CR266 Interpretation– definition in policy of “accidental death”.

CR266
Interpretation– definition in policy of “accidental death”.

BACKGROUND

In terms of two separate policy contracts the insured was covered for “accidental death”. In each policy the term “accidental death” was defined but the definitions differed significantly.

The insured had a history of cardio-vascular disease which necessitated bypass surgery a considerable time prior to his death. He thereafter functioned normally in his occupation as a truck driver, however, his condition being controlled by medication. On the day of his death there was a disagreement between him and a co-worker which developed into an assault on the insured. He was punched and fell to the ground and when he got up stones were hurled at him. He again fell to the ground and “..was frothing..”. He was rushed to a doctor but was declared dead on arrival.

The doctor conducting the post-mortem examination noted the cause of death as “acute on chronic heart disease with history of scuffle”. On the “Notification of Death” he stated the immediate cause of death to be “acute on chronic heart disease” and the condition leading to the immediate cause of death as “history of assault”.

DISCUSSION

It was clear from the available information that the heart condition and the assault had both contributed to the death of the insured. It was accepted that the insured would not have died of the assault had he not suffered from the underlying condition, and equally that he would not have died as a result of the underlying condition had he not been assaulted.

The insured lodged a claim under each policy but the insurer declined to pay either.

An accidental death was defined in the one policy as “death resulting directly and independently of all other causes from bodily injury caused solely by external, violent and accidental means…” In the second it was defined as occurring “if death was caused as a result of bodily injury sustained solely by accidental, violent, external, visible and tangible means”.

CONCLUSION

Although the bodily injury was a contributory cause of the death of the insured, it was not the sole cause thereof, the underlying health condition also being a contributory cause. The office could not uphold the claim on the first policy because by its terms the definition had required the accidental death to be the sole cause of death. It upheld the claim on the second policy, however, because its definition did not require that the bodily injury making up the accidental death must be the sole cause of death. In the circumstances, where bodily injury was a significant contributory cause to the injured’s death, the claim was enforceable.

EdB
January 2009

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