Pilcher v. New York Life Insurance

Opinion

On July 12, 1968, the defendant issued a policy of life insurance to Phillip R. Pilcher, plaintiff’s husband, insuring his life in the amount of $10,000. The policy included a provision for the payment of an additional $10,000 if “the insured’s death resulted directly, and independently of all other causes, from accidental bodily injury. . . .” The plaintiff and the children born of the marriage were the beneficiaries of the policy.

On April 9, 1970, while the policy was in effect, the insured died as a result of a self-administered overdose of heroin which caused acute heroin intoxication. His body was found at about 6:45 p.m. in the toilet stall of a service station rest room.

A postmortem examination report indicated there were many fresh venipunctures, and old ones too, of both antecubital spaces, wrists and hands. The visual examination of the vital organs, heart, gastro-intestinal tract, liver, spleen, genito-urinary tract, adrenals and pancreas, were all normal.

The death certificate described the cause of death as acute heroin intoxication with the explanation, “Decedent attempting narcotic assistance thru body veins, accidentally over-dosed, expired from accidental reasons.”

Plaintiff properly notified the defendant of the insured’s death and the defendant paid the face amount of the policy but refused to pay accidental

In our analysis of the issues of this case we are compelled to bear in mind an elementary concept generally applicable to the interpretation of rights under an insurance contract; An insurance policy is a form of contract and while it must be construed the same way as any other con- t tract, giving reasonable and fair attention to the object and intention of the i parties, it shall be liberally construed in favor of the insured. (Southwestern Funding Corp. v. Motors Ins. Corp., 59 Cal.2d 91 [28 Cal.Rptr. , 161, 378 P.2d 361 ].) The policy is drawn by the insurer and it must use j such language as to make the contract clear to the ordinary mind and the ' language will be deemed to be used in the most inclusive sense. (Ensign v. Pacific Mut. Life Ins. Co., 47 Cal.2d 884 [ 306 P.2d 488 ].) In addition, we shall bear in mind that the words “accident” and “accidental” have never acquired any technical meaning in the law and must be construed according to ordinary understanding and common usage. (Richards v. Travelers Ins. Co., 89 Cal. 170 [ 26 P. 762 ].) Webster’s Second Unabridged Dictionary defines it as follows: “An event which takes place without one’s foresight or expectation; an undesigned, sudden and unexpected event . . . .”

It is variously defined in law but with the same general language. In Zuckerman v. Underwriters at Lloyd’s, 42 Cal.2d 460 , 473 [ 267 P.2d 777 ], accident is defined as “ ‘a casualty—something out of the usual course of events and which happens suddenly and unexpectedly and without any design of the person injured.’ ”

The policy, subject of this action, contains the following provision: “Subject to the terms and conditions of the policy and these Accidental Death Benefit provisions, the Company will pay the Accidental Death Benefit, as a part of the policy’s death benefit proceeds, upon receipt of due proof that the Insured’s death resulted directly, and independently of all other causes, from accidental bodily injury . . . .”

We note in passing that some jurisdictions have followed the suggestion of Justice Cardozo in his dissenting opinion in Landress, supra, and repudiated .that distinction between accidental means and accidental death or results and, in spite of the restrictive language, have held the insurer liable where either the means or the result is accidental. (Mansbacher v. Prudential Ins. Co. of America, 273 N.Y. 140 [ 7 N.E.2d 18 , 111 A.L.R. 618 ] —unintentional overdose of veronal; Morgan v. Indemnity Ins. Co. of North America, 302 N.Y. 435 [ 99 N.E.2d 228 ]—amytal (barbiturate) poisoning. ) Even when applying the means test, however, the courts nevertheless have held consistently that where the voluntary action consisted of an unintentional overdose of drugs, the resulting death occurred by an accidental means. (Dezell v. Fidelity & Casualty Co., 176 Mo. 253 [ 75 S.W. 1102 ]— morphine; Hawkins v. New York Life Ins. Co. of New York, N.Y., 176 Kan. 24 [ 269 P.2d 389 ]—barbiturates; Feldmann v. Connecticut Mut. Life Ins. Co., etc., 142 F.2d 628 —nembutal; Mansbacher v. Prudential Ins. Co. of America, supra, 273 N.Y. 140 —veronal.) The cases on this subject are collected in 52 A.L.R.2d 1083 .

In two of the leading cases which were required by the law of their state to follow the “means” test and found no liability, the courts said there was no accident because a normal or usual dosage of the drug was taken, and the dicta indicates it would rule otherwise if there were an unusual or over-dosage of the drug. (Glaeser v. Prudential Ins. Co. of America, 57 F.Supp. 198 , 200 [applying California law]; Aubuchon v. Metropolitan Life Ins. Co., 142 F.2d 20 , 26.) In the Aubuchon case the court said: “If the circumstances can be said to be such as reasonably to permit of an inference that by some mischance, slip or mishap he took a greater quantity than he intended or realized, then his death might properly be found to be one from accidental means.”

It is apparent that if there is a case of an unintended overdose of a drug, even using the “means” test, this court undoubtedly would be compelled to find there was an accidental death. The fact is, however, that this more difficult determination has been obviated by the terms of the policy we have before us. If we do as the ordinary person might do, and as the courts generally have done, substitute the words “unintentional and unexpected” for the word “accident,” we need only determine that the death resulted directly and independently of all other causes from an unintentional and unexpected injury. The nature of the means causing the injury is not at issue.

We have a limited amount of evidence available to us. The death certificate is prima facie evidence of the facts contained in it. (Health & Saf. Code, § 10577.) The certificate verifies for us certain facts, namely, Pilcher died of acute heroin intoxication as a result of a self-administered overdose of heroin. The postmortem report which went into evidence without objection, indicates no abnormal condition of the vital organs, ruling out their deterioration from long or repeated use of drugs as a possible factor in the death.

The trial court said in reading the death certificate it would substitute “not intended” for “accidental” as it referred to the overdose. Intention is a state of mind, however, and would normally be considered a conclusion. It is not a “fact” within the meaning of section 10577 which can be reported by a medical officer, but there is other uncontradicted evidence of the unintentional nature of the acts which cannot be ignored and which binds the court to reach the same conclusion.

All of this uncontradicted evidence without anything being offered by the defendant leads one inescapably to the conclusion that the decedent was just getting another “fix” to satisfy his addiction to the drug, and that the overdose was unexpected, undesigned and certainly unintentional. Very obviously he intended the act of administering the drug but he did not intend the overdose or the resultant death.

There were no other contributing causes of death suggested by the evidence or by counsel, so we must conclude his death came as a result, directly and independently of all other causes, from accidental bodily injury occasioned by acute heroin intoxication when the overdose of heroin was unintenionally self-administered.

We find no authority to suggest we should refuse to enforce an insurance contract on the theory that the use of narcotics should be deterred and that allowing recovery is against public policy.

We have read the case cited by the respondent (Republic National Life Insurance Co. v. Hamilton (Tex.Civ.App.) 373 S.W.2d 275 ), which involved a double indemnity provision of a life insurance policy similar to this and a death resulting from the use of heroin. In that case, however, there was an additional factor, the deceased remained in a closed car having a 148° temperature and limited oxygen. The testimony did not establish an overdose of drugs was used; also it was made clear by expert medical testimony that the heroin alone was not sufficient to cause death. The Texas court, while it expounded at length on the evils of heroin by way of dicta and indicated that the death from heroin “would not be the

Brown (Gerald), P. J., and Ault, J., concurred.

A petition for a rehearing was denied June 2, 1972.