In October 2011, the client purchased a life and accident insurance policy from an insurer. The benefit would be paid if she were involved in an accident resulting in physical injury or death. She died one month after sustaining an injury in an accident. The insurer refused to pay the benefit, and the court ruled in its favour.

The policy was purchased from Scotia Life in October 2011 by Safia Begum, the plaintiff’s mother. While travelling in India in August 2022, she fractured her femur. Because of a pre-existing condition, the specialist surgeon decided against surgery.

After leaving the hospital and returning to the place where she was staying, the insured died in her sleep on September 22, 2022. Ahmed Sarfraz, her son and universal legatee, submitted a claim to Chubb Life Insurance Company of Canada, which had since acquired the insurance portfolio of the insurer that had issued the policy.

Chubb, which became the defendant in the ensuing court case, denied the claim on the grounds that the circumstances of the death were not covered by the policy. The insurer made the same argument before the court.

The plaintiff sought the $25,000 death benefit but reduced his claim to $15,000 so that the dispute could be heard by the Small Claims Division of the Court of Québec.

The circumstances of the accident

The parties were heard in Saint-Jérôme on June 25, 2026, by Justice Chantale Massé, of the Terrebonne judicial district of the Court of Québec. She carefully reviewed the circumstances surrounding Mr. Sarfraz’s claim.

Following his mother’s death, the plaintiff claimed the benefit provided under the contract. The insurer responded that it needed additional documents to confirm the cause of death and its connection to the accident. In December 2022, Chubb retained an investigator in India to obtain information related to the policyholder’s death. The investigation continued into early 2023.

Mr. Sarfraz stated that his mother was visiting family members when she fell and fractured her femur.

The son maintained that his mother had diabetes, which prevented the surgeon from operating on her. The medication provided when she was discharged from hospital was intended only to relieve her pain. Three weeks later, the plaintiff said, his mother died in her sleep because she could no longer bear the pain.

He submitted a certificate issued by the surgeon, dated August 30, 2022, explaining the treatment provided and the medication prescribed. The family physician who subsequently cared for his mother also issued a certificate. She indicated that the woman’s main health issue was her fractured leg.

In his testimony, the plaintiff alleged that his mother died because she had not undergone surgery. He was unable to provide further information in support of his claim because health records are maintained differently in India than they are in Canada.

Denial of the claim

In its denial letter, Chubb referred to the provisions of the contract. Before the court, the insurer’s representative summarized the steps taken in the file and confirmed that the claim had been denied in writing on May 4, 2023. The investigation conducted in India did not establish a link between the accident and the death.

The surgeon reportedly told the insurer that the insured’s medical records had been given to her family. As for the death certificate, the cause of death was listed as “natural,” and the document included a reference to the fracture.

Regarding the certificate completed by the family physician, Chubb’s investigation in India indicated that the document had initially been completed by the physician’s brother. In June 2023, a new death certificate was issued by the physician who had personally confirmed Ms. Begum’s death. Despite this, Chubb reiterated its refusal to honour Mr. Sarfraz’s claim.

The judgment

In its decision dated September 3, 2026, the court noted that the insurer had drafted its contract so as to avoid any ambiguity, expressly excluding any death “caused directly or indirectly or that is in any way associated with any natural condition, disease, infirmity (physical or mental) as well as death related to medical treatment or intervention in connection with any condition, disease or infirmity.”

Although the coverage offered may appear limited, the insurer is entitled to issue this type of policy “limited to certain cases, because it receives premiums accordingly and does not require medical declarations or examinations, which are generally required when taking out life insurance that guarantees any type of death,” the court wrote.

The insurance purchased by Ms. Begum carried a premium of $5.83 per month, or $69.96 per year. She was over 69 years old when she purchased it. The death benefit was $50,000 but was reduced to $25,000 if the insured had reached age 75, which was the case at the time of her death.

The plaintiff was required to prove that the loss was covered by the policy. However, the documentation provided did not establish that the fractured leg was the sole and exclusive cause of his mother’s death. Her death, which occurred while she was sleeping, could also have resulted from other health problems.

When she was discharged from hospital, the insured had the treatments and medications required for her rehabilitation. There was nothing to suggest that the fracture caused her death. Even though the family physician personally confirmed the death, the note referring to the fractured leg was not sufficient to conclude that it was the cause of the woman’s death.

The claim was dismissed, but given the particular circumstances of the case, the court did not order the plaintiff to pay legal costs.