Beneficial Standard Life Insurance v. Usalavage
Beneficial Standard Life Insurance v. Usalavage
Dissenting Opinion
dissenting.
The judicial construction of insuring and exclusionary clauses in policies of insurance has long troubled the courts of this state. No part of this problem has been more troubling than the interpretation of accidental death clauses when the insured had a preexisting infirmity which might have caused or contributed to the death. The cases dealing with this issue seem to turn upon the language of the policies and the wording of the clauses. Pippin v. Mutual Life Ins. Co.,
The language in the policy sub judice insures against death "resulting directly and independently of all other causes” other than accident. While this language is exactly like that interpreted in Monroe, the Hall case notes there is no difference in the construction of policy language which purports to compensate death by accident "independently of all other causes” and that which limits recovery for death due "solely and exclusively” from accident. Hall, supra, p. 74. It appears to me that this case requires this court to choose between two fundamentally differing interpretations of accidental death clauses, as evidenced by the Hall and Monroe cases when the insured suffered from a pre-existing disease,. Hall on the one hand stands for the proposition that in
There was ample evidence on which the court, hearing the matter without a jury, could decide the issue of proximate cause in favor of the insured’s beneficiary, although the evidence as a whole also requires a finding that the pre-existing physical infirmity was a contributing factor in her death. Because I believe that Monroe should be overturned and that Hall should be followed whereas the majority believes that Monroe is to be preferred to Hall, I must respectfully dissent.
Dissenting Opinion
dissenting.
Samuel Holcombe and his wife were insured against accidental death in a policy written by Allstate Insurance Company, if insured sustained an injury while occupying a private passenger automobile. Ms. Usalavage (her
On June 8, 1971, she was injured in an automobile incident in a parking lot when the steering wheel of the automobile driven by her came off, the automobile hit a curve and ran down an incline. She injured her abdomen, but refused to go to the hospital. Instead she went home and went to bed. The next day her abdomen was considerably swollen but she still refused to go to the hospital. Her sister who was a practical nurse came to take care of her. The next night her abdomen was still swollen and her family doctor was called who tried to get her to go to the hospital, but she refused. She never got out of bed, began hemorrhaging on June 17, and died on June 18, 1971, at DeKalb General Hospital.
Proof of loss and claim was made, and the insurer refused to pay. Samuel L. Holcombe, as beneficiary, sued to collect on the policy. Ms. Usalavage likewise filed suit.
The lower court denied a motion for summary judgment by the defendant, which ruling was affirmed and is fully reported in Allstate Ins. Co. v. Holcombe, 132 Ga. App. 111 (207 SE2d 537). In a whole court decision, voting 7 to 2, this court held a fact question remained, whether the deceased died as a result of the accidental injury received in the automobile incident 8 days before her death although the death certificate stated that the deceased died from infarction of the lower bowel due to marked arteriosclerosis.
The cases were tried before the court without a jury resulting in judgments for the plaintiffs. Defendants appeal.
1. The court found as a matter of fact that the deceased sustained an injury in her abdominal region on June 8, 1971; that she complained of pain, refused hospitalization; was cared for by a nurse; and did not recover, but remained in bed until her death. The court also found that'the immediate cause of her death was an infarction of the lower bowel; that there was opinion testimony that such an injury as the deceased received
2. The conclusion of law by the court in both cases was that the defendant is liable under the terms of the policy, the claim is liquidated, and plaintiff is entitled to judgment.
3. As stated in Allstate Ins. Co. v. Holcombe, 132 Ga. App. 111, 115 (3), supra, (the testimony being almost identical to that submitted to the trial judge as was presented on summary judgment) the evidence was sufficient to show that the infarction of the bowel was caused by and immediately followed the abdominal injury sustained by the deceased in the automobile incident and "was caused directly and independently of all other causes by the accidental injury received.” Inferences clearly arise that when the steering wheel came off, there was injury to her abdomen. As further stated at page 115 of that opinion, there was testimony to rebut the presumption created by the death certificate that the infarction was caused by the existing arteriosclerosis.
4. Based upon all of the evidence heard by the court since the evidence did not demand a finding for the defendants (as stated in Allstate Ins. Co. v. Holcombe, 132 Ga. App. 111, supra), there was evidence to authorize findings and conclusions of law as found by the lower court in the Holcombe case (No. 50848) as well as the Usalavage (No. 50693) case.
In view of all of the foregoing, I respectfully dissent from the majority opinion, feeling that the trial judge was correct in holding the plaintiffs were entitled to recover.
Opinion of the Court
The facts of these cases are to be found in Allstate Ins. Co. v. Holcombe, 132 Ga. App. 111 (207 SE2d 537) in which this court affirmed the denial of summary judgment to the defendant insurer. Although the beneficiaries and the insurance companies differ, each case involves substantially identical accidental death benefit clauses in plaintiffs’ insurance policies. The controlling clause in each policy provides for death benefits resulting from accidental bodily injury, "directly and independently of all other causes. ”
The trial judge made the following finding of fact: "The court, therefore, from all the facts and circumstances, finds that the injury received by the deceased on June 8th, 1971, did contribute to the infarction of the small bowel and to her death on June 17th, 1971.” (Emphasis supplied.) The trial judge made the following conclusion of law: "The plaintiff’s wife having received an injury to her person arising out of the use of an automobile which contributed to her death, the defendant is liable under the terms of the policy.” (Emphasis supplied.)
The trial judge’s finding of fact and conclusion of law, quoted above (made pursuant to Code Ann. § 81A-152 (a) (Ga. L. 1969, pp. 645, 646; 1970, pp. 170, 171) (made applicable to the State Court of DeKalb County by Code Ann. § 24-2107a (Ga. L. 1970, pp. 679, 681)), are in irreconcilable conflict. In policies such as those in the present cases, covering death resulting directly and independently of all causes other than the injury itself, the plaintiff has the burden of proof that the alleged injury was the proximate cause of the death of the
When a judge presides as trier of fact, pursuant to Code Ann. § 81A-152 (a), supra, he must make written findings of fact and conclusions of law. Except in cases of special verdicts, this is not required of the jury. Its verdict speaks its finding of fact and is upheld where there is any competent evidence to support it.
The trial judge heard the case without a jury. In his findings of fact and conclusions of law, quoted above, he found as a matter of fact, only an injury which "did contribute to the infarction of the small bowel and to her death on June 17, 1971” (R.16), but concluded that by reason of such findings, "the defendant is liable under the terms of the policy.” (Emphasis supplied.) Thus, the trial judge has found as a matter of fact in each case an injury which contributed to the insured’s death, whereas the insurance policy requires that death result from accidental bodily injury "directly and independently of all other causes.” (Emphasis supplied.) Since the conclusion of law must be based on the finding of fact, it is inescapable that coverage cannot be held to exist in this
50693,
50848,
The judgment of the State Court of DeKalb County is reversed with direction that the conclusions of law and judgments in each of the above cases be amended in conformity with the findings of fact previously made.
Judgment reversed.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.