Accident insurance 2 in United Kingdom
Accident insurance 2 in the Business Encyclopaedia and Legal Adviser
Based on the Business Encyclopaedia and Legal Adviser , by W.S.M. Knight, Barrister –at – Law.
What Accidents are within the these are clearly defined in the policy. Now, as to some particular points hereon. (a) The injury must be caused by some external violence operating directly upon the person of the assured. accordingly suicide is not an accident; though it will not be presumed and must be affirmatively proved by the company. This rule will be construed by the courts in the way a person of ordinary intelligence would read it, attention being paid to the whole of the policy. The question will be (1) By what means was the assured injured ? If the means were violent; and also accidental, as by getting, without intention, into the particular position in which the injury could happen; the answer is that the means were ” violent.” The next important question is (2) Were they external? And the answer to this will be in the affirmative, if they were, without nice distinction, the opposite of example, a stopping on the part of the assured to reach an article on the pavement. (b) There is generally a provision excluding death or disablement, resulting from any natural disease or weakness. Under this provision the company would not be liable in the case of death by sunstroke. Generally, disease, though produced by the action of a known cause, can hardly be considered an accident. (c) The case of the assured exposing himself to risk or injury. The rule is, that if such risk was obvious to him at the time; or would have been obvious to him if he had paid reasonable attention to what he was doing, he would not be in a position to claim compensation under the policy. (d) The death or disablement must be the direct result of the accident. Here, in every case the determining question will be—What really caused the death ? As this point is both important and intricate, we will give an illustration. An assured under a policy against “death from the effects of injury caused by accident,” fell and dislocated his shoulder. He was at once put to bed, and died in less than a month from the date of the accident, having been all the time confined to his bed. It was discovered that the death resulted from pneumonia caused by cold, but that the assured would not have died as and when he did had it not been for the accident. The fatal effects of the cold, and his susceptibility thereto, were both clue to the condition of health to which he had been reduced by the accident. It was held that his death was clue to the “effects of injury caused by accident” within the meaning of the policy. ” Cause” and ” effects” are correlative terms; and it is sufficient to construe the word “effects” from that point of view. If, as in the above case, the assured lives for some time after the injury, he must during this time live as an invalid, subject to the ordinary conditions of such a mode of life. These conditions of life are something distinct from the injury, but when a question arises as to whether the death of the assured while subject to them was caused by the injury, it becomes essential to take into consideration these conditions of life as well as the injury. And not only these conditions, but such things as are either inseparable from them o. are their natural consequences. There can be no pretence, in such case as the above, for treating the case as less due to the injury because one stop in the train of circumstances which followed was that the assured caught a cold.
Defences to an action on the policy.—It is a defence to a claim upon such a policy, as in other cases of insurance, that the assured did not make a full disclosure of all material facts. The contract of insurance is one based upon utmost faith between the parties. Consequently false statements, misrepresentation, or suppression of truth, whether fraudulent or not, in any proposal for the policy, or any claim under it, avoids the contract, and affords a complete defence to any action in respect therefore. Particular care must therefore be taken in this respect when filling up the form of proposal. Where notice of the accident is expressly made a condition precedent to liability, the absence of such a notice, even though it was impossible to give it, is a defence to any action on the policy. So also is the non-compliance with any other conditions of the policy; as, for example, where the company may send its medical man to see the patient, or require a or require other proof satisfactory to its directors as to cause, nature and extent of the accident. But the last-mentioned proof need only be such as ought to be satisfactory to the directors. See also EMPLOYERS’ LIABILITY; WORKMEN’S COMPENSATION.