Mr Quek Kiat Siong, the co-owner of a popular popiah business, passed away on 4 Aug 2012.
After his demise, his estate tried to make a claim on both of his Personal Accident (PA) policies.
However, AIA rejected the claim, based on suicide exclusion.
The aggrieved family litigated the matter but the judgment was unfavourable.
They did not give up and pursued further to the Highest Court in Singapore – the Court of Appeal.
Their conviction and perseverance were rewarded when their appeal succeeded.
This is a curious story of how a death was initially assessed to be a suicide and then overruled to be an accident.
It has a profound effect on PA insurance coverage.
The landscape of PA insurance in Singapore may be changed due to this latest judgment too.
Without further ado, let us start by giving you the facts of the case.
The Fateful Event
Mr Quek was found lying unresponsive on his bedroom floor.
The Deceased had suffered from long-term severe chronic back pain due to his many years of carrying heavy bags of flour and his history of falls in the shop-house.
As a highly responsible man who believed in traditional Chinese values such as diligence, loyalty and commitment, he became depressed when he was no longer able to undertake some of the business functions due to his ailing health condition.
He developed insomnia and anxiety problems.
After two bad falls, Mr Quek admitted himself to the hospital on 2 Jul 2012.
When he was finally discharged on 31 Jul 2012, he was prescribed 14 different types of medicines by the doctors.
Those drugs were double-edged swords – they relieved his pain but caused his death.
When the forensic pathologist investigated the death, he reported that the cause of death was multi-organ failure with pulmonary haemorrhage, due to mixed drugs intoxication.
The state coroner concluded that the Deceased had in all probability taken an overdose of prescription drugs with the intention of ending his life.
Suicide, it is.
Or so it seems.
The Turn About.
Mr Quek had two PA insurance – namely PA Policy and Platinum Policy with sum assured of $200k and $1million respectively with AIA.
Supported by the coroner’s report, AIA rejected the claims.
The estate had no option but to escalate it to the Court.
The Court studied the material at hand and ascertained that AIA did no wrong.
Post-mortem blood samples of the deceased showed an elevated amount of drugs that was way over the prescribed limit.
The overdose of these drugs induced respiratory depression which caused the fatality.
As the Deceased was briefed about the danger of overdose by the doctor, the Judge concluded that the Deceased must have expected to die if he deliberately consumed an overdose.
The verdict was overturned by the Court of Appeal (CA) though.
The CA re-visited the evidence and found that there was no evidence to arrive at the conclusion that the Deceased had overdosed as post-mortem blood sample was not a reliable tool to gauge consumption.
CA also evaluated that the late Mr Quek had consumed the medication with the expectation that he would not suffer injury.
It was an unexpected and unintended reaction of his body to the drugs that resulted in his demise.
Thus, it was well within the scope of his PA insurance.
AIA was ordered to pay up the compensation.
The Evolution of Accident.
We are curious about this case not because of the finger-pointing and fault-finding potential.
Of course, if we really have to point to someone for putting the estate through all the unnecessary trauma, it would be the Coroner’s report.
It put AIA in a position that it had to reject the claim due to the suicide exclusion in the policy and thus started the whole legal tussle.
What is intriguing for us is that the construction of a PA policy was examined by the CA.
And how the policy is written is crucial to whether you can or cannot make a claim.
In the PA policy, the ‘injury’ (in this case, death) is defined as bodily injury effected directly and independently of all other causes by accident. However, ‘accident’ is not defined.
In the Platinum policy, it defines ‘accident’ as an unforeseen and involuntary event that causes an injury.
However, the CA was not satisfied by the definitions.
It took the opportunity to construe the term ‘accident’.
The CA reviewed past case laws all over the world.
What it showed is the ever-changing definitions of ‘accident’ in PA policies.
Interestingly enough, the case Clidero vs Scottish Accident Insurance 1892 revealed that PA plan covered only ‘bodily injury caused by violent, accidental, external and visible means.
If one were to choke on a piece of tofu and kick the bucket back then, the PA policy would not be liable to pay as it was not visible or violent!
Thankfully, the Court in the United States highlighted the problem regarding the definitions of ‘accident’ in insurance policies.
It states that insurance policies should be interpreted in a way that gives effect to the reasonable expectations of parties (insurer and consumer).
In order to ascertain if something is accidental, the consequences of the actions and events that produced deaths must be unexpected.
Going back to the case at hand, the CA determined that the estate had to establish on a prima facie basis that the Deceased did not intend or expect the injury.
Then the evidential burden shifts to the insurer to show the converse.
What this meant is that there is policy coverage as long as we do not have the intent or expectation of hurting ourselves.
When this is shown, the insurer must pay up or produce contrary evidence.
This represents a positive change to us as consumers as our burden of proof is lessened.
What you need to know.
If you have no interest in following the above legal-jumble, this is where you should start paying attention.
With no additional cost, your PA plan has widened its scope due to this new judgment.
The Court have ruled that as long as you have no intent or expectation of hurting yourself, you are entitled to make a claim under your PA insurance.
This makes some previously-uninsured events covered.
And if you are going to buy a PA policy, you may wish to do it soon.
With the legally-enforced improved coverage, the insurers may raise prices after reviewing it with their legal and actuarial teams.
Alternatively, they may choose to re-word the accident definition more tightly.
The next time it gets challenged, the result may well be very different.
Thus, do look out on whether the term ‘accident’ is defined and if yes, how it is worded.
We understand there is a negative backlash against AIA and insurance companies in general.
It is not an example of an insurer employing dirty tactics to avoid claims.
The CA had overturned the findings of the coroner, indicating that there was no mistake on AIA’s part for this case.
AIA was merely following the result of the initial findings.
Hopefully, the public can understand the case a little better and retain its confidence in insurance.
PA policies form a vital part of your financial portfolio.
And you certainly do not wish to miss out on some of its finest benefits.
Drop us a line and we shall have someone take care of the business.
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