Case Name: Burne, Appellant, v. Franklin Life Insurance Company
Court: Supreme Court of Pennsylvania
Jurisdiction: Pennsylvania
Decision Date: 1973-03-16
Citations: 451 Pa. 218
Docket Number: Appeals, Nos. 2 and 3
Parties: Burne, Appellant, v. Franklin Life Insurance Company.
Judges: Before Jones, C. J., Eagen, O’Brien, Roberts, Pomeroy, Nix and Manderino, JJ.
Reporter: Pennsylvania State Reports
Volume: 451
Pages: 218–241

Head Matter:
Burne, Appellant, v. Franklin Life Insurance Company.
Argued April 28, 1971;
reargument November 16, 1972.
Before Jones, C. J., Eagen, O’Brien, Roberts, Pomeroy, Nix and Manderino, JJ.
Joseph E. Gallagher, with him O’Malley, Morgan, Hour & Gallagher, for appellant.
J. Charles Hamahue, with him Warren, Hill, Henhelman <& McMenamin, for appellee.
March 16, 1973:

Opinion:
Opinion by
Mr. Justice Roberts,
This is an appeal from the order of the Court of Common Pleas of Lackawanna County denying plaintiff-appellant's motion for summary judgment and from the judgment entered below in favor of defendant-insurance company, upon said defendant's motion for summary judgment. The action below, in assumpsit, was for the recovery of the accidental (double indemnity) death benefits of a life insurance policy, of which appellant is the beneficiary. For the reasons set out below, we reverse.
In 1919, defendant-appellee issued to the insured (appellant's husband) a life insurance policy in the face amount of $15,000. The policy also contained a double indemnity proviso for an additional $15,000 if the death of the insured resulted from purely accidental means. This double indemnity provision, and the exceptions contained therein, are the subject of this appeal.
On January 30, 1959, while the policy was in effect, the insured Bartholomew Burne, was struck by an automobile while crossing a street in North Miami, Florida. Immediate and extensive brain surgery was required. From the moment of the accident until his death, Mr. Burne's existence was that of a complete and hopeless invalid, unable to speak, subject to seizures and requiring constant nursing and medical care. Vast sums of money were expended by appellant, and the most sophisticated medical techniques utilized, merely to keep her husband medically alive, albeit in a vegetative state, for áy2 years. It is conceded by the appel lee insurance company that the injuries sustained were the direct and sole cause of the insured's death. Appellee paid the face amount of the policy, but refused to pay the accidental death benefits.
The life insurance policy under consideration provides for double indemnity liability for death resulting from accident. However, the policy states that such accidental death benefits will be payable only if ". . . such death occurred . . . within ninety days from the date of the accident." One further exception in the double indemnity rider provides: "This Accidental Death Benefit shall not be payable (10) if the death of the insured shall occur while any premium is being waived under any disability benefit attached to or incorporated in said policy. " (It should be noted, however, that under the policy, no premiums are waived until the insured furnishes proof to the company that the insured has been totally incapacitated for at least six months.) On the basis of these exceptions, the trial court, en banc, granted defendant-appellee's motion for summary judgment. This appeal challenges the validity of these exceptions as applied to the facts of the instant case.
There are strong public policy reasons which militate against the enforceability of the ninety day limitation. The provision has its origins at a much earlier stage of medicine. Accordingly, the leading case construing the provision predates three decades of progress in the field of curative medicine. Advancements made during that period have enabled the medical profession to become startlingly adept at delaying death for indeterminate periods. Physicians and surgeons now stand at the very citadel of death, possessing the awesome responsibility of sometimes deciding whether and what measure should be used to prolong, even though momentarily, an individual's life. The legal and ethical issues attending such deliberations are gravely complex.
The result reached by the trial court presents a gruesome paradox indeed—it would permit double indemnity recovery for the death of an accident victim who dies instantly or within ninety days of an accident, but would deny such recovery for the death of an accident victim who endures the agony of prolonged illness, suffers longer, and necessitates greater expense by his family in hopes of sustaining life even momentarily beyond the ninety day period. To predicate liability under a life insurance policy upon death occurring only on or prior to a specific date, while denying policy recovery if death occurs after that fixed date, offends the basic concepts and fundamental objectives of life insurance and is contrary to public policy. Hence, the ninety day limitation is unenforceable.
All must recognize the mental anguish that quite naturally accompanies these tragic occurrences. Surely that anguish ought not to be aggravated in cases of this hind with concerns of whether the moment of death permits or defeats the double indemnity claim. So too, the decisions as to what medical treatment should be accorded an accident victim should be unhampered by considerations which might have a tendency to encourage something less than the maximum medical care on penalty of financial loss if such care succeeds in extending life beyond the 90th day. All such factors should, wherever possible, be removed from the antiseptic halls of the hospital. Rejection of the arbitrary ninety day provision does exactly that.
Aside from considerations of public policy, the ninety day provision possesses no persuasive decisional support. In granting appellee's motion for summary judgment, the trial court obviously relied upon a single thirty year old case, Sidebothom v. Metropolitan Life Insurance Co., 339 Pa. 124, 14 A. 2d 131 (1940). That case, as well as virtually every other case which construed a ninety day limitation provision, is based on considerations which have no pragmatic applicability to the factual situation here. The earlier judicial interpretation of the ninety day provision was that its underping purpose was to govern situations where there existed some possible uncertainty over whether injuries sustained in an accident would actually result in death. The ninety day provision attempted to delineate a line governing cases where the injuries may or may not cause death. Ninety days was the arbitrary period advanced by the carrier within which to ascertain whether death will in fact result from the accident.
The factual situation in Bidebothom is illustrative of the principles underlying a ninety day provision. There the insured suffered injuries from two different exposures to carbon monoxide. While in the hospital he suffered further injuries from a fall from a hospital bed. In two crucial ways that case is distinguishable from the instant one. First, the injury involved in Bidebothom was not the type that with any degree of certainty could be regarded as fatal. In addition Bidebothom presented distinct causation problems, the deceased having suffered injuries both within and without the ninety day period. The instant case suffers from neither of these infirmities. It was clear from the moment of the accident that the husband would die as a result thereof, the only question being one of time. Nor was there any causation problem, it being conceded by the defendant that the sole cause of death was the injuries suffered by the husband when struck by the car.
It is well settled that if a provision in an insurance policy cannot reasonably be applied to a certain factual situation it should be disregarded. This sound rule of law was succinctly articulated as early as Grandin v. Rochester German Insurance Company, 107 Pa. 26 (1884), where the Court refused to mechanically apply an insurance provision, saying: "It will thus be seen that where the reason of a condition does not apply this court has refused to apply it. Other instances of the same might be cited were it necessary. We are not to suppose that conditions involving forfeitures are introduced into policies by insurance companies, which are purely arbitrary and without reason, merely as a trap to the assured or as a means of escape for the company in case of loss. When therefore a general condition has no application to a particular policy; where the reason which alone gives it force is out of the case, the condition itself drops out with it." Id. at 37. See also Tennant v. Hartford Steam Boiler Inspection and Insurance Company, 351 Pa. 102, 40 A. 2d 385 (1944) ; Norland v. Reliance Life Ins. Co., 282 Pa. 389, 128 Atl. 93 (1925). This case is clearly one where "the reason of a condition does not apply." The provision should not be applied to cases where, as this record establishes, no dispute exists as to the cause of death. Surely the ninety day provision was not meant to be "merely . a trap to the assured or as a means of escape for the company in case of loss."
Demonstrative of the principle that if a general condition has no relevance to a particular fact situation it is not applied are jurisdictions construing insurance policy provisions allowing awards for the loss of a limb, only if the loss occurs within sixty days of the accident. Claimants have successfully recovered when they produced medical testimony which established that it was obvious before the end of the sixty day period that the insured victim would need an amputation, but the actual amputation was delayed by doctors until after the sixty days period for reasons of health. Westenhover v. Life & Casualty Insurance Co., 27 So. 2d 391 (La. App. 1946) ; Interstate Life & Accident Co. v. Waters, 213 Miss. 265, 56 So. 2d 493 (1952). Such rationale is directly applicable to the instant case. Here the appellant was prepared to prove through expert medical testimony that well within the ninety day period it was certain that the husband would die as a result of the injuries received; it was only due to extraordinary efforts on the part of attending physicians, implementing the most advanced medical techniques available, that the husband was kept scientifically alive.
Under the life insurance contract the specific hazard indemnified is premature death resulting from an accident. Recovery for that loss should not be forfeited by the arbitrary and unreasonable condition that payment will be made only if the accident victim dies within ninety days but not if he survives beyond that point. On this record it is obvious that to enforce the ninety day condition would serve only "as a trap to the assured or as a means of escape for the company in case of loss."
The waiver of premium exception in the accidental death supplement, previously noted, suffers from precisely the same public policy infirmities as does the ninety day limitation. Further, the waiver-of-premium exception, when read in conjunction with the entire waiver-of-premium supplement, creates an obvious ambiguity. Simply, the two provisions when read together yield the following interpretation: If the insured is totally and continuously incapacitated for a period of at least six months, the premiums due on the policy are waived by the company; however, if during the post-six month waiver-of-premium period the insured should die by accident, no double indemnity benefits will be paid. It is unclear whether the policy provisions preclude double indemnity recovery only in those cases where death is caused by a second accident which occurred after the six month period, or whether the policy bars double indemnity recovery in all cases where the insured dies by accidental means during a period when premiums are being waived.
As this Court has stated on innumerable occasions: ". . . [T]he contract of insurance is to be read, in the event of any ambiguity in its language, in the light most strongly supporting the insured." Weissman v. Prashker, 405 Pa. 226, 233, 175 A. 2d 63, 67 (1961). See, e.g., Cadwallader v. New Amsterdam Casualty Co., 396 Pa. 582, 152 A. 2d 484 (1959); Beley v. Mutual Life Ins. Co., 373 Pa. 231, 95 A. 2d 202 (1953); MacDonald v. Metropolitan Life Ins. Co., 304 Pa. 213, 155 Atl. 491 (1931). Accordingly, on this record, the policy does not preclude double indemnity benefits.
The judgment is reversed and it is directed that summary judgment be entered for the plaintiff-appellant.
Mr. Justice Manderino joins in this opinion and also files a concurring opinion.
It is not inappropriate to observe, in view of this record, that the insurance carrier suffered no prejudice by the retention of the double indemnity death proceeds for these additional 4% years. What appears in fact is that the appellee enjoyed an economic benefit by having the use of these funds during that period, rather than having to pay out that sum at or near the time of the accident.
Appellant also alleges that "the policy gave undue prominence to the accidental death benefit without corresponding prominence to the ninety-day limitation period", in contravention of Section 617(A) (4) of The Insurance Company Law of 1921, Act of May 17, 1921, P. L. 682, art. VI, §617, as amended, 40 P.S. §752(A) (4). In view of our disposition, we need not pass upon this claim.
For general discussions of the legal and ethical problems surrounding euthanasia see Symposium—The Medical, Moral, and Legal Implications of Recent Medical Advances, 13 Vill. L. Rev. 732 (1968) ; Silving, Euthanasia: A Study in Comparative Criminal Law, 103 U. Pa. L. Rev. 350 (1954). The purpose of this opinion is not to introduce this controversy into the area of life insurance policies but to forestall it.
The leading eases concerning the ninety day provision have assumed that if death is to he the result of an accident it will manifest itself within ninety days. Bach of these cases dealt with the type of injuries where there was inherent uncertainty as to whether death would in fact ensue. Brown v. United States Casualty Co., 95 Fed. 935 (1899) (insured suffered injuries from being thrown from dog cart) ; Kerns v. Aetna Life Ins. Co., 291 Fed. 289 (8th Cir. 1923) (piece of metal dislodged from esophagus while pushing car) ; Barnett v. Travelers' Ins. Co. of Hartford, Conn., 32 F. 2d 479 (8th Cir. 1929) (artery accidently cut during nose operation) ; Spaunhorst v. Equitable Life Assur. Soc., 88 F. 2d 849 (8th Cir. 1937) (stab wound suddenly became virulent).