Opinion ID: 622538
Heading Depth: 3
Heading Rank: 2

Heading: “Disease, Illness or Infirmity” Exclusion

Text: Because the District Court held that Mr. Figueroa‟s death was not covered under the policy as a death resulting from an “accidental bodily injury,” it did not reach Liberty Life‟s alternative argument that coverage was precluded under the policy‟s exclusion for “death which results directly or indirectly, in whole or in part, from . . . disease, illness or 3 Although the record indicates that an “[a]llergic reaction warning was given” (A. 55), it is not clear whether Mr. Figueroa was specifically warned about the risk of a fatal reaction. Regardless, in light of the very low risk of severe or fatal anaphylaxis, the warning does not render Mr. Figueroa‟s injury the “the natural and expected result” of his receiving the contrast dye. See Baumhammers, 938 A.2d at 292 (“An injury . . . is not „accidental‟ if the injury was the natural and expected result of the insured‟s actions.”). 6 infirmity of the body or mind.” (A. 22.) Liberty Life argued below and maintains on appeal that this exclusionary clause applies because Mr. Figueroa‟s gastrointestinal illness, which the autopsy revealed to be caused by “[n]umerous diverticula . . . present in the descending colon” (A. 87), “precipitated [the] chain of events” that resulted in Mr. Figueroa receiving the intravenous injection of contrast dye. (Liberty Life‟s Br. at 23.) In Shiffler v. Equitable Life Assurance Society of the United States, 838 F.2d 78 (3d Cir. 1988), this Court, applying Pennsylvania law, held that when an insurance “policy contains a . . . clause precluding recovery if the death was caused directly or indirectly by disease, there can be no recovery if the preexisting disease contributed to the death.” Id. at 84 (emphasis added). It is clear that Mr. Figueroa‟s illness was not a contributing factor in his death, it being undisputed that the sole cause of death was “acute anaphylaxis.” (A. 82.) See Speer v. W. & S. Life Ins. Co., 43 A.2d 562, 566 (Pa. Super. Ct. 1945) (holding that because it was an admitted fact that the insured‟s death was due solely to a skull fracture from falling on a concrete floor, “death could not have been due, even partially, to a preexisting disease or infirmity”). We accordingly hold that Mr. Figueroa‟s death does not fall within the policy‟s exclusion for death “result[ing] directly or indirectly, in whole or in part, from . . . disease, illness or infirmity of the body or mind.”