the tenth day septicaemia set in and on the twentieth day the injured dies of septicaemia. The policy covered death by accident but excluded death by disease. The court in this case held that the proximate cause of death was accident and not the ensuing disease. In this scenario the 'chain of events' was unbroken in the sense that septicaemia was a natural consequence of Ricky falling from his horse and suffering the leg injury. The personal accident insurers would therefore be liable even though he died from septicaemia an excluded peril.

Topics: Personal Accident Insurance

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