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