Opinion ID: 78557
Heading Depth: 2
Heading Rank: 3

Heading: accidental results v. accidental means

Text: Georgia law distinguishes between insurance coverage for accidental results and coverage for injuries caused by accidental means. See Provident Life & Accident Ins. v. Hallum, 276 Ga. 147, 576 S.E.2d 849, 851 (2003). In Hallum, the Georgia Supreme Court explained that an accidental result is an injury that is unexpected but arises from a conscious voluntary act, without any intervening circumstances. See id. Conversely, an injury from accidental means is one that is the result of an unforeseen act that was involuntarily or unintentionally done. See id. The insurance policy has two relevant provisions: (1) This plan pays a benefit, if, while insured, a person suffers a bodily injury caused by an accident : and if, within 365 days after the accident and as a direct result of the injury, he or she loses:  His or her life.  A hand, by actual severance at or above the wrist joint.  A foot, by actual severance at or above the ankle joint.  An eye, involving irrecoverable and complete loss of sight in the eye.  His or her speech or hearing, the loss must be total and permanent.  The thumb and index finger of the same hand, by actual severance of entire digit. Loss of thumb and index finger means complete severance through or above the metacarpophalangeal joint of both digits. . . . (2) This plan also pays a benefit if, while insured, a person suffers a bodily injury in an accident and if, within 30 days after the accident and as a direct result of the injury, he or she is stricken with one of the following forms of paralysis:  Quadriplegia: the entire and irrecoverable paralysis of both upper and lower limbs.  Paraplegia: the entire and irrecoverable paralysis of both lower limbs.  Hemiplegia: the entire and irrecoverable paralysis of the upper and lower limbs on one side of the body.  Uniplegia: the entire and irrecoverable paralysis of one limb. (emphasis added). Georgia courts have consistently held the language in the first provision, caused by an accident, to mandate accidental means. See Laney v. Continental Insurance Co., 757 F.2d 1190, 1192 (11th Cir.1985). The reasoning deduces that in the phrase accidental means, the word accidental is an adjective describing the quality of the events precipitating the ultimate result. The focus is on the occurrence or happening which produces the result, not the result itself. See id. The distinction is grounded on the idea that means is synonymous with cause; that the difference between accidental means and the other terms is the difference between cause and effect. See Winters v. Reliance Standard Life Ins. Co., 209 Ga.App. 369, 433 S.E.2d 363 (1993). There is no settled interpretation for the language in the second provision. While there is no precedent directly on point, Capone points to the language examined in Hallum. 576 S.E.2d at 849. Hallum dealt with the phrase accidental bodily injuries, holding that the phrase mandated an accidental results standard. Hallum reasoned that by using accidental to modify the cause or means of any injuries, the policy places the focus of the coverage on the injuries, not the means that caused the injury. Id. We have serious doubt as to whether the language in the second provision would be controlled by Georgia's accidental means standard. We believe that the language used closely resembles the language used by the Georgia Supreme Court in Hallum. However, it makes no difference because we hold that under the facts of this case, it appears Capone would qualify under either reading.