Title: LIFE INS CO OF NORTH AMERICA v E
Citation: N/A
Docket Number: 81-257
State: Montana
Issuer: Montana Supreme Court
Date: November 6, 1981

No. 81-257 IN THE SUPREME COURT OF THE STATE OF MONTANA 1981 LIFE INSURAXCE COMPANY OF NORTH AMERICA, Petitioner and Appellant, JUDITH ANN EVANS, individually and as Personal Representative of the Estate of LORENZO LLOYD EVANS, Deceased., Respondent and Respondent. ORIGINAL PROCEEDING: Counsel of Record: For Appellant: Anderson, Brown, Gerbase, Cebull & Jones, Billings, Montana For Respondent: Douglas & Bostock, Libby, Montana Submitted on Briefs: July 2, 1981 Decided: November 6, 1981 Filed: h ' O \ ' 6 - 1%? Mr. J u s t i c e Gene B. Daly d e l i v e r e d t h e Opinion of t h e Court. Honorable R u s s e l l E. Smith , a s e n i o r United S t a t e s D i s t r i c t Judge f o r t h e D i s t r i c t of Montana, h a s c e r t i f i e d t o us a q u e s t i o n of law i n which it a p p e a r s t h e r e a r e substan- t i a l grounds f o r d i f f e r e n c e of o p i n i o n , t h e a d j u d i c a t i o n o f which by t h i s Court would m a t e r i a l l y advance a d e c i s i o n i n f e d e r a l l i t i g a t i o n . The f o l l o w i n g q u e s t i o n s were c e r t i f i e d : Are t h e d e c i s i o n s of law set down i n Kingsland v . M e t r o p o l i t a n L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 97 Mont. 558, 37 P.2d 335, and S u l l i v a n v. M e t r o p o l i t a n L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 96 Mont. 254, 29 P.2d 1046, still law i n Montana? I f t h e Kingsland and S u l l i v a n c a s e s still s t a t e t h e law i n Montana, a r e t h e d i f f e r e n c e s i n t h e language of t h e " e x c l u s i o n s " c l a u s e s s u f f i c i e n t t o d i s t i n g u i s h t h e p o l i c y i n v o l v e d h e r e f r o m t h o s e c o n s i d e r e d i n K i n q s l a n d and S u l l i v a n ? Lorenzo Lloyd Evans l i v e d a t an i s o l a t e d l o c a t i o n , known a s "Copper Creek," f i f t y m i l e s from Libby, Montana, and twelve m i l e s from Noxon, Montana. He was a lawyer, admitted t o p r a c t i c e i n Montana, w i t h o f f i c e s i n Libby. Evans kept v a r i o u s wild animals and b i r d s a t h i s p l a c e on Copper Creek, i n c l u d i n g an eleven-year-old wolf which he had r a i s e d from a pup. On t h e morning of June 27, 1979, Lloyd Evans was f e e d i n g h i s wolf when t h e wolf a t t a c k e d and b i t him on h i s r i g h t hand and w r i s t . Evans went back t o t h e house, wrapped h i s hand w i t h a towel, and s a t down. Within a p e r i o d of approximately e i g h t t o f i f t e e n minutes a f t e r t h e wolf a t t a c k , Evans i n d i c a t e d t o h i s w i f e t h a t t h e b i t e had p r e c i p i t a t e d a h e a r t a t t a c k and t h a t he should be d r i v e n t o a h o s p i t a l r i g h t away. Evans walked t o h i s c a r and l a i d down i n t h e b a c k s e a t . H i s w i f e had c a l l e d an ambulance, and when t h e y had t r a v e l e d a l i t t l e over h a l f of t h e d i s t a n c e t o Libby, t h e y met t h e ambulance on t h e highway. Evans was t r a n s f e r r e d t o t h e ambulance where oxygen was a d m i n i s t e r e d t o him, and h i s p u l s e was monitored. While i n t h e ambulance, and a f t e r a l a p s e of approximately f o r t y - f i v e t o s i x t y minutes f o l l o w i n g t h e wolf a t t a c k , Evans' p u l s e s t o p p e d , and he went i n t o c a r d i a c a r r e s t . Oxygen and C. P.R. were a d m i n i s t e r e d , and Evans showed some s i g n s of l i f e when t h e ambulance a r r i v e d a t t h e h o s p i t a l emergency room i n Libby. Approximately f i f t e e n minutes a f t e r a r r i v a l a t t h e h o s p i t a l , Lloyd Evans d i e d . Lloyd Evans had p r e v i o u s l y s u f f e r e d a h e a r t a t t a c k on A p r i l 4 , 1979. He was h o s p i t a l i z e d a t t h e V e t e r a n ' s A d m i n i s t r a t i o n h o s p i t a l i n Spokane, Washington, f o r a b o u t t h r e e weeks. On A p r i l 25, 1979, he was g i v e n a r e g u l a r d i s c h a r g e and r e t u r n e d t o t h e c a r e of h i s p h y s i c i a n , w i t h t h e recommendation t h a t he be i n house r e s t f o r another s i x weeks and g r a d u a l l y resume h i s p r e h o s p i t a l a c t i v i t i e s . Medical evidence i n d i c a t e s t h a t t h e immediate c a u s e of Lloyd Evans' d e a t h was h e a r t a t t a c k , b u t t h a t t h e h e a r t a t t a c k was " t r i g g e r e d " by t h e wolf b i t e . The wolf b i t e was n o t s e v e r e enough, by i t s e l f , t o have caused t h e d e a t h of Evans. Lloyd Evans had a p p l i e d f o r , and L i f e I n s u r a n c e Company o f N o r t h America had i s s u e d , a c e r t a i n g r o u p v o l u n t a r y a c c i d e n t a l d e a t h and dismemberment i n s u r a n c e p o l i c y , No. OK-2598, i n t h e p r i n c i p a l sum of $50,000, e f f e c t i v e November 1, 1972. The p o l i c y was i n f u l l f o r c e and e f f e c t , according t o its terms, on t h e d a t e of Lloyd Evans' d e a t h . The p o l i c y c o n t a i n e d t h i s language: "[The i n s u r e d ] is i n s u r e d . . . a s a i n s t l o s s r e s u l t i n g d i r e c t l y a n d i n d e p e n d e n t l y o f a l l o t h e r c a u s e s from b o d i l y i n j u r i e s caused by a c c i d e n t o c c u r r i n g while t h e p o l i c y is i n f o r c e a s t o the I n s u r e d , h e r e i n c a l l e d such i n j u r i e s . "EXCLUSIONS "The p o l i c y does n o t cover l o s s caused by o r r e s u l t i n g from any one o r more of t h e follow- ing : "(D) I l l n e s s , d i s e a s e . . . b o d i l y i n f i r m i t y or any b a c t e r i a l i n f e c t i o n o t h e r t h a n bac- t e r i a l i n f e c t i o n o c c u r r i n g i n consequence of an a c c i d e n t a l c u t o r wound." (Emphasis sup- p l i e d . ) The issue h e r e is whether Kingsland v. M e t r o p o l i t a n L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 97 Mont. 558, 37 P.2d 335, and S u l l i v a n v. M e t r o p o l i t a n L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 96 Mont. 254, 29 P.2d 1046, a r e s t i l l law i n t h e S t a t e of Montana. A f t e r a review of t h e r u l e s i n t h e s e c a s e s , we a g r e e w i t h respondent J u d i t h Evans t h a t t h e reasoning and r u l e s set down i n S u l l i v a n and Kinqsland a r e s t r i c t and h a r s h . I n S u l l i v a n , t h e i n s u r e d t r i p p e d over a p i e c e of s h e e t metal and f e l l , h i t t i n g h i s head. F i v e days l a t e r he d i e d of a c e r e b r a l hemorrhage. Evidence was submitted a t t h e t r i a l t h a t t h e i n s u r e d was s u f f e r i n g from high blood p r e s s u r e and a r t e r i o s c l e r o s i s a t t h e t i m e of t h e f a l l . Evidence a l s o i n d i c a t e d t h a t had a man n o t s u f f e r i n g from high blood p r e s s u r e and a r t e r i o s c l e r o s i s t r i p p e d over t h e s h e e t m e t a l , i n a l l p r o b a b i l i t y , no hemorrhage would have r e s u l t e d . The i n s u r a n c e p o l i c y i n S u l l i v a n provided coverage i f t h e i n s u r e d s u s t a i n e d " b o d i l y i n j u r i e s , s o l e l y t h r o u g h e x t e r n a l v i o l e n t and a c c i d e n t a l means, r e s u l t i n g d i r e c t l y and independently of a l l o t h e r c a u s e s . " The Court i n S u l l i v a n admitted t h a t a r e a s o n a b l e scope of i n s u r a n c e was contemplated by t h e p o l i c y . N e v e r t h e l e s s , because of t h e c l e a r and unequivocal n a t u r e of t h i s language i n t h e p o l i c y , t h e Court h e l d t h a t t h e r e would be no recovery i f ". . . t h e i n s u r e d might s u f f e r an a c c i d e n t r e s u l t i n g i n d e a t h t o which d i s e a s e o r b o d i l y i n f i r m i t y c o n t r i b u t e d i n d i r e c t l y o r p a r t i a l l y . . . " S u l l i v a n , 29 P.2d a t 1052. Because t h e i n s u r e d was s u f f e r i n g from a r t e r i o s c l e r o s i s , which c o n t r i - buted t o and a c t i v e l y cooperated w i t h t h e a c c i d e n t t o c a u s e t h e i n s u r e d ' s d e a t h , t h e r e was no recovery. I n Kingsland, t h e i n s u r e d had s t e p p e d o n t o a c h a i r s i t t i n g on an uneven cement s u r f a c e ; he l o s t h i s b a l a n c e and f e l l head f i r s t on t h e rough cement. The i n s u r e d d i e d s h o r t l y a f t e r t h e f a l l . The cause of t h e i n s u r e d ' s d e a t h was d e s c r i b e d a s a r u p t u r e d aneurysm of t h e a o r t a , p r e c i p i - t a t e d by t h e f a l l and by s t r i k i n g h i s head on t h e cement f l o o r . The Court i n Kingsland f i r s t looked t o t h e language of t h e i n s u r a n c e p o l i c y which c o n t a i n e d t h e c o n d i t i o n t h a t d e a t h must be shown t o r e s u l t " s o l e l y through e x t e r n a l , v i o l e n t and a c c i d e n t a l means." Kingsland, 37 P.2d a t 3 3 7 . The Court t h e n reasoned t h a t t h e term "proximate cause" is i n a p t i n t h i s c l a s s of c a s e s because "recovery can be had o n l y i f d e a t h r e s u l t e d ' s o l e l y ' ( n o t p r o x i m a t e l y ) from i n j u r i e s r e c e i v e d t h r o u g h a c c i d e n t a l means . I1 Kingsland, 37 P.2d a t 3 3 7 . According t o t h e Court i n Kinqsland, t h e r e could be no recovery i f t h e i n s u r e d ' s c o n d i t i o n was a c o n t r i b u t i n g cause of d e a t h . I f a pre- e x i s t i n g i n f i r m i t y were shown, recovery could o n l y be had i f t h e a c c i d e n t a l i n j u r y was s u f f i c i e n t i n i t s e l f t o c a u s e t h e d e a t h of a h e a l t h y man. The Kinqsland Court reasoned f u r t h e r t h a t i n S u l l i v a n t h e f a l l a l o n e was n o t s u f f i c i e n t t o c a u s e t h e i n s u r e d ' s d e a t h , and h i s c o n d i t i o n was t h e r e f o r e a c o n t r i b u t i n g c a u s e . I n c o n t r a s t , because evidence showed t h a t t h e f a l l of t h e i n s u r e d i n Kingsland was s u f f i c i e n t t o cause t h e d e a t h of t h e i n s u r e d , recovery was g r a n t e d . The i s s u e h e r e is whether t h i s Court should s t i l l f o l l o w t h e r u l e s e t down i n Kingsland and S u l l i v a n t h a t i f a p r e e x i s t i n g c o n d i t i o n c o n t r i b u t e s t o an i n s u r e d ' s d e a t h , t h e r e can be no recovery. Given t h e extreme h a r s h n e s s of t h i s r u l e and t h e l i b e r a l i n t e r p r e t a t i o n p l a c e d on such i n s u r a n c e p o l i c i e s i n many j u r i s d i c t i o n s today, we must o v e r r u l e t h e Kingsland and S u l l i v a n c a s e s t o t h e e x t e n t t h a t t h e y hold t h a t t h e r e can be no recovery i f a p r e e x i s t i n g d i s e a s e e i t h e r d i r e c t l y o r i n d i r e c t l y c o n t r i b u t e s t o an i n s u r e d ' s d e a t h . W e a r e persuaded t h a t t h e b e t t e r r u l e f o r t h e i n t e r - p r e t a t i o n of such i n s u r a n c e p o l i c i e s is t h e following: Where an a c c i d e n t a l i n j u r y a g g r a v a t e s or t r i g g e r s a pre- e x i s t i n g dormant d i s e a s e or p h y s i c a l i n f i r m i t y , t h e a c c i d e n t may be s a i d t o have been t h e proximate c a u s e of t h e r e s u l t - i n g d i s a b i l i t y w i t h i n t h e terms and meaning of an o r d i n a r y a c c i d e n t i n s u r a n c e p o l i c y . See, Boring v. Haynes ( 1 9 7 2 ) , 209 Kan. 413, 496 P.2d 1385; C a r l s o n v. N e w York L i f e I n s u r a n c e ( 1 9 6 6 ) , 76 I l l . A p p . 2 d 1 8 7 , 222 N.E.2d 363; McMackin v. Great American Reserve I n s . Co. ( 1 9 7 1 ) , 22 Cal.App.3d 428, 99 C a l . R p t r . 227; Nash v. P r u d e n t i a l I n s . Co. of America ( 1 9 7 4 ) , 39 Cal.App.3d 594, 114 C a l . R p t r . 299; Brown v. S t a t e Mutual L i f e I n s u r a n c e Company of America (La.App. 1 9 7 9 ) , 377 So.2d 355; Zurich I n s . Co. v . Ruscoe (Miss. 1 9 6 7 ) , 203 So.2d 305; Couey v. N a t i o n a l B e n e f i t L i f e I n s u r a n c e Company ( 1 9 6 7 ) , 77 N.M. 512, 424 P.2d 793. For a d i s c u s s i o n of c a s e s on t h i s m a t t e r , s e e 84 A.L.R.2d 176. The mere p r e s e n c e of a p r e e x i s t i n g d i s e a s e o r i n f i r - mity w i l l no longer r e l i e v e t h e i n s u r e r from l i a b i l i t y i n t h i s s t a t e . Recovery may be had even though t h e d i s e a s e a p p e a r s t o have a c t u a l l y c o n t r i b u t e d t o t h e cause of d e a t h a s long a s t h e a c c i d e n t sets i n motion t h e c h a i n of e v e n t s l e a d i n g t o d e a t h , or i f it is t h e prime or moving cause. S e e , Brooks v. M e t r o p o l i t a n L i f e I n s . Co. ( 1 9 4 5 ) , 27 Cal.2d 305, 163 P.2d 689; Kater v. United I n s u r a n c e Company of America ( 1 9 6 0 ) , 22 Ill.App.2d 22, 165 N.E.2d 74. A mere f r a i l c o n d i t i o n should n o t r e l i e v e an i n s u r e r from l i a b i l i t y . A s Chief J u s t i c e Cardozo noted i n S i l v e r - s t e i n v. M e t r o p o l i t a n L i f e Co. ( 1 9 3 0 ) , 254 N.Y. 81, 171 N . E . 914, an i n s u r a n c e p o l i c y is n o t accepted w i t h t h e t h o u g h t t h a t its coverage is t o be r e s t r i c t e d t o an Appollo o r a Hercules. W e a g r e e w i t h t h e f o l l o w i n g language from Couey v. N a t i o n a l B e n e f i t L i f e I n s u r a n c e Company, s u p r a , 424 P.2d a t 795: " I n our view of t h e c a s e , e v e r y i n j u r y o r d i s e a s e s u f f e r e d by a person from h i s b i r t h t o t h e d a t e of a p a r t i c u l a r i n j u r y c o n t r i - b u t e s t o some d e g r e e t o t h e c o n d i t i o n t h e n p r e s e n t . N e c e s s a r i l y , by t h e words used i n t h e p o l i c y it could n o t have been intended t h a t payment would be due o n l y when t h e a c c i d e n t was l i t e r a l l y t h e s o l e c a u s e of h o s p i t a l i z a t i o n . I f a person had s u f f e r e d a broken l e g which had healed p e r f e c t l y f i v e y e a r s b e f o r e , and a second a c c i d e n t wherein t h e l e g had broken a t t h e same p l a c e , could it be said that the condition resulting from the first break did not in any way contribute to the second break? We think the answer is obvious and, under defendants' theory, plain- tiff would not be entitled to recover. In our view, this application of the language of the policy is entirely too restrictive and would be unreasonable. Other courts have agreed . . Likewise, the rulings of Sullivan and Kingsland were too restrictive, and any rules in these cases must be overruled to the extent they are inconsistent with this opinion. Since we have held that Kingsland and Sullivan no longer state the law in Montana, we need not discuss the second 4 l' question certified to us. Justice V We concur: ? A 4 $ j w d w Chief Justice