Opinion ID: 2632257
Heading Depth: 1
Heading Rank: 1

Heading: accident and/or intentionally self-inflicted injury

Text: ¶ 6 The policy provides coverage for loss of life as a result of bodily injury suffered in an accident but excludes coverage for intentionally self-inflicted injuries. ¶ 7 Mrs. Cranfill argues the word accident is ambiguous and must be construed against Aetna. Aetna argues the word accident is not ambiguous. Whether policy language is ambiguous is a question of law. Wynn v. Avemco Ins. Co., 1998 OK 75, ¶ 17, 963 P.2d 572, 575. The absence of an express definition of a word within the policy does not necessarily render the word ambiguous. Similarly, the fact that a word cannot be precisely defined to make clear its application in every factual situation does not mean the word is ambiguous. See, e.g, Allstate v. Humphrey, 246 Md. 492, 229 A.2d 70 (1967). Rather, the test to be applied in determining whether a word is ambiguous is whether the word is susceptible to two interpretations on its face. Littlefield v. State Farm Fire and Cas. Co., 1993 OK 102, 857 P.2d 65, 69. ¶ 8 This test for ambiguity is applied from the standpoint of a reasonably prudent lay person, not from that of a lawyer. Couch on Insurance 3d § 21:14 (1995). In our view the word accident is not, on its face, susceptible to two interpretations. A reasonably prudent lay person applying for accidental death insurance would understand what an accident is. Accordingly, we conclude the word accident as used in the policy is not ambiguous. Having made this determination, we must accept the word in its plain, ordinary and popular sense. Mc-Donald v. Schreiner, 2001 OK 58, ¶ 7, 28 P.3d 574, 577. ¶ 9 In Willard v. Kelley, 1990 OK 127, 803 P.2d 1124, 1128-29, we described an accident as an event that is unexpected, unintended and unforeseen in the eyes of the insured and said that the standard to be used is that of a reasonable person appraising the event from the insured's perspective. Aetna, relying on this language in Willard, argues that since Mr. Cranfill's death was a reasonably foreseeable consequence of his driving while intoxicated, his death was not accidental. ¶ 10 We reject this argument. In the context of life and accident insurance, contract terms are not analyzed under the tort principle of foreseeability. Otherwise, deaths resulting from almost any high-risk driving activity would be excluded from coverage under an accident insurance policy ( e.g., driving at an excessive speed, failing to keep a proper lookout, failing to maintain brakes in good condition, changing lanes without using a proper turn signal, floating a stop sign). If one applied tort principles, death from such high-risk activity could be said to be reasonably foreseeable. ¶ 11 Foreseeability has a more specific meaning in the context of life and accident insurance. It is only when the consequences of the act are so natural and probable as to be expected by any reasonable person that the result can be said to be so foreseeable as not to be accidental. See Mid-Continent Life Ins. Co. v. Davis, 1935 OK 1019, 51 P.2d 319 Syllabus by the Court ¶ 1 (Death of the insured is `accidental' within policy where it is unexpected and not [the] probable result of his conduct.). The mere fact that an insured's death may have resulted from his or her own negligence, or even gross negligence, does not prevent that death from being accidental under the plain meaning of the word accident. Id. Syllabus by the Court ¶ 2. ¶ 12 Aetna asserts there is a split of authorities on this issue and further asserts that the majority of jurisdictions, as well as the more recent decisions, support its denial of Mrs. Cranfill's claim. As it turns out, the split is between the federal courts on one hand and state courts on the other. Aetna urges us to adopt the federal rationale that is used to resolve insurance disputes that are governed by ERISA. [4] We decline to do so for two reasons. First, federal courts are entirely free to choose the meaning that is to be given to the critical terms in contest ( i.e., the word accident and the phrase intentionally self-inflicted injury). [5] We, in contrast, are bound by Oklahoma's common-law jurisprudence. Second, in most ERISA cases, the federal courts must affirm the denial of benefits unless the decision to deny benefits was arbitrary and capricious. [6] We are not persuaded by the federal scheme. Instead, we are persuaded by the reasoning of other state courts which have overwhelmingly held that an insured's death, in circumstances similar to the circumstances of this case, is accidental and is not intentionally self-inflicted. [7] ¶ 13 Separate and apart from the issue of whether Mr. Cranfill's death is covered as an accidental death is whether it is excluded as an intentionally self-inflicted injury. Again, we do not view the phrase as susceptible to two interpretations on its face and therefore we conclude the phrase is not ambiguous. ¶ 14 Aetna argues that an intentionally self-inflicted death is any death that is the natural and probable consequence of an intentional act. [8] Stated another way, Aetna's argument is that a court may infer an insured's intent to inflict his or her own death. We reject that notion. We are guided by our earlier decision in New York Life Ins. Co. v. Riggins, 1936 OK 528, 61 P.2d 543. In Riggins, the insured's surviving spouse sought insurance benefits for the death of her husband pursuant to two life insurance policies. The issue was whether the insured's chronic alcoholism was intentionally self-inflicted. We held it was not. We held that although the insured's act of consuming alcohol was intentional, his resulting brain damage from chronic alcoholism was not an intentional act of self-destruction. We held that the exclusion for intentionally self-inflicted injury applies only when then insured intended self-destruction, not when the insured intentionally committed an act which unexpectedly results in death. Id. at 552. ¶ 15 Similarly in the instant case, we conclude that Mr. Cranfill's conduct of intentionally driving while intoxicated is not the equivalent of his intent or plan to cause his death. [9] A death is not intentionally self-inflicted for purposes of an accidental death policy merely because it resulted from engaging in negligent or even grossly negligent conduct, unless the insured intended to cause his own death. See Mid-Continent Life Ins. Co. v. Davis, 1935 OK 1019, 51 P.2d 319 Syllabus by the Court ¶ 2. To hold otherwise would be contrary to the expectations of Oklahoma insureds who have purchased accidental death insurance to protect their beneficiaries. ¶ 16 In sum, we answer the first certified question as follows. Under Oklahoma law, for purposes of an accidental death and dismemberment insurance policy, an insured's death is accidental and is not an intentionally self-inflicted injury in the context of the certified question.