Court Opinion

ID: 9575966
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:18:59.27319+00
Date Added: 2024-06-11T12:52:17.031611
License: Public Domain

Justice Carlton
concurring in the result.
I concur only in the result reached by the majority because I cannot agree with its interpretation of the term “self-inflicted.” In interpreting that term to require an intent to inflict but not to kill, the majority has, in effect, created coverage for shooting deaths in which the shooting was intentional but the result, death, was not. Such an interpretation is clearly inconsistent with the express purpose and scope of the insurance policy — to compensate only those losses caused by an accidental means. Because the policy expressly covers only losses due to “accidental means” and the express purpose of the clause which contains the term “self-inflicted” is to reduce the scope of coverage, the term “self-inflicted” can be logically interpreted only to refer to accidental means and not to accidental result.
My reasoning is simple: Defendant issued Carter Maddox, the deceased, a “Master Select Risk Accident Policy.” The policy in*655sured him “against loss resulting directly and exclusively of all other causes from bodily injuries effected solely through external, violent and accidental means.” (Emphasis added.) As the majority states:
“ ‘Accidental means’ refers to the occurrence or happening which produces the result and not to the result. That is, ‘accidental’ is descriptive of the term ‘means.’ The motivating, operative and causal factor must be accidental in the sense that it is unusual, unforeseen and unexpected. Under the majority view the emphasis is upon the accidental character of the causation — not upon the accidental nature of the ultimate sequence of the chain of causation.”
(quoting Fletcher v. Security Life & Trust Co., 220 N.C. 148, 150, 16 S.E. 2d 687, 688 (1941)). Thus, the policy insuring Carter Maddox insured only against loss resulting from an accidental cause. It follows, then, that the policy does not insure against losses resulting from non-accidental means even though the resulting injury was accidental. In short, under this “Master Select Risk Accident Policy,” the accidental nature of the result is irrelevant; the loss is covered only if it results from accidental means.
The policy issued by defendant does not provide full coverage for all losses resulting from accidental means. As its title indicates, the policy insures only against selected risks. Further, the policy coverage for loss resulting from accidental means is limited. One of these limitations is for “shooting self-inflicted.” With regard to this risk, the policy provides: “For death covered by the provisions of this policy, when it results from . . . shooting self-inflicted, . . . the amount payable shall be one-fifth the amount otherwise payable.” (Emphasis added.) It is with regard to the interpretation of his provision that the majority and I disagree. The above-quoted clause provides a reduction in the proceeds payable for a certain class of loss already covered by the policy. This reduction clause begins with, “For death covered by the provisions of the policy,” and does not create, but reduces, coverage. The policy covers loss effected through accidental means only, and the interpretation of the term “shooting self-inflicted” in the limitation or reduction clause must, I submit, be interpreted in light of the scope of the policy’s coverage. Therefore, death from “shooting self-inflicted” can refer only to death due to accidental means.
*656The majority has interpreted this reduction clause to apply to situations in which the insured intends the act of shooting but does not intend to kill himself: intentional means, but accidental results. I strenuously contend that because the general coverage clause of the policy limits its coverage to losses resulting from accidental means, the reduction clause can only further reduce the coverage and does not create coverage for losses resulting from an intentional means.
In my opinion, the reduction in coverage for death resulting from shooting self-inflicted applies to reduce coverage in a situation in which the insured shoots himself and the means is accidental, ie., when the insured does not intend to, but accidentally does, cause the gun to fire. “Self-inflicted” means simply that the insured pulled the trigger or otherwise directly caused the gun to fire. Whether the result was accidental is irrelevant. The policy covers losses from accidental means only; therefore, the reduction in coverage for “shooting self-inflicted” must also refer only to accidental means. A clause which reduces coverage cannot be interpreted to create coverage. “Shooting self-inflicted” can mean only the situation in which the deceased is shot by his own hand when he accidentally pulled the trigger, ie., the causal factor of pulling the trigger must be “unusual, unforeseen and unexpected.” Fletcher v. Security Life & Trust Co., 220 N.C. at 150, 16 S.E. 2d at 688.
In this case, there is no direct evidence of who or what caused the gun to fire. We know only that the gun was fired while in its holster, that the gun was found a few feet from the insured’s body, and that the gun could discharge if it struck the ground while holstered. There is no evidence that the insured committed suicide; indeed, in this state there is a strong presumption against suicide. Adcock v. Life Assurance Co. of Carolina, 31 N.C. App. 97, 228 S.E. 2d 654 (1976). Both plaintiff and defendant agree that this shooting resulted from an accidental means; defendant’s concession of coverage in the amount of $750 is an admission that the shooting resulted from accidental means. Whether the insured accidentally pulled the trigger or whether he dropped the gun and the force of impact caused the discharge is a matter we will never know. To decide on the cause would be pure speculation. The amount to which plaintiff is entitled depends upon the burden of proof with regard to the issue of “shooting self-inflicted.” In my opinion, whenever the plaintiff has established coverage, the *657burden shifts to the insurer to prove that coverage has been reduced. Because the insurer cannot, under the facts of this case, meet the burden of showing that the shooting was self-inflicted, i.e., that the insured pulled the trigger, plaintiff is entitled to recover the full amount of the policy, $3,750.
Chief Justice BRANCH joins in this concurring opinion.