Opinion ID: 175986
Heading Depth: 3
Heading Rank: 1

Heading: Injury independent of all other causes

Text: The policies' coverage language provides for benefits if death occurs as a direct result of an injury. The policies explain that an injury is a bodily injury caused by an accident and that [t]he injury must be the direct cause of the Loss and must be independent of all other causes. [1] (Appellant's App. at 61, 75.) Loss is defined as the death of the Covered Person or any physical impairment, incurred expense, or other benefit covered under the terms of this Policy and any attached Riders. (Appellant's App. at 61, 75.) Although the policies do not define the word accident, the Oklahoma Supreme Court has held that this term is an unambiguous word describing an event that is `unexpected, unintended and unforeseen in the eyes of the insured.' Cranfill, 49 P.3d 703 at 706 (quoting Willard v. Kelley, 803 P.2d 1124, 1128-29 (Okla.1990)). The district court agreed with Defendant that Plaintiff's claim for insurance benefits did not come within the coverage language of his policies because Mrs. Flores's death was not independent of all other causes. Specifically, the court concluded that Mrs. Flores's high blood pressure and her treatment for that condition were at least contributing causes (or a contributing cause) of her death because she would not have died from an overdose if Verapamil had not been prescribed for her. (Appellant's App. at 407.) The court therefore concluded Mrs. Flores's death was not caused by an accidental bodily injury that acted independently of all other causes as required by the policy's definition of injury. Defendant argues we should affirm this result on appeal, citing for support to several Oklahoma cases in which a pre-existing medical condition concurred with an accident in bringing about death. We agree Mrs. Flores's fall was not an injury that resulted in death independently of all other causes, and we therefore agree her fall cannot be an injury triggering coverage under the policies. As to the alleged accidental overdose, however, we disagree with Defendant's interpretation of Oklahoma law. Setting aside for the moment the question whether Mrs. Flores's death was caused by an overdose or by Verapamil accumulation resulting from her liver problems, we conclude an accidental overdose of prescription medication would constitute an injury under Plaintiff's insurance policies with Defendant. Defendant argues the alleged accidental overdose in this case did not independently cause Mrs. Flores's death because the overdose that caused the death was in turn caused by the treatment of Mrs. Flores's hypertension with Verapamil. In other words, because the accidental injury that led to Mrs. Flores's death had its own cause, it cannot be considered an injury independent of all other causes. We conclude, however, that it would be absurd to read the policies to bar coverage whenever any cause can be identified for the accidental injury that caused the death, where this cause of a cause did not otherwise contribute to the death. The policies provide that an accidental injury, to be covered, must be independent of all other causes. This does not mean, however, that the injury must have occurred in a vacuum with nothing contributing to bring it about, but rather, the accidental injury itself must be the sole proximate cause of the death. As Bacon says, if it were infinite with the law to consider causes that would lead us back to the birth of a person, for if he had never been born the accident would not have happened. U.S. Fid. & Guar. Co. v. Smith, 249 Miss. 873, 164 So.2d 462, 470 (1964) (internal quotation marks omitted). Thus, courts have long rejected attempts to preclude recovery on the basis that the accident would not have happened but for the insured's illness. Kellogg v. Metro. Life Ins. Co., 549 F.3d 818, 831 (10th Cir. 2008) (collecting cases). Of course, as Defendant points out, the question in this case is one of Oklahoma law, not of the other jurisdictions to have considered the question. However, Oklahoma's case law is fully consonant with this interpretation of the pertinent policy language. In all of the cases cited by Defendant for support, the death or other loss was caused by the concurrence of both a pre-existing medical condition and an unrelated accident. In Hume v. Standard Life & Accident Insurance Co., 365 P.2d 387 (Okla.1961), for instance, the insured died after an automobile accident hastened the bursting of a pre-existing aneurysm. Similarly, in Bewley v. American Home Assurance Co., 450 F.2d 1079 (10th Cir.1971) (applying Oklahoma law), the insured died as a result of the concurrence of a pre-existing heart condition and a fall. Thus, in these cases death resulted because the accident aggravated the effects of the disease, or the disease aggravated the effects of the accident, with both the disease and the accident acting as concurring causes of the death. Kerns v. Aetna Life Ins. Co., 291 F. 289, 292 (8th Cir. 1923) (cited with approval in Hume, 365 P.2d at 390). By contrast, where a pre-existing disease only contributed to death insofar as it placed the insured in a position where an unanticipated and unintended occurrence might happen, the Oklahoma Supreme Court has found coverage under the terms of similar accidental insurance policies. In Cooper v. New York Life Insurance Co., 198 Okla. 611, 180 P.2d 654 (1947), the insured was given morphine injections to relieve pain brought on by an attack of renal lithiasis. Id. at 655. These injections resulted in opium poisoning and ultimately led to the insured's death. Id. Although the insurance policy required proof that the death of the insured resulted directly and independently of all other causes from bodily injury effected solely through external, violent and accidental means, the Oklahoma Supreme Court held the death was within the terms of this policy. Id. at 655-56. In other words, as the Oklahoma Supreme Court stated in a somewhat different context in another insurance case, the fact that an insured's pre-existing disease causes her to voluntarily seek medical treatment and thus put herself in a position to be exposed to the unexpected happening does not mitigate against recovery. Bosley v. Prudential Ins. Co. of Am., 192 Okla. 304, 135 P.2d 479, 481 (1943). As Plaintiff points out, the facts in Cooper are quite similar to the alleged facts in the instant situationthe insured suffered from a pre-existing medical problem for which the insured sought treatment, and that treatment accidentally caused the insured's death. The pre-existing medical problem in both cases did not otherwise contribute to or cause the death, but simply exposed the insured to the risk that an accident might occur during the course of medical treatment. And, under these circumstances, the Oklahoma Supreme Court concluded coverage was warranted in Cooper, despite the insurance policy's requirement that the death result directly from injury independent of all other causes. Defendant contends that Cooper has been implicitly overruled by other Oklahoma cases such as Hume. In none of these other cases, however, was the Oklahoma Supreme Court considering a situation in which a pre-existing medical condition merely places the insured in a position where a medical accident may occur but does not otherwise contribute to the death. Indeed, Defendant has cited to no Oklahoma case in which a cause of a cause has been held to bar coverage under similar policy terms to the ones at issue here. We see no basis for departing from the distinction in Oklahoma law between cases where disease concurs with an accident in bringing about a loss, as in Hume, and cases where the disease simply exposes the insured to the risk that an unexpected injury may happen, as in Cooper. We therefore conclude that, under Oklahoma law, an accidental prescription drug overdose that is the sole proximate cause of a insured's death is an injury independent of all other causes. Defendant also contends Plaintiff is not entitled to coverage because he is alleging medical malpractice, which cannot constitute an accident under an accidental insurance policy. For support, Defendant cites to a single Seventh Circuit ERISA case, Senkier v. Hartford Life & Accident Ins. Co., 948 F.2d 1050, 1054 (7th Cir.1991). However, among the courts that have considered the issue, [d]eath from overdose, absent affirmative evidence that the insured intended death, is almost invariably treated as accidental. Hardy v. Beneficial Life Ins. Co., 787 P.2d 1, 3 (Utah Ct.App.1990) (collecting cases). Moreover, the reasoning in Senkier does not accord with the Oklahoma Supreme Court's decision in Cooper and Bosley to permit recovery for losses incurred in the course of medical treatment. We therefore see no basis under Oklahoma law for concluding that an accidental drug overdose does not constitute an accident simply because it occurs in the course of medical treatment. In addressing this issue, we have thus far assumed Mrs. Flores's Verapamil toxicity was caused by an overdose. However, as Defendant points out, the medical examiner did not know whether Mrs. Flores's death was caused because she was given more Verapamil than prescribed or whether she received the prescribed amount but was unable to process it because of her pre-existing liver disease. [2] Under the latter scenario, Mrs. Flores's death would not have been caused by an accidental bodily injury independent of all other causes, and therefore Plaintiff would not be entitled to insurance benefits under the terms of the policies. Defendant contends that the lack of specific evidence on the exact cause of death bars coverage under the policies. In reply, Plaintiff argues that the facts and the reasonable inferences to be drawn therefrom support the conclusion that Mrs. Flores's death was caused by an overdose, not her liver problems. According to the undisputed facts, Mrs. Flores had been taking Verapamil as treatment for [her high blood pressure] for a long time prior to her death (Appellant's App. at 35), and she apparently showed no ill effects from this medication during the years prior to her hospitalization. Based on these facts, Plaintiff argues, a jury could reasonably infer that Mrs. Flores received a fatal overdose of Verapamil while hospitalized, rather than she just happened to attain toxic levels of the drug while she was under the care, control, and supervision of the health care providers at the hospital. (Appellant's Reply Br. at 4.) Defendant contends that Plaintiff's theory relies entirely on speculation. However, the medical examiner's report and affidavit indicated there were only two possible causes of death, neither of which he identified to be more likely than the other. Thus, this is not a situation complicated by a multitude of other competing inferences, the existence of which would diminish the probability of the injury's having been sustained in the manner the plaintiff['s] theory suggests. Wratchford v. S.J. Groves & Sons Co., 405 F.2d 1061, 1066 (4th Cir.1969). And, given the evidence of Mrs. Flores's long-term use of Verapamil with no ill effects, we agree with Plaintiff that a jury might reasonably conclude the inference of an overdose was more probable than the inference that Mrs. Flores's pre-existing liver disease suddenly and coincidentally caused her death during her hospital stay. Of course, at trial Defendant might be able to point the jury to other evidence supporting the opposite conclusion. However, where the evidence indicates only two possible causes for an injury, either one of which is supported by permissible but competing inferences, we agree with the Fourth Circuit that the question should be submitted to the jury for resolution, rather than being decided on summary judgment. See id. at 1067; see also Brown v. Parker-Hannifin Corp., 746 F.2d 1407, 1411 (10th Cir.1984) ([W]here different ultimate inferences may be drawn from the evidence presented by the parties, the case is not one for summary judgment.). We therefore conclude the district court erred in holding that Plaintiff was not entitled to coverage based on the policies' requirement that a covered injury be independent of all other causes.