Quek Kwee Kee Victoria (executor of the estate of Quek Kiat Siong, deceased) and another v American International Assurance Co Ltd and another

• Judge: Sundaresh Menon CJ
• Judgment Date: 02 February 2017
• Neutral Citation: [2017] SGCA 10
• Citation: [2017] SGCA 10
• Defendant Counsel: Lim Tong Chuan and Joel Wee (Tan Peng Chin LLC)
• Published date: 08 February 2017
• Hearing Date: 28 October 2016
• Plaintiff Counsel: Melanie Ho, Chang Man Phing, and Tang Shangwei (WongPartnership LLP)
• Docket Number: Civil Appeal No 57 of 2016
• Court: Court of Appeal (Singapore)
• Date: 02 February 2017
• Subject Matter: Insurance,Accident Insurance

Sundaresh Menon CJ (delivering the judgment of the court): Introduction

On the morning of 4 August 2012, Mr Quek Kiat Siong (“the Deceased”), aged 50, was found lying unresponsive on his bedroom floor. He was rushed to the hospital and pronounced dead shortly after. The forensic pathologist subsequently reported that the Deceased’s death was caused by “multi-organ failure with pulmonary haemorrhage, due to mixed drug intoxication”.

The Appellants are the executors of the Deceased’s estate (“the Estate”). In Suit No 820 of 2014 (“S 820/2014”), the Appellants claimed against the Respondents, insurance companies that had insured the Deceased under two personal accident insurance policies. The Respondents deny that the Deceased’s death was accidental. The central question before the High Court judge (“the Judge”) was whether the Deceased had consumed certain medicinal drugs expecting to die as a result of the fatal adverse reaction that ensued.

In Quek Kwee Kee Victoria (executrix of the estate of Quek Kiat Siong, deceased) and another v American International Assurance Co Ltd and another [2016] 3 SLR 93 (“the Judgment”), the Judge dismissed the Appellants’ claim, holding that the Deceased had consumed overdoses of at least three drugs, and that as a result, his death was not an accident entitling the Estate to payment under the insurance policies. The Judge concluded that the Deceased consumed more than the prescribed dosage of drugs and she appeared to have thought that because the Deceased intended to consume the drugs that he did, he must be taken to have expected the consequences that flowed from this even though she seemed also not to find any specific intention on his part to commit suicide. The Appellants have brought the present appeal against the Judge’s decision.

Background facts The parties and the background to the dispute

The 1st and 2nd Appellants are the executors of the Deceased’s estate. The 1st Appellant, Ms Quek Kwee Kee Victoria, is the Deceased’s elder sister, while the 2nd Appellant, Mr Ker Kim Tway, is the Deceased’s nephew.

The 1st and 2nd Respondents are insurance companies. The Deceased purchased two insurance policies with the 1st Respondent in September 2001 and November 2008. These policies will be referred to in this judgment respectively as “the PA Policy” and “the Platinum Policy”, and collectively as “the Insurance Policies”. Under the Insurance Policies, the 1st Respondent agreed, subject to certain conditions, to pay the total sum of $1.2m if the Deceased sustained an injury in an accident that resulted in the loss of his life. The assured sum under the PA Policy and Platinum Policy for loss of life indemnity was $200,000 and $1m respectively. In 2012, these polices were transferred to the 2nd Respondent. It is therefore the 2nd Respondent that is liable under the Insurance Policies, and accordingly, the 1st Respondent is not an active participant in the present proceedings. Unless otherwise specified, any reference to the Respondent in this judgment is a reference to the 2nd Respondent.

After the Deceased’s death, the Appellants presented their claim under the Insurance Policies. On 30 January 2013, the Respondent informed the 1st Appellant that the claim was not payable because the coroner had found that the Deceased had committed suicide. Subsequently, on 21 May 2014, the Respondent further notified the Appellants’ solicitors that under the policies, the Deceased “must have sustained bodily injury in an accident before the sum assured is payable”. As there was “no evidence of an injury sustained in an accident”, the Respondent maintained its position that the assured sums were not payable to the Estate.

On 31 July 2014, the Appellants commenced S 820/2014.

The Deceased’s circumstances and the events surrounding his death

The Deceased was the fourth-youngest in a family of sixteen siblings. Despite this, he played a leading role in the family business, Kway Guan Huat Joo Chiat Popiah & Kueh Pie Tie, which involved the manufacture and sale of popiah. The business was located at Joo Chiat Road, which also served as the Deceased’s residence for most of his life and will be referred to in this judgment as “the Joo Chiat house”. The Deceased never married, and lived for most of his life in the Joo Chiat house with the 1st Appellant and a younger sister, Ms Quek Siew Kim (“Siew Kim”).

The Deceased suffered from severe chronic back pain due to his years of carrying heavy loads of flour in the course of working in the popiah business. He had also suffered a number of falls in the Joo Chiat house – an old shop-house which has been described as being in a “dilapidated” condition – and these too evidently contributed to and exacerbated his back injury. In July 2009, the Deceased consulted Dr Yeo Sow Nam (“Dr Yeo”), a pain specialist, in connection with his chronic back pain. At the time of his first consultation, the Deceased scored his pain as 10/10. He complained of severe lower back pain shooting to his legs and reported that he was only able to sit for 30 minutes at any one time.

The Deceased also developed insomnia, depression, and anxiety. To better deal with these issues, Dr Yeo referred the Deceased to Dr Ang Yong Guan (“Dr Ang”), a psychiatrist, in early 2010. In Dr Ang’s assessment, because of his chronic back pain, the Deceased was unable to carry out many manual tasks, and this affected the Deceased adversely. As a “highly responsible man” imbibed with “a lot of traditional Chinese values such as diligence, loyalty and commitment”, the Deceased’s inability to undertake some of the things he had commonly done in the course of his business had caused him to develop symptoms of depression with anxiety and insomnia.

Between 2009 and 2012, the Deceased was hospitalised on various occasions for the treatment of his physical and psychological ills. From around early 2012 to the middle of that year, the Deceased was also embroiled in a legal dispute with his brother which, as the Deceased’s physicians observed, became for him an additional source of stress.

On 2 July 2012, after two bad falls, the Deceased admitted himself to Mount Elizabeth Novena Hospital for the treatment of his back pain by Dr Yeo. At the same time, the Deceased was co-managed for his depression by Dr Ang. After two weeks in hospital, he was well enough to go home during the day, only returning to the hospital to rest at night. During his period of hospitalisation, the Deceased purchased two second-hand luxury cars on 17 and 19 July 2012. He was eventually discharged on 31 July 2012. Upon discharge, the Deceased was prescribed 14 different types of medicine by Dr Ang and Dr Yeo. A summary of the types and quantities of medication that the Deceased was prescribed and issued upon discharge is set out below: Table of the Deceased’s prescribed medication

S/No.	Prescription	Indications	Dosage
Medication prescribed by Dr Ang (6 months’ supply)
1	Mirtazapine	Anti-depressant	2 tablets (30mg/tab) every night
2	Quetiapine	Anti-psychotic	2 tablets (100mg/tab) every night
3	Bromazepam	Anti-anxiety	1 tablet (3mg/tab) 2 times a day
4	Zolpidem	Hypnotic	2 tablets (12.5mg/tab) every night
5	Olanzapine	Anti-psychotic	1 tablet (10mg/tab) every night
6	Duloxetine	Anti-depressant	1 capsule (60mg/tab) 2 times a day
7	Diazepam	Hypnotic	1 tablet (10mg/tab) every night
8	Midazolam	Hypnotic	1 tablet (15mg/tab) every night
Medication prescribed by Dr Yeo (6 weeks’ supply)
9	Oxycodone	Pain	1 tablet (20mg/tab) every morning or nil and only as breakthrough
10	Hydromorphone	Pain	1 tablet (16mg/tab) 2 times a day
11	Sennosides	Laxative	2 tablets (7.5mg/tab) 2 times a day
12	Pregabalin	Pain	2 tablets (150mg/tab) 2 times a day
13	Rabeprazole-Na	Gastric	1 tablet (20mg/tab) every morning
14	Atorvastatin	Cholesterol	1 tablet (20mg/tab) every night

In all, the Deceased was discharged from hospital with around 2,500 tablets. Of these drugs, bromazepam, duloxetine, mirtazapine, and olanzapine were found to be elevated in the Deceased’s post-mortem blood samples (see [17] below). Whilst the Deceased had been on most of these medicines prior to his hospitalisation in July 2012, duloxetine had been introduced to the Deceased only a few months earlier in March 2012 and sennosides and atorvastatin were introduced during the period of hospitalisation in July 2012. Changes were also made to the prescribed dosage of some of these medicines during the Deceased’s hospitalisation. In particular, the prescribed dosages of mirtazapine, quetiapine, bromazepam, and zolpidem were doubled during the Deceased’s hospitalisation. Diazepam was also added to the Deceased’s regime of medication upon his discharge.

The Deceased spent the first two nights following his discharge (31 July and 1 August 2012) at the Joo Chiat house. He then spent the next two nights (2 and 3 August 2012) at his family’s property at 35C Everitt Road (“the Everitt house”). The Appellants’ position is that the Deceased had relocated to the Everitt house on the advice of Dr Yeo and also his own family members so as to avoid any further falls in the Joo Chiat house. One room in the Everitt house was leased to one Mdm Chee Wai Lian (“Mdm Chee”). Another room was occupied by one of the Deceased’s nephews, Mr Lucas Lim (“Lucas”), and his girlfriend.

In the evening of 3 August 2012, Siew Kim walked the Deceased from the Joo Chiat house to the Everitt house. Between 8.00 pm to 9.00 pm, Mdm Chee spoke to the Deceased in the sitting room of the Everitt house. In a closed-circuit television (“CCTV”) clip, the Deceased was also seen moving...