Life Insurance Co. of North America v. Evans

No. 81-257
IN THE SUPREME COURT OF THE STATE OF MONTANA
1981

LIFE INSURAXCE COMPANY OF NORTH
AMERICA,
Petitioner and Appellant,

JUDITH ANN EVANS, individually and as
Personal Representative of the Estate
of LORENZO LLOYD EVANS, Deceased.,
Respondent and Respondent.

ORIGINAL PROCEEDING:

Counsel of Record:
For Appellant:

Anderson, Brown, Gerbase, Cebull & Jones, Billings,
Montana

For Respondent:
Douglas & Bostock, Libby, Montana

Submitted on Briefs: July 2, 1981
Decided: November 6, 1981

Filed: h'O\' 6 - 1%?
Mr. J u s t i c e Gene B. D a l y d e l i v e r e d t h e O p i n i o n o f t h e C o u r t .

Honorable R u s s e l l E. Smith , a s e n i o r United S t a t e s
D i s t r i c t J u d g e f o r t h e D i s t r i c t o f Montana, h a s c e r t i f i e d t o

u s a q u e s t i o n of law i n which it a p p e a r s t h e r e a r e s u b s t a n -
t i a l grounds f o r d i f f e r e n c e of opinion, t h e a d j u d i c a t i o n of

which by t h i s C o u r t would m a t e r i a l l y a d v a n c e a d e c i s i o n i n
federal litigation. The f o l l o w i n g q u e s t i o n s w e r e c e r t i f i e d :
Are t h e d e c i s i o n s of law s e t down i n Kingsland v.

Metropolitan Life I n s u r a n c e Co. (1934), 97 Mont. 558, 37
P.2d 3 3 5 , and S u l l i v a n v . Metropolitan L i f e I n s u r a n c e Co.

( 1 9 3 4 ) , 96 Mont. 254, 29 P.2d 1 0 4 6 , s t i l l l a w i n Montana?
If t h e K i n g s l a n d and S u l l i v a n c a s e s s t i l l s t a t e t h e
l a w i n Montana, a r e t h e d i f f e r e n c e s i n t h e l a n g u a g e o f t h e
"exclusions" clauses sufficient to distinguish the policy
involved here from those considered in Kinqsland and

Sullivan?
L o r e n z o Lloyd Evans l i v e d a t a n isolated location,

known a s "Copper C r e e k , " f i f t y m i l e s from Libby, Montana,
and twelve miles f r o m Noxon, Montana. He was a lawyer,

admitted to practice in Montana, with offices in Libby.
Evans k e p t v a r i o u s w i l d a n i m a l s and b i r d s a t h i s p l a c e o n
Copper C r e e k , i n c l u d i n g a n e l e v e n - y e a r - o l d wolf which h e had

r a i s e d from a pup. On t h e m o r n i n g o f J u n e 2 7 , 1 9 7 9 , L l o y d

Evans was f e e d i n g h i s wolf when t h e wolf a t t a c k e d and b i t
him on h i s r i g h t hand and w r i s t . Evans went b a c k t o t h e
h o u s e , wrapped h i s hand w i t h a t o w e l , and s a t down.
Within a period of approximately eight to fifteen
m i n u t e s a f t e r t h e wolf a t t a c k , Evans i n d i c a t e d t o h i s w i f e
t h a t t h e b i t e had p r e c i p i t a t e d a h e a r t a t t a c k and t h a t h e

s h o u l d be d r i v e n t o a h o s p i t a l r i g h t away. Evans walked t o
h i s c a r a n d l a i d down i n t h e b a c k s e a t . H i s w i f e had c a l l e d

a n a m b u l a n c e , and when t h e y had t r a v e l e d a l i t t l e o v e r h a l f

of the distance to Libby, they met the ambulance on the

highway. Evans was transferred to the ambulance where

o x y g e n was a d m i n i s t e r e d t o him, and h i s p u l s e was m o n i t o r e d .

While i n t h e ambulance, and a f t e r a l a p s e o f a p p r o x i m a t e l y

forty-five to sixty minutes following the wolf attack,

Evans' pulse stopped, and he went into cardiac arrest.

Oxygen and C . P . R . were a d m i n i s t e r e d , and Evans showed some

s i g n s of l i f e when the ambulance arrived a t the hospital

emergency room in Libby. Approximately fifteen minutes

a f t e r a r r i v a l a t t h e h o s p i t a l , Lloyd Evans d i e d .

L l o y d Evans had p r e v i o u s l y s u f f e r e d a h e a r t a t t a c k on

April 4, 1979. He was hospitalized at the Veteran's

Administration hospital in Spokane, Washington, for about

three weeks. On A p r i l 25, 1979, h e was g i v e n a regular

d i s c h a r g e and r e t u r n e d t o t h e c a r e of h i s physician, with

t h e recommendation t h a t h e be i n h o u s e r e s t f o r a n o t h e r s i x

weeks and g r a d u a l l y resume h i s p r e h o s p i t a l a c t i v i t i e s .

Medical evidence i n d i c a t e s t h a t the immediate c a u s e

o f Lloyd E v a n s ' d e a t h was h e a r t a t t a c k , but t h a t the heart

a t t a c k was " t r i g g e r e d " by t h e wolf b i t e . The wolf b i t e was

n o t s e v e r e enough, by i t s e l f , t o have caused t h e d e a t h of

Evans.

Lloyd Evans had applied for, and Life Insurance

Company of North America had issued, a certain group

voluntary accidental death and dismemberment insurance

policy, No. OK-2598, in the principal sum of $50,000,

e f f e c t i v e November 1, 1 9 7 2 . The p o l i c y was i n f u l l f o r c e

and effect, according to its terms, on t h e d a t e of Lloyd
Evans' d e a t h . The p o l i c y c o n t a i n e d t h i s l a n g u a g e :

"[The i n s u r e d ] is i n s u r e d . . . asainst loss
r e s u l t i n g d i r e c t l y and independently of a l l
o t h e r c a u s e s f r o m b o d i l y i n j u r i e s c a u s e d by
a c c i d e n t o c c u r r i n g w h i l e t h e p o l i c y is i n
f o r c e a s t o the I n s u r e d , h e r e i n c a l l e d s u c h
injuries.

"EXCLUSIONS

"The p o l i c y d o e s n o t c o v e r l o s s c a u s e d by o r
r e s u l t i n g f r o m a n y o n e o r more o f t h e f o l l o w -
ing :

"(D) I l l n e s s , d i s e a s e . . . bodily infirmity
o r a n y b a c t e r i a l i n f e c t i o n o t h e r t h a n bac-
t e r i a l i n f e c t i o n o c c u r r i n g i n consequence of
a n a c c i d e n t a l c u t o r wound." ( E m p h a s i s sup-
plied.)
The i s s u e h e r e i s w h e t h e r K i n g s l a n d v . Metropolitan

L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 97 Mont. 558, 37 P.2d 3 3 5 , and

S u l l i v a n v . M e t r o p o l i t a n L i f e I n s u r a n c e Co. ( 1 9 3 4 ) , 96 Mont.
254, 29 P.2d 1 0 4 6 , a r e s t i l l law i n t h e S t a t e o f Montana.
A f t e r a review of t h e r u l e s i n t h e s e c a s e s , we a g r e e w i t h
r e s p o n d e n t J u d i t h Evans that the reasoning and rules set

down i n S u l l i v a n and K i n q s l a n d a r e s t r i c t and h a r s h .

In Sullivan, the insured tripped over a piece of
s h e e t m e t a l and f e l l , h i t t i n g h i s head. F i v e d a y s l a t e r he

d i e d of a c e r e b r a l hemorrhage. E v i d e n c e was s u b m i t t e d a t
the t r i a l that the i n s u r e d was s u f f e r i n g from h i g h blood

pressure and arteriosclerosis at the time of the fall.
Evidence a l s o i n d i c a t e d t h a t had a man n o t s u f f e r i n g f r o m
high blood pressure and a r t e r i o s c l e r o s i s t r i p p e d o v e r the
sheet metal, in a l l probability, no h e m o r r h a g e would h a v e
resulted.
The i n s u r a n c e p o l i c y i n S u l l i v a n p r o v i d e d c o v e r a g e i f

the insured sustained "bodily injuries, s o l e l y through
external violent and accidental means, resulting directly
and independently of all other causes." The Court in
S u l l i v a n admitted t h a t a reasonable scope of i n s u r a n c e was

c o n t e m p l a t e d by the policy. Nevertheless, because of the
c l e a r and u n e q u i v o c a l n a t u r e o f t h i s l a n g u a g e i n t h e p o l i c y ,

t h e C o u r t h e l d t h a t t h e r e would be no r e c o v e r y i f ". . . the
i n s u r e d might s u f f e r an a c c i d e n t r e s u l t i n g i n d e a t h t o which
disease or bodily infirmity contributed indirectly or
partially . . ." S u l l i v a n , 29 P.2d a t 1052. Because t h e
i n s u r e d was s u f f e r i n g f r o m a r t e r i o s c l e r o s i s , which c o n t r i -

b u t e d t o and a c t i v e l y c o o p e r a t e d w i t h t h e a c c i d e n t t o c a u s e

t h e i n s u r e d ' s d e a t h , t h e r e was no r e c o v e r y .

I n Kingsland, t h e i n s u r e d had stepped onto a chair
s i t t i n g on a n uneven c e m e n t s u r f a c e ; he l o s t h i s b a l a n c e and
fell head first on the rough cement. The insured died

shortly after the f a l l . The c a u s e o f the insured's death

was d e s c r i b e d a s a r u p t u r e d a n e u r y s m o f t h e a o r t a , p r e c i p i -
t a t e d by t h e f a l l and by s t r i k i n g h i s h e a d on t h e c e m e n t
floor.

The C o u r t i n K i n g s l a n d f i r s t l o o k e d t o t h e l a n g u a g e
of t h e i n s u r a n c e p o l i c y which c o n t a i n e d t h e c o n d i t i o n t h a t

d e a t h must be shown to result "solely through external,

v i o l e n t and a c c i d e n t a l m e a n s . " Kingsland, 3 7 P.2d a t 337.
The C o u r t t h e n r e a s o n e d t h a t t h e t e r m " p r o x i m a t e c a u s e " i s

i n a p t i n t h i s c l a s s of c a s e s b e c a u s e " r e c o v e r y c a n be had
only if death resulted 'solely' (not proximately) from
injuries received through accidental means . I1

Kingsland, 37 P.2d at 337. According to the Court in
Kinqsland, there could be no recovery if the insured's
c o n d i t i o n was a c o n t r i b u t i n g c a u s e of death. If a pre-
e x i s t i n g i n f i r m i t y w e r e shown, r e c o v e r y c o u l d o n l y b e had i f

t h e a c c i d e n t a l i n j u r y was s u f f i c i e n t i n i t s e l f t o c a u s e t h e
d e a t h o f a h e a l t h y man.

The K i n q s l a n d C o u r t r e a s o n e d f u r t h e r t h a t i n S u l l i v a n

the fall a l o n e was n o t s u f f i c i e n t t o c a u s e t h e insured's
d e a t h , and h i s c o n d i t i o n was t h e r e f o r e a c o n t r i b u t i n g c a u s e .

In contrast, b e c a u s e e v i d e n c e showed t h a t t h e f a l l o f the
insured i n K i n g s l a n d was s u f f i c i e n t t o c a u s e t h e d e a t h o f
t h e i n s u r e d , r e c o v e r y was g r a n t e d .
The issue here is whether t h i s Court should still

f o l l o w t h e r u l e s e t down i n K i n g s l a n d and S u l l i v a n t h a t i f a
preexisting condition contributes to an insured's death,

t h e r e c a n be no r e c o v e r y . Given t h e e x t r e m e h a r s h n e s s o f
this rule and the liberal interpretation placed on such

insurance policies in many jurisdictions today, we must

o v e r r u l e t h e K i n g s l a n d and S u l l i v a n c a s e s t o t h e e x t e n t t h a t
they hold t h a t t h e r e c a n b e no r e c o v e r y if a preexisting

disease either directly or indirectly contributes to an

insured's death.
W a r e persuaded t h a t t h e b e t t e r r u l e f o r t h e i n t e r -
e
pretation of such insurance policies is the following:

Where an accidental injury aggravates or triggers a pre-
e x i s t i n g dormant d i s e a s e or p h y s i c a l i n f i r m i t y , t h e a c c i d e n t

may be s a i d t o h a v e b e e n t h e p r o x i m a t e c a u s e o f t h e r e s u l t -
i n g d i s a b i l i t y w i t h i n t h e t e r m s and meaning o f a n o r d i n a r y
accident insurance policy. See, Boring v. Haynes (1972),
209 Kan. 413, 496 P.2d 1385; Carlson v. New York Life
Insurance (1966), 76 Ill.App.2d 187, 222 N.E.2d 363;
McMackin v. Great American Reserve Ins. Co. (1971), 22
Cal.App.3d 428, 99 C a l . R p t r . 227; Nash v . Prudential Ins.
Co. o f America ( 1 9 7 4 ) , 39 Cal.App.3d 5 9 4 , 114 C a l . R p t r . 299;

Brown v. State Mutual Life Insurance Company of America

(La.App. 1 9 7 9 ) , 377 S o . 2 d 355; Zurich Ins. Co. v. Ruscoe

(Miss. 1 9 6 7 ) , 203 S o . 2 d 305; Couey v . N a t i o n a l B e n e f i t L i f e

I n s u r a n c e Company ( 1 9 6 7 ) , 77 N . M . 5 1 2 , 424 P.2d 793. For a

d i s c u s s i o n o f c a s e s on t h i s m a t t e r , s e e 84 A.L.R.2d 176.

The mere p r e s e n c e o f a p r e e x i s t i n g d i s e a s e o r i n f i r -

m i t y w i l l no l o n g e r relieve the insurer from l i a b i l i t y in

this state. R e c o v e r y may be had even though the disease

a p p e a r s t o have a c t u a l l y c o n t r i b u t e d t o t h e c a u s e of d e a t h

a s long a s t h e a c c i d e n t sets i n motion t h e c h a i n of e v e n t s

leading t o death, or if i t is t h e p r i m e o r moving c a u s e .

S e e , B r o o k s v . M e t r o p o l i t a n L i f e I n s . Co. ( 1 9 4 5 ) , 27 C a l . 2 d

305, 1 6 3 P.2d 689; Kater v. United Insurance Company of

America ( 1 9 6 0 ) , 22 I l l . A p p . 2 d 2 2 , 1 6 5 N.E.2d 74.

A mere f r a i l c o n d i t i o n s h o u l d n o t r e l i e v e a n i n s u r e r

from l i a b i l i t y . A s Chief J u s t i c e Cardozo n o t e d i n S i l v e r -

s t e i n v . M e t r o p o l i t a n L i f e Co. ( 1 9 3 0 ) , 254 N . Y . 81, 171 N.E.

914, an insurance p o l i c y is not accepted with t h e thought
that i t s coverage i s t o be r e s t r i c t e d t o a n A p p o l l o o r a
Hercules.

W e agree with t h e following language f r o m Couey v .

N a t i o n a l B e n e f i t L i f e I n s u r a n c e Company, s u p r a , 424 P.2d a t

795:

" I n our view of t h e c a s e , e v e r y i n j u r y o r
d i s e a s e s u f f e r e d by a p e r s o n f r o m h i s b i r t h
t o t h e d a t e of a p a r t i c u l a r i n j u r y c o n t r i -
b u t e s t o some d e g r e e t o t h e c o n d i t i o n t h e n
present. N e c e s s a r i l y , by t h e w o r d s u s e d i n
t h e p o l i c y it c o u l d n o t have been i n t e n d e d
t h a t payment would be d u e o n l y when t h e
a c c i d e n t was l i t e r a l l y t h e s o l e c a u s e o f
hospitalization. I f a p e r s o n had s u f f e r e d a
b r o k e n l e g which had h e a l e d p e r f e c t l y f i v e
y e a r s b e f o r e , and a s e c o n d a c c i d e n t w h e r e i n
t h e l e g had b r o k e n a t t h e same p l a c e , c o u l d
 it be said that the condition resulting from
the first break did not in any way contribute
to the second break? We think the answer is
obvious and, under defendants' theory, plain-
tiff would not be entitled to recover. In our
view, this application of the language of the
policy is entirely too restrictive and would
be unreasonable. Other courts have agreed . .
Likewise, the rulings of Sullivan and Kingsland were too
restrictive, and any rules in these cases must be overruled to
the extent they are inconsistent with this opinion.
Since we have held that Kingsland and Sullivan no
longer state the law in Montana, we need not discuss the second
4
l'

question certified to us.

Justice V

We concur:

? A 4 $ j

Chief Justice
wdw