Opinion ID: 784593
Heading Depth: 2
Heading Rank: 3

Heading: The Disease Exclusion

Text: 26 We next consider whether the policy's disease exclusion is applicable. Because Chale's death was accidental, Mrs. Chale is entitled to the $100,000 accidental death benefit unless Allstate can surmount its burden to show that the death was caused by disease or infirmity. See Stanford v. American Guar. Life Ins. Co., 280 Or. 525, 571 P.2d 909, 911 (1977) (The insurer has the burden of proof that the loss is excluded.). 27 We note, as an initial matter, that disease and infirmity are properly treated as synonymous. Hutchison v. Aetna Life Ins. Co., 182 Or. 639, 189 P.2d 586, 590 (1948). Although the definitions of these terms are exceptionally broad in common usage, see Paulissen, 205 F.Supp.2d at 1129-30 (remarking that they would include the slightest and most temporary ailment), they must be narrowly construed in the context of insurance policies. Id. at 1130; see also Todd v. Occidental Life Ins. Co., 208 Or. 634, 303 P.2d 492, 495 (1956) (In construing a contract of insurance, the courts will give as favorable a construction for the benefit of the insured as is cognizable in the words used to prevent forfeiture.). Under Oregon law, we must limit our construction of the term disease in Chale's policy only to some ailment or disorder of an established or settled character to which the insured is subject. Hutchison, 189 P.2d at 590; see also Todd, 303 P.2d at 495. 28 Allstate does not dispute that Chale did not have HAPE or HACE before ascending to high altitudes, or that rapid descent would have alleviated his symptoms. These afflictions thus can hardly be described as any more established or settled than, for example, hypothermia or suffocation. See Paulissen, 205 F.Supp.2d at 1130 (holding deceased's HAPE was not a disorder of a somewhat established or settled character but a mere temporary disorder ... arising from sudden and unexpected derangement of the system (internal quotations and alterations omitted)). It is true that someone who is freezing to death or drowning certainly suffers from a physiological abnormality. But in neither case could the affliction be considered so established or settled as to amount to disease. For both disorders, the onset is sudden and the outcome either death or rapid rescue from the brink of death — just like HAPE and HACE. 29 Nor does Allstate suggest that Chale had any other established or settled disorder that contributed to his death. Instead, it rests its argument upon two faulty premises. First, Allstate views as dispositive its medical expert's uncontested use of the word disease to describe HAPE and HACE. Unfortunately for Allstate, resolution of this issue goes beyond medical semantics. Whether HAPE and HACE are diseases or infirmities as contemplated by the insurance policy is a question of law. See id., 205 F.Supp.2d at 1127 n. 8. Although testimony from medical experts can help inform the legal decision maker about the nature of these afflictions, it does not dictate the proper legal interpretation of this policy term. See id. This is the province of courts rather than doctors. 30 Allstate's second argument reveals the weakness of its position. It contends that because there is no evidence of any ... accident, the diseases of HAPE and HACE directly caused Chale's death. In other words, it ties its argument on the disease issue to an outcome in its favor on the accidental injury issue. But because Chale's death was accidental, Allstate's effort to bootstrap is unavailing. The district court should have granted summary judgment to Mrs. Chale on her claim for recovery of accidental death benefits under the insurance policy. Considering only the evidence before the court at the time Mrs. Chale moved for summary judgment, no genuine issue of material fact remains to be litigated. Accordingly, we reverse the district court's grant of summary judgment to Allstate and its denial of summary judgment to Mrs. Chale.