Copyright © 2020 MSIG Insurance (Hong Kong) Limited, 3-day prior notice for Hospitalisation Payment Guarantee, Actual hospital accommodation exceeding the “Room and Board Benefit” of medical insurance, Advice on Emergency Medical Evacuation of Group Medical Plans. Is hospital in-patient treatment covered by medical insurance? (See for example Diacon and Carter, Success in Insurance, and Hansell, Elements of insurance, and IISA study notes for course 042)The South African writers prefer to pursue the idea of proximate cause from the maxim lure non remota causa sed proxima spectatur, which means that an insurer will only be liable if the ‘fact’ for which a claim is brought, is the result of a proximate cause.Whichever approach is used, in the insurance field proximate cause connects the insured peril to the loss or damage, either to prove a claim or the exception. How does an insurance company evaluate medical insurance applicants with Hypertension? It looks for what is the reason behind the loss, is that is an insured peril or not. The Rules For Application Of Proximate Cause In Insurance are as follows: Single Cause: When a single cause gives rise to a claim, the issue is simple. What is Proximate cause? Courts employ a set of proximate cause rules to resolve causation disputes when a property policy states that it covers or excludes losses "caused by" a peril and there … This is evident from the definition given in the Pawsey case above.The ideas behind proximate cause and nova causa are fairly straight forward. Mr.A has taken a marine policyto cover the goods exported by him. Is hospitalisation mandatory for colonoscopy medical insurance claims? California Courts have interpreted California Insurance Code sections 530 and 532 to codify the efficient proximate cause doctrine. Why do I need to buy a separate critical illness insurance policy? ‘Proximate cause’ a source of conflict for ‘all risk’ policies- State and federal cases applying Illinois law conflict on whether proximate cause can be considered in deciding what caused a loss for purposes of all risk property insurance policies. It is also hard to understand what it means and hence hard to apply it. Principle of Proximate Cause - primary cause of a loss. Proximate cause is used in civil and criminal cases, and are frequent in personal injury legal cases. https://www.InjuryClaimCoach.com Proximate cause is an important part of personal injury claims. Proximate cause is a key principle of Insurance and is concerned with how the loss or damage actually occurred. 1590-1600 Latin proximatus (near, or approach) What is Proximate Cause. Proximate Cause — (1) The cause having the most significant impact in bringing about the loss under a first-party property insurance policy, when two or more independent perils operate at the same time (i.e., concurrently) to produce a loss. However, the insurance company rejected her claim. The important point to consider here is that proximate cause is the only nearest cause and not the remote cause. Benefits payable for illness existing prior to policy upgrade. For an act or event to be considered a proximate cause, it does not necessarily have to directly precede a loss or begin a chain of occurrences leading to the same. It was occasioned by a concussion or disturbance of the air caused by fire elsewhere. The Malaysian insurer argued that the proximate cause was the inherent vice in the inability of the legs to withstand the ordinary incidents of the voyage, meaning the loss was excluded from cover, or alternatively, that the loss was an inevitable consequence of the voyage embarked upon. The doctrine of proximate cause, which is common to all branches of insurance, must be applied with good sense so as to give effect to and not to defeat the intention. Its use in this sense is illustrated by s55(1) of the English Marine Insurance Act 1906 which provides:Subject to the provisions of this Act, and unless the policy otherwise provides, the insurer is liable for any loss proximately caused by a peril insured against, but, subject as aforesaid, he is not liable for any loss which is not proximately cause by a peril insured againstProximate cause is not confined to insurance law but is important to most branches of law and.But besides the common law doctrine of proximate cause policy wordings generally also convey the idea of causation. Facilitator : Jan Schubart Description : This module deals with one of the 5 pillars of insurance, namely Proximate Cause.Essential to any claim in terms of an insurance contract, is to ratify that the cause of a loss is proximate to an insured peril. As the proximate cause of the second operation was related to the first operation and the first operation was excluded from Ms. Ho's medical policy, her insurance company was not liable for Ms. Ho's hospitalisation claim. Proximate cause refers to the first event, or first peril, in a series of events that cause damage in an insurance claim. proximate cause. Accordingly the loss was held to be proximately caused by peril of … Learn more about our insurance plans: CriticalCare 1.0 … Proximate Cause Active, direct, and efficient cause of loss in insurance that sets in motion an unbroken chain of events which bring about damage, destruction, or injury without the intervention of a new and independent force. If the proximate cause (Cause 1) is covered, the loss is covered. Through this hole, sea water has entered into the ship and damaged the goods insured. There are many instances where causation appears to be interrupted by another act or peril. For example, many people buy auto insurance in case they accidentally cause an accident on the road while they are driving. It is hard to disagree. In this case, there are two causes of the mishap. Noun. Proximate cause is not confined to insurance law but is important to most branches of law and. The drowning was nova causa.In Everett v London Assurance, a fire caused an explosion which in turn damaged property half a mile away. Under the policy, goods have been insured against damage likely to be caused by sea water. During the voyage, a hole was caused at the bottom of the ship. But besides the common law doctrine of proximate cause policy wordings generally also convey the idea of causation. As the proximate cause of the second operation was related to the first operation and the first operation was excluded from Ms. Ho's medical policy, her insurance company was not liable for Ms. Ho's hospitalisation claim. First, the hole that was caused in the bottom of the ship and second, the seepage of sea water into the ship. It was held that the drowning was the proximate cause of death rather than the fit or the fall. Proximate cause is a legal concept that relates to the connection between an injury and the event that caused the injury. Proximate cause has been defined in a well known case of Pawsey Vs Scottish Union and National Insurance Company. Proximate cause.This may not be a “principle” of marine insurance but section 55 (1) of the U.K. Marine Insurance Act 1906 elevates it to a condition which must be fulfilled before the underwriter becomes liable to pay a claim. A judge once briefed a jury that had to determine cause by simply saying, “cause means what you twelve men and women sitting as a jury would regard it in a common- sense way as the cause.”1.2 The effect of the “last straw” casesThe last straw rule does not disturb the operation of the proximate cause rule.When, through an insured peril, a loss becomes inevitable, then even though the loss in caused in the final analysis by another peril, the original peril remains the proximate cause. What was the proximate cause of the damage on the distant property; the fire or the explosion? That is, where (Cause 1) Covered Peril → (Cause 2) Excluded Peril → (Loss) (i.e., where a covered peril causes an excluded peril that causes the loss), courts view this as a loss "caused by" the initial covered peril within the meaning of a property policy's insuring agreement. n. a happening which results in an event, particularly injury due to negligence or an intentional wrongful act. For an act to be deemed to cause a harm, both tests must be met; proximate cause is a legal limitation on cause-in-fact. Principle of Proximate Cause - primary cause of a loss. The last straw which breaks the camel’s back, is not the proximate cause.2 ExamplesIn the case of Etherington v Lancashire and Yorkshire Accidental Insurance Company a man fell from his horse and sustained injuries which prevented him from moving. Can recovered cancer patients take out health insurance? INSURANCE: THE PROXIMATE CAUSE IN ENGLISH LAW Malcolm Clarke The proximate cause, whether an event covered by a policy (" peril") or an event excluded from a policy (" exception "), " is the dominant or effective or operative cause." Origin of Proximate. The explosion was held to be the proximate cause of the damage to the property since the distance involved provided a break in the chain between the fire at that premises and the damage.Wiles J said:We are bound to look at the immediate cause of the loss or damage, and not to some remote or speculative cause. When she was discharged from hospital, she only submitted a claim to her medical insurance company for reimbursement of medical expenses incurred during the second operation. Speaking of the injury no person would say that it was caused by fire. The Principle of Proximate Cause in Medical Claims. The question which arose was, did she sink as a result of the storm or as a result of the torpedoing?It was held that the proximate cause of the loss was the torpedoing rather than the storm, because the chain of causation was unbroken, and the proximate cause of the loss was still operating when the storm blew up. In the insurance context the so-called proximate cause approach to legal causation is considered to be in accordance with the intention of the parties. Ms. Ho admitted that her operation for treatment of a prolapsed intervertebral disc was a pre-existing condition which should be excluded from the policy. If this new act or peril intervenes then it could be argued that the original act or peril was not the proximate cause of the loss or damage.Thus, nova causa is a new intervening cause of the loss, the effect of which is that, if it is not insured, the insurer is not liable in terms of the policy to pay the claim. If the cause is an insured one, the claim is payable, if the cause is uninsured or excepted the claim is not payable. This was in issue in a number of South African cases including Rabinowitz v Ned-Equity Insurance (1980).1.1 The effect of novus actus (or nova causa) interveniens.This has been defined as an abnormal event which breaks the chain of causation. But two days later she sank in a storm. Ms. Ho thought that her emergency confinement for the second operation, the aim of which was to remedy the blood vessel puncture that occurred during the first operation, was entirely unforeseen and unexpected. It is hard to disagree. It would be going to the cause of causes to say that this was an injury caused by property fire to the insured. It is its practical the application which is difficult. If the first operation had not taken place, the second operation would not have been necessary. When a claim occurs under a general insurance policy the insurers will identity the proximate cause of the loss to ensure that the loss or damage has been caused by an insured peril but what is proximate cause and how does this affect the settlement of claims. Proximate cause is an act, whether intentional or negligent, that is determined to have caused someone else’s damages, injury, or suffering. People often purchase liability insurance in case they are responsible for being the proximate cause of an injury or a loss. Unluckily, Ms. Ho's abdominal aorta wall was punctured during the operation and she went into shock with internal bleeding. proximate cause, all causes preceding the proximate cause being rejected as too remote. Proximate cause is very relevant in liability cases. Discover how we are protecting biodiversity to ensure thriving ecosystems that underpin the well-being of millions of people. May I choose a class of hospital accommodation which exceeds the limit of the “Room & Board Benefit” stated in my medical insurance plan? Proximate Cause Principle of Insurance Proximate cause is concerned with how the actual loss or damage happened to the insured party and whether it is a result of an insured peril. The definition given in this case reads as follows:Proximate cause means the active, efficient cause that sets in motion a train of events that brings about the result, without the intervention of any force started and working actively from a new and independent source. As a result, she believed that her insurance company should reimburse her medical expenses incurred for the second operation. It has been well defined in the leading case of Pawsey V. Scottish Union and National (1907) as follows : “Proximate cause means the active, efficient cause that sets in motion a train of events which brings about a result, without the intervention of any force started and working actively from a new and independent source”,’ It is the immediate cause and not the remote cause. In Washington, a judicial doctrine called the “efficient proximate cause” rule may apply and affect insurance coverage when multiple events combine to cause a loss. The direct cause of loss; exists if there is no unbroken chain of events leading from one act to a r Proximate cause is a key principle of insurance and is concerned with how the loss or damage actually occurred and whether it is indeed as a result of an insured peril. As a matter of urgency, she was transferred to another hospital to undergo a repair operation on her blood vessel. The nearest cause of the damage caused … Proximate cause is a key principle of Insurance and is concerned with how the loss or damage actually occurred. The storm was simply the last straw.In the case of Winspear v Accidental Insurance Company 1880 a man had a fit while he was crossing a stream and fell into the water and drowned. This was because the court considered there was a break in the chain of causation between the fit and the drowning.The man could, for example, have had a fit and fallen to the ground, in which event he would not have died. Proximate Cause is an important principle of insurance, which helps in deciding how the loss or damage happen and whether it is the result of an insured peril or not. Are infectious diseases like human swine flu covered by medical insurance? This means understanding if the injury would occur but for … A fact is the proximate consequence of an alleged cause if it can be described as the dominant, direct, actual, effective, determining or operative cause … Medical Insurance Coverage for Public Hospital Confinement, Medical insurance plans with “Top-up” feature help customers to reduce insurance expenses, Medical insurance provides benefits for day care surgery, Medical Insurance Tips --- Public Hospital Cash Benefit, Mind the gap: don't get caught out by uninsured medical expenses, Multiple surgical procedures in one single incision, Pre-existing conditions exclusion of healthcare insurance, Relationship between Critical Illness Benefits and Medical Insurance Coverage, The importance of disclosing the complete truth, The Importance of Guarantee of Payment for Hospitalisation, The meaning of “Guaranteed Renewal” in medical insurance, Waiting period of critical illness insurance. The doctrine of proximate cause is one of the six principles of insurance. The ship managed to reach port where she was moored. There are several competing theories of proximate cause (see Other factors ). The proximate cause itself may not do any direct damage. Proximate cause refers to a direct cause of loss, without which the loss would not occur; therefore, it is a highly relevant principle in the insurance industry. The proximate cause of his death was the fall and not pneumonia.Pneumonia was thus not nova causa.In the case of Leyland Shipping Company v Norwich Fire Insurance Company 1918 a ship was torpedoed in the English Channel during the First World War. Identifying the cause of loss in general insurance claims. As a result of lying on wet ground he contacted pneumonia and died. In practice it is very important to study the policy wording to assess its impact on the concept of proximate cause. The proximate cause of the damage was the violence of the mob and the insurers were held to be liable under the policy. The insurance policy may cover the proximate cause, but not the event that actually causes the damage, so the policy holder will not be reimbursed for his claim. How to choose a top-up medical plan to supplement existing medical cover - Part 1, How to choose a top-up medical plan to supplement existing medical cover - Part 2, How to select a suitable medical insurance plan, Illness that occurred before policy coverage upgrade, Importance of a health declaration in medical insurance, In a gloomy economic situation, medical insurance plans with a “Top-up” feature help prevent a healthcare vacuum. There is a long line of decisions which say that the cause is proximate if it can be described as the “dominant”, “direct”, “real”, “actual”, “determining”, “operative”, “predominant”, or “efficient” cause. This section provides a definition of proximate cause and explains how it should be determined in practice. That which causes a negative event, such as an injury. Determining Proximate Cause Through Different Rules Certain states take into consideration the “but for” rule for proximate cause. Learn more about our insurance plans:CriticalCare 1.0MediSure PlusHospitalCare, All Rights Reserved. Continuity of benefits after policy termination, Critical Illness Insurance protection for renal failure, Definition of Cosmetic or Plastic Surgery, Difference between Yearly Renewal and Guaranteed Renewal, Emergency Evacuation & Repatriation Service, Hospital Cash Insurance – Period of Hospital Confinement, How does an insurance company determine pre-existing conditions - Part A, How does an insurance company determine pre-existing conditions - Part B. A German appeal court determined, in a marine claim, that the proximate cause of a vessel’s grounding and ultimate sinking after its main engine cut out was bad weather rather than an engine problem. Insurers’ liability is excluded if the proximate cause was an excluded peril. What is Proximate Cause? Robert Vivian is Professor of insurance and risk management at the department of Business and Economics at the University of Witwatersrand.He continues with his monthly column on answering exam questions for the Insurance Institute of SA qualifications. 1 Why was Ms. Ho's second hospitalisation not covered by her medical insurance policy? Ms. Ho was admitted to hospital with lower back pain last month and was diagnosed with a prolapsed intervertebral disc which required a surgical operation to be performed. Proximate cause is concerned with causation. This question came from the April 1989 paper in the subject Principles and Practice of Insurance (042).The question: 1 Define proximate cause; 2 Explain the effect of the following on the doctrine of proximate cause: 2.1 novus actus interveniens; and, 2.2 ‘last straw’ cases.1 DefinitionsThe proximate causeIn most British text books the definition of proximate cause is taken from the case of Pawsey v Scottish Union and National Insurance Company (1907). In practice it is very important to study the policy wording to assess its impact on the concept of proximate cause. 8.1 Proximate Cause Definition Proximate cause was defined in the case of Pawsey v Scottish Union & National Insurance Company … There are no hard and fast rules to determine the proximate cause of a loss, since this is a question of fact concerning specific circumstances. As recently noted … An insurer is liable for a loss of which a peril insured against was the proximate cause, although a peril not contemplated by the contract may have been a remote cause of the loss; but it is not liable for a loss of which the peril insured against was only a remote cause. Why will a claim for cancer discovered 10 days after the policy effective date be declined. Are chiropractic treatment expenses covered under medical insurance? By Robert Vivian, From the Department of Business and Economics at Wits University (insurance and risk management), Copyright © 2020 Insurance Times and Investments®, Copyright © Insurance Times and Investments® Vol:3.3, 6107 views, page last viewed on December 21, 2020, Explaining vicarious liability in the law of torts, Cyber-attacks on the rise in media industry, Adverse drug reactions a leading cause of death worldwide, Security in offshore discretionary trusts, Beneficiary funds: what financial advisers should know, Need for quality improvements and new technologies, From the Department of Business and Economics at Wits University (. So says MacGillivray and Parkington.1 So say the courts. Definition of Proximate Cause. The second operation for remedying the puncture was caused by a potential operation risk arising from the first operation for her prolapsed intervertebral disc. Is there any minimum confinement period for operation? The proximate cause, whether an event covered by a policy (“peril”) or an event excluded from a policy (“exception”), “is the dominant or effective or operative cause.” So says MacGillivray and Parkington.1 So say the courts. A completely acceptable test has not been developed to establish proximate cause or nova causa.As one of the leading texts declares: “Few problems have troubled philosophers and lawyers as that of causation.”So if students do not always agree with the judgment, this is not surprising. Given in the bottom of the damage on the road while they are driving generally also convey idea. Assess its impact on the concept of proximate cause of a loss the point! Ms. Ho 's second hospitalisation not covered by medical insurance for proximate cause is the behind. In this case, there are several competing theories of proximate cause of death rather than the or! First event, particularly injury due to negligence or an intentional wrongful act a definition of proximate is... 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