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

Heading: The Accidental Injury Provision

Text: 11 We first consider the parties' dispute over the interpretation of the term accidental injury in the life insurance policy. As with any contract, our goal is to ascertain the intention of the parties. Hoffman Constr. Co. v. Fred S. James & Co., 313 Or. 464, 836 P.2d 703, 706 (1992) (quoting Totten v. New York Life Ins. Co., 298 Or. 765, 696 P.2d 1082, 1086 (1985)). 12 Initially, we look to the policy as a whole. See id. As the drafter of the contract, Allstate could have explicitly defined accidental or accident any way it wished. Botts v. Hartford Accident & Indem. Co., 284 Or. 95, 585 P.2d 657, 660 (1978). Because it did not, and because the rest of the contract sheds no additional light on the parties' intent, Allstate must accept the common understanding of the term by the ordinary member of the purchasing public. Id.; see also Pope v. Benefit Trust Life Ins. Co., 261 Or. 397, 494 P.2d 420, 421 (1972); Finley v. Prudential Life & Cas. Ins. Co., 236 Or. 235, 388 P.2d 21, 26 (1963). 13 The next step, Oregon law instructs, is to seek clarification from the plain meaning of the term. See Hoffman Constr. Co., 836 P.2d at 706. This inquiry is equally unavailing, as we do not presume to discover a workable definition of accident where the Oregon Supreme Court found none. See St. Paul Fire & Marine Ins. Co., Inc. v. McCormick & Baxter Creosoting Co., 324 Or. 184, 923 P.2d 1200, 1212 (1996) (finding the dictionary definition of accident broad enough to encompass the definitions offered by both parties). 14 The lack of a commonly accepted, singular meaning of accident has given Oregon courts a number of occasions to grapple with the task before us today. Carving out a universally applicable definition is no mean feat. Cf. Botts, 585 P.2d at 660 (There are probably not many words which have caused courts as much trouble as `accident' and `accidental.'). Notably, the Oregon Supreme Court has acknowledged the futility of such an undertaking. The court's approach in Botts treats the legal interpretation of accident as malleable to the facts of a given case. Thus, [i]n situations in which `accident' or `accidental' are not defined in the policy, it is for the court to decide the definition which is properly applicable to the particular factual situation. Id. at 661. 15 Although Botts makes clear that ours is a moving target, we are not entirely without guidance. It is well established that the proper focus of the inquiry is the injurious result, not the conduct leading to that result. See Fox v. Country Mut. Ins. Co., 327 Or. 500, 964 P.2d 997, 1006 (1998) (where the insured was a voluntary passenger in a friend's car when the friend intentionally drove it off a cliff in order to collect insurance money, the court focused on the insured's state of mind with respect to sustaining the injury (death), not his state of mind with respect to placing himself in a position where he risked the injury (getting in the car)); see also North Clackamas Sch. Dist. v. Oregon Sch. Bds. Assn. Prop. & Cas. Trust, 164 Or.App. 339, 991 P.2d 1089, 1092 (1999) (reaffirming that the meaning and determination of `accident' focuses not on conduct, but on result). Hence, we must focus on whether Chale's contracting HAPE and HACE and his resulting death were accidental. Whether his act of climbing Mt. Kilimanjaro was intentional — which it certainly was — plays no part in this inquiry. 16 At the broadest level, an accidental event must contain at least some kernel of chance or abnormality. See St. Paul Fire & Marine Ins. Co., 923 P.2d at 1213 (defining accident as an incident or occurrence that happened by chance (quoting Finley, 388 P.2d at 26)). Under some circumstances, the insured's state of mind is relevant to this inquiry. If Chale's purpose was to bring about his death, or if he engaged in an act so certain to cause ... [his death] that the court will say that... [he] intended the harm, his widow cannot recover the accidental death benefit. See Fox, 964 P.2d at 1005. 2 17 Intentional injury is, of course, antithetical to accidental injury. In various contexts, Oregon cases have expressed this concept in different ways, requiring accidents to be unexpected and unintended, Pope, 494 P.2d at 423 (internal quotation marks omitted), to happen without design and contrary to intention and expectation, Finley, 388 P.2d at 26, or be unforeseen, unexpected, unintended or the like, Safeco Ins. Co. v. House, 80 Or.App. 89, 721 P.2d 862, 866 (1986). Most of these definitions simply exclude from coverage as accidents events that are intentional under the ordinary tort meaning of intentional as purposeful or done with knowledge of substantially certain outcome. However, the additional concept of foreseeability appears to have created a stumbling block for litigants. 18 Foreseeability is but one factor that can help courts effectuate the reasonable expectations of the insured. Botts, 585 P.2d at 660. It is also a term loaded with vagaries. As the Botts court pointed out, some unforeseeable injuries, such as when an elderly person dies in her sleep of old age, are not commonly considered accidental. Id. Yet it is equally true that some perfectly foreseeable injuries are universally considered accidental. 19 Consider, for example, a mountaineer who falls into a crevasse while traveling on a glacier. Climbers know that crevasses are a danger associated with glaciers; yet when apparently solid snow crumbles underfoot and causes the mountaineer to fall to an icy death, no one would dispute, and even Allstate concedes, that this perfectly foreseeable event would be classified as an accident. Automobile travel provides a far more mundane example. Every automobile passenger is aware of the risk of a car accident, yet no one would argue that a run-of-the mill collision is not an accident. As these examples illustrate, if the litmus test for foreseeability turns on mere awareness of the possibility of risk, a legal rule that excludes all foreseeable events from accident coverage would yield absurd results. 20 Thus, the district court erred by equating accidental to reasonably unforeseeable where, in its view, an injury may be reasonably foreseeable even if it is not certain or substantially certain that it will occur in every instance. Chale v. Allstate Life Ins. Co., No. CV 01-1622-BR, slip op. at 13 (D.Or. May 31, 2002). In premising its ruling on Mrs. Chale's failure to produce[] any evidence to establish a reasonable person endeavoring to climb Mt. Kilimanjaro would be unaware of  the risk of HAPE and HACE, id. at 12 (emphasis added), the district court turned Oregon law on its head. Urging us to affirm this faulty reasoning, Allstate argues that, in an analogous situation, someone who voluntarily walks across a field during an electrical storm would not have suffered an accidental injury if he were struck by lightning because the risk was foreseeable. This illustration is perhaps the most convincing evidence of the flaw in Allstate's argument. Any interpretation of the insurance policy that assumes that a reasonable insured person would not consider such a scenario to be accidental strains credulity. 21 At the very least, such an interpretation flouts the firmly established rule that ambiguous terms are to be construed against the insurance company. Hoffman Constr. Co., 836 P.2d at 706; I-L Logging Co. v. Mfrs. & Wholesalers Indem. Exch., 202 Or. 277, 275 P.2d 226, 232 (1954); see also North Clackamas, 991 P.2d at 1091-92. Application of this rule is appropriate because the use of accidental in Chale's policy was reasonably susceptible to more than one meaning. See Botts, 585 P.2d at 661 (contemplating many different definitions of accident). 22 Mrs. Chale argues that, as in Fox, the accidental injury term in the policy should be construed to include Chale's death because he had not expected or intended to contract HAPE and HACE. We agree. Chale contracted an unusual and extremely serious medical condition while engaging in the activity of mountain climbing. Even if he was or should have been aware of the risk of HAPE and HACE, his chances of falling victim to these conditions were slim. Because Chale was struck by altitude-induced edema much in the way someone might be struck by lightning, his death falls within the definition of accidental injury contemplated by any reasonable purchaser of Allstate's life insurance policy. 23 In reaching this conclusion, we are persuaded by the reasoning in Paulissen v. United States Life Ins. Co., 205 F.Supp.2d 1120 (C.D.Cal.2002), where, under California law, the insured's death by HAPE was accidental because [d]eath from HAPE cannot be said to be a common or expected result of a trek at high altitudes. Id. at 1128. Allstate urges us to ignore Paulissen due to claimed irreconcilable differences between Oregon and California law. Specifically, Allstate complains that California recognizes a difference between policy language that provides coverage for accidental death and language that provides coverage for death resulting from accidental means, whereas Oregon long ago rejected this distinction. Compare Paulissen, 205 F.Supp.2d at 1127-28 (applying California law's distinction between policies that cover `accidental death' and those that cover death by `accidental means'), with Botts, 585 P.2d at 659-60 (lay[ing] the distinction to rest in Oregon), and Pope, 494 P.2d at 421-22 & n. 1 (criticizing [t]he distinction between injury by `accidental means' and `accidental results from intended means' as logomachy incomprehensible to the average insurance policy purchaser). 24 Allstate's protest rings hollow. When the Oregon Supreme Court abolished the remaining vitality of the means-result distinction in Botts, its purpose was to broaden coverage for insurance policy holders bound by accidental means language — not, as Allstate would have it, to constrict accidental injury coverage. See Botts, 585 P.2d at 659-660 (expressing its doubts as to whether the ordinary purchaser would expect the concept of `accident' to have a different meaning depending upon whether the policy purports to require accidental means or accidental results but explaining that its elimination of the narrow accidental means construction was not strictly necessary because the policy at issue did not contain an accidental means requirement). Nonetheless, Allstate argues that although the means-result distinction no longer exists, we must still determine whether there was an accident. It insists that we look no further than Chale's intentional choice to reach high altitudes, which was undisputedly not accidental. In other words, Allstate's test for whether there was an accident is to identify whether the means of the injury — Chale's choice to climb Mt. Kilimanjaro — was accidental. 25 Accepting Allstate's position would not only require Oregon law to re-embrace the abolished means-result distinction, but would also require us to read accidental means in place of accidental injury into the policy. Because the proper focus is on the injury that befell Chale, Paulissen's rationale is particularly apposite. There, Paulissen, the insured, died while trekking in Nepal at altitudes similar to the ones experienced by Chale. Like Paulissen, Chale's death was caused by accident because it was an unusual or unanticipated result flowing from a commonplace cause. Paulissen, 205 F.Supp.2d at 1128.