Court Opinion

ID: 9575333
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:13:04.580363+00
Date Added: 2024-06-11T12:48:08.476664
License: Public Domain

Pope, Judge,
concurring in part and dissenting in part.
I must dissent to Division 2 of the majority opinion, because I cannot concur with the majority’s strained construction of the pertinent insurance contract language. Under the majority’s interpretation of this contract language, if an airplane fell from the sky and killed an automobile driver whose blood alcohol level was at least .15 percent, that person’s beneficiaries would not be able to recover despite the fact that the person’s alcohol level was clearly unrelated to the accident. The exclusions and exceptions paragraph of the insurance policy provides in pertinent part: “This policy does not cover any loss, caused by or resulting from: ... (6) any injury sustained while operating a motor vehicle if the Covered Person was under the influence of alcohol as evidenced by a blood alcohol level of at least 0.15% by weight/volume (150 milligrams per 100 milliliters).” (Emphasis supplied.) The caused by or resulting from language does not just modify the word loss as the majority contends; it plainly requires that a causal connection be shown between the insured being under the influence of alcohol and any injury sustained by the insured while operating a motor vehicle in that condition before this exclusion from coverage is applicable.1
In essence, the majority decision disregards the causation language contained in the prefatory paragraph setting forth exclusions and exceptions from coverage and considers only the language of sub-paragraph (6) which states that injuries are excluded from coverage if they are “sustained while operating a motor vehicle if the Covered Person was under the influence of alcohol. . . .” (Emphasis supplied.) Assuming arguendo that the language relied upon by the majority does not plainly require a showing of a causal connection, “[e]xceptions, limitations and exclusions to insuring agreements require a narrow construction on the theory that the insurer, having affirmatively expressed coverage through broad promises, assumes a duty to define any limitations on that coverage in clear and explicit *394terms. Where the language contained in an insurance policy is susceptible to two or more constructions, the one most favorable to the insured will be adopted.” (Punctuation and citations omitted.) Vulcan Life Ins. Co. v. Davenport, 191 Ga. App. 79, 83 (380 SE2d 751) (1989), disapproved on other grounds, Santiago v. Safeway Ins. Co., 196 Ga. App. 480, 482 (1) (396 SE2d 506) (1990). At best, the language in question would be susceptible to two interpretations, and the majority errs in adopting the construction most favorable to the insurer rather than the insured.
Burnette v. Ga. Life &c. Co., 190 Ga. App. 485 (379 SE2d 188) (1989), the only case relied upon by the majority to support its position, is clearly distinguishable from this case. In that case Robert Burnette, a minor, was injured when a car in which he was a passenger crossed the centerline and struck another vehicle. Burnette’s guardian sought benefits pursuant to Burnette’s student blanket insurance policy. The beneficiary brought suit after the insurer denied coverage under an exclusion contained in the policy for “ ‘(i)njuries sustained while (the insured) is an occupant of a private automobile . . . being driven in violation of any law or ordinance. . . .’’’Id. at 485. That case is distinguishable for two reasons. First, the insurance policy in question was a limited one designed to provide certain coverage to students engaged in school activities, and Burnette was not engaged in a school activity at the time of his death; it was not a general accidental death or injury policy as is the policy in this case. Also, contrary to the majority’s contention, it is impossible to determine from our decision in Burnette if the exclusion in question contained the words “resulting from,” as does the policy sub judice. This court’s failure to quote such language from the policy, as it did the language quoted above, suggests that the “resulting from” language was not present in that policy. Because the Burnette decision is clearly distinguishable from this case, the majority’s contention that this opinion would require the reversal of that case is erroneous.
While this court has not had the opportunity to decide whether similar contract language requires a showing of a causal connection, our decisions in Vulcan Life Ins. Co. v. Davenport, supra, and Progressive Life Ins. Co. v. Smith, 71 Ga. App. 157 (30 SE2d 411) (1944) support the trial court’s ruling. In Vulcan, supra, the insured brought suit against his health insurance carrier when it refused to pay his medical bills arising from an automobile collision which occurred while the insured’s blood alcohol content was above the level that would support a conviction for driving under the influence. The exclusion in that case provided: “ ‘INTOXICANTS AND NARCOTICS: We will not be liable for any loss resulting from your being drunk (except in Oklahoma or Minnesota) or under the influence of any narcotic unless taken on the advice of a physician.’ ” (Emphasis sup*395plied). Vulcan, supra at 79-80. In that case, this court recognized that the policy language required the jury to make two decisions: (1) whether the insured’s blood alcohol content of .19 percent meant he was drunk as that term was used in the policy; and (2) if the insured was drunk whether that condition proximately caused the automobile accident underlying the case. Id. at 82 (1). Thus, the only material difference in the policy language between the two cases is that the exclusion in the Vulcan case required an initial determination of whether the insured was drunk, whereas the language of the exclusion in this case makes it clear when the insured is considered to be under the influence of alcohol. Both exclusion clauses, however, contain the pertinent “resulting from” language, which this court in the Vulcan case recognized requires a showing of proximate cause.
In Progressive Life Ins. Co. v. Smith, supra, the insured died in a house fire. The accidental death policy provided by Progressive Life Insurance Company contained the following exclusion: “ ‘No accidental death benefit will be paid if the death of the insured is a result of suicide, whether sane or insane or while under the influence of narcotics or intoxicating liquor.’ ” Id. at 157-158. There was evidence that the insured was intoxicated at the time of the fire. This court concluded that the evidence was insufficient to conclude as a matter of law “that at the time the house was consumed by fire, the insured was under the influence of intoxicating liquor within the meaning of the insurance policy to such an extent as to show a causal connection between his death and the fire which consumed the building.” Id. at 160. Although the majority contends this language is merely dicta, it is clear from the language quoted above that this court in Progressive imposed a causation requirement when considering whether the evidence was sufficient to support the jury’s verdict.
The majority’s focus on public policy in this case is misplaced. The unambiguous language of this contract dictates a showing of a causal connection and makes it unnecessary to decide whether the public policy of this state would require that such a connection be shown.2 While I share the majority’s concern of removing intoxicated drivers from our highways and do not consider a driver’s blood/alco*396hoi level unrelated to a driver’s ability to operate a vehicle as the majority contends, this court cannot allow that concern to cause us to abandon time-honored rules of contract construction or, in this case, to ignore the plain language of the contract. I do not agree with the majority’s conclusion that a showing of causation subjects the insurer to unreasonable exposure, because the contract language clearly exonerates the insurer from all liability in those situations in which alcohol is a causative factor. If alcohol is unrelated to the accidental death, the insurer’s risk is the same as it would be in any non-alcohol-related accident.
Decided December 5, 1991
Reconsideration denied December 20, 1991
Wilkes, Johnson & Smith, Ken W. Smith, for appellant.
Simpson & Gray, Ralph F. Simpson, Joseph I. Carter, for appellee.
In sum, the language of the policy exclusion in question clearly requires a showing of a causal connection between the event causing injury or death and the insured’s condition of being under the influence of alcohol before the exclusion is applicable. Even if the language is arguably ambiguous, when the language is construed to support the jury’s verdict and in favor of the insured, as we are required to do, we must affirm the trial court’s ruling. Accordingly, the trial judge correctly charged the jury that the insurer had the burden of showing a causal connection between the deceased’s blood alcohol level at the time of death and the accident resulting in his death and did not err in submitting a special interrogatory to the jury concerning causation.
I am authorized to state that Presiding Judge Carley and Judge Cooper join in this dissent.

 Although appellee erroneously relied on OCGA § 33-29-4 in pbsiting his argument to the court, he has, contrary to the majority’s contention, always maintained that a causation requirement should be a part of the exclusion in question.

 In my opinion the public policy of this state would require that a causal connection be shown between any exclusion from coverage and the event causing injury or death. Insurance companies properly should be able to exclude from coverage certain voluntary risks taken by the insured which increase the chance that the insurer will be exposed to liability. The insurance industry, however, is closely affected with the public welfare. For that reason, public policy requires that insurance contracts be interpreted in a practical, reasonable and fair manner, consistent with the understanding of the average man. To allow an insurance company to insert an exclusion from coverage and not require any correlation between the exclusion and the event causing injury or death smacks against notions of fairness and allows insurance companies to injustly avoid the obligation they assume to their insureds by accepting premiums from them.