Scribd Logo
Upload

Welcome to Scribd!

  • 33 views

    Patrick S. Hensley and Charles E. Hensley v. Life Insurance Company of North America, 551 F.2d 35, 3rd Cir. (1977)

    Uploaded by

    Scribd Government Docs
    The court reversed a lower court's summary judgment ruling in favor of an insurer in a dispute over accidental death benefits. The lower court found that although the insured died from accidental gunshot wounds while alighting from a vehicle, as specified in the policy, there was no causal connection between the death and use of the vehicle. The appellate court found that the plain language of the policy did not require a causal connection, as it was a casualty policy rather than a liability policy, and the accidental death occurred during the specified hazard period. It remanded the case for entry of judgment in favor of the beneficiaries. The dissent argued that the specific hazard referred to the activity (alighting) rather than the injury, and thus a causal connection was

    Copyright:

    Public Domain
    Download as PDF or read online from Scribd

    Patrick S. Hensley and Charles E. Hensley v. Life Insurance Company of North America, 551 F.2d 35, 3rd Cir. (1977)

    Uploaded by

    Scribd Government Docs
    33 views5 pages
    The court reversed a lower court's summary judgment ruling in favor of an insurer in a dispute over accidental death benefits. The lower court found that although the insured died from accidental gunshot wounds while alighting from a vehicle, as specified in the policy, there was no causal connection between the death and use of the vehicle. The appellate court found that the plain language of the policy did not require a causal connection, as it was a casualty policy rather than a liability policy, and the accidental death occurred during the specified hazard period. It remanded the case for entry of judgment in favor of the beneficiaries. The dissent argued that the specific hazard referred to the activity (alighting) rather than the injury, and thus a causal connection was

    Original Description:

    Filed: 1977-03-04 Precedential Status: Precedential Citations: 551 F.2d 35 Docket: 76-2007

    Copyright

    © Public Domain

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The court reversed a lower court's summary judgment ruling in favor of an insurer in a dispute over accidental death benefits. The lower court found that although the insured died from accidental gunshot wounds while alighting from a vehicle, as specified in the policy, there was no causal connection between the death and use of the vehicle. The appellate court found that the plain language of the policy did not require a causal connection, as it was a casualty policy rather than a liability policy, and the accidental death occurred during the specified hazard period. It remanded the case for entry of judgment in favor of the beneficiaries. The dissent argued that the specific hazard referred to the activity (alighting) rather than the injury, and thus a causal connection was

    Copyright:

    Public Domain
    Download as PDF or read online from Scribd
    Download as pdf
    33 views5 pages

    Patrick S. Hensley and Charles E. Hensley v. Life Insurance Company of North America, 551 F.2d 35, 3rd Cir. (1977)

    Uploaded by

    Scribd Government Docs
    The court reversed a lower court's summary judgment ruling in favor of an insurer in a dispute over accidental death benefits. The lower court found that although the insured died from accidental gunshot wounds while alighting from a vehicle, as specified in the policy, there was no causal connection between the death and use of the vehicle. The appellate court found that the plain language of the policy did not require a causal connection, as it was a casualty policy rather than a liability policy, and the accidental death occurred during the specified hazard period. It remanded the case for entry of judgment in favor of the beneficiaries. The dissent argued that the specific hazard referred to the activity (alighting) rather than the injury, and thus a causal connection was

    Copyright:

    Public Domain
    Download as PDF or read online from Scribd
    Download as pdf
    of 5

    551 F.

    2d 35

    Patrick S. HENSLEY and Charles E. Hensley, Appellants,


    v.
    LIFE INSURANCE COMPANY OF NORTH AMERICA.
    No. 76-2007.

    United States Court of Appeals,


    Third Circuit.
    Argued Dec. 9, 1976.
    Decided March 4, 1977.

    Joseph L. Costello, Bryant, Costello, Burke & Scott, Christiansted, St.


    Croix, U.S., V. I., for appellants.
    James R. Coleman, James L. Hymes, III, Grunert, Stout, Hymes & Mayer,
    Charlotte Amalie, St. Thomas, V. I., for appellee.
    Before SEITZ, Chief Judge, and GIBBONS and HUNTER, Circuit
    Judges.
    OPINION OF THE COURT
    GIBBONS, Circuit Judge.

    In this suit to recover the death benefits provided in a specified hazards


    accident insurance policy the plaintiffs Patrick and Charles Hensley appeal
    from a summary judgment for the insurer. Plaintiffs are the children of the
    deceased insured and are the named beneficiaries of the policy. Judgment was
    granted below on the ground that the death was not within the coverage of the
    policy.

    The policy of insurance is divided into two parts. Part I is captioned "Insuring
    Agreement," and Part II is captioned "Provisions." The relevant part for
    purposes of decision is Part I, set forth in pertinent part in the margin.1

    The beneficiaries contend that the decedent suffered an accidental death while
    alighting from an automobile. It is undisputed that decedent was killed by a

    shotgun blast as or shortly after she stepped from the passenger seat of an
    automobile driven by her husband. One of her children was the assailant, and he
    also killed her husband. The facts were established by requests for admission,
    and both sides moved for summary judgment. The insurer contended (1) that
    the shooting did not take place while the decedent was alighting from the
    automobile, but thereafter, and (2) that the accidental death was not within the
    specified hazards. The insurer conceded that the shooting resulted in an
    accidental death.2 The district court concluded that on the undisputed facts the
    decedent was alighting from the car when she was shot. Nevertheless the court
    granted summary judgment for the insurer on the ground that the accidental
    death was not within the specific hazards insured against. The court reasoned
    that the language of the specific hazards clause required some causal nexus
    between the accidental death and the use of the vehicle.
    4

    Certainly the plain language of the policy does not require this reading. The
    insured event, which in this case is conceded, is an accidental death. That event
    is insured against "only while the Insured is . . . alighting from, any . . . land
    conveyance." The event took place while the insured was alighting from such a
    vehicle. Moreover when the insurer intended to exclude some accidental deaths
    which might otherwise have been covered by the insuring agreement it chose
    perfectly appropriate language: "shall not cover loss caused by or resulting
    from" specified activities or hazards. The distinction in language between the
    two clauses, in a casualty policy as distinguished from a liability policy, was
    obviously intentional. Purchasers of casualty insurance, including life insurance,
    expect that if the insured event occurs within the time and at the place of
    coverage they will be paid. They do not expect to have to litigate any nexus or
    causal connection between the insured event and the activities of third persons.

    A leading authority on the law of insurance describes the difference in the two
    forms of coverage:

    6 the modern automobile liability policy, the insurer usually agrees to pay, on
    In
    behalf of the insured and within specified limits, all sums which the insured shall
    become legally obligated to pay as damages because of personal injury to or death of
    any person, or because of injury to or the destruction of property caused by accident
    and arising out of the ownership, maintenance, or use of the vehicle or vehicles
    insured. . . .
    7
    Liability
    policies may also provide for medical payments caused by accident to a
    person injured "while alighting from or entering" the insured vehicle or while "in or
    on" or "in or upon" the vehicle; such payments, however, do not depend upon the
    liability of the insured for the accident and accordingly may more properly be

    characterized as accident insurance rather than liability insurance.


    812 Couch on Insurance 2d, 45:27, p. 125 (1962) (footnote omitted).
    9

    Another volume of the same work deals with accident and health insurance.
    There the author writes:

    10

    An automobile accident policy covering death sustained by accidental means


    by the insured "while driving, riding in or on an automobile" insures against all
    accidental injury occurring during the period covered and is not confined to
    risks arising out of and incident to the operation of an automobile. Accordingly,
    injuries received by being accidentally shot while seated at the wheel of an
    automobile being used to transport hunters are the "result of operating or riding
    in an automobile."20 Likewise, the fact that the automobile had come to a stop
    at the end of the journey and the insured, in preparation for leaving the car, was
    then shot by the accidental discharge of a pistol which she was taking out of the
    glove compartment did not take the accident out of the coverage of such a
    policy.1

    11US: Provident L & A Ins. Co. v. Nitsch (C.A. 5 Tex.) 123 F.2d 600, 138 A.L.R.
    1.
    399.
    12 Tex: Dorsey v. Fidelity U. Cas. Co. (Tex.Civ.App.) 52 S.W.2d 775, error
    20.
    dismissed.
    13

    10 Couch on Insurance 2d, 41:286 (1962) (footnote 19 omitted). See also


    Harper v. Mutual of Omaha, 232 So.2d 96 (La.App.), writ refused, 233 So.2d
    562 (La.1970).

    14

    The failure of the district court to observe this distinction between casualty
    insurance and liability insurance led it, in construing the policy, to rely upon
    authorities in other jurisdictions, all of which dealt with the scope of the duty to
    defend or indemnify under an automobile liability insurance policy.3 The long
    and the short of it is that the district court treated a time and place accidental
    death policy as if it were an automobile liability policy.

    15

    The insurer urges that the language in the opening clause of the insuring
    agreement, "arising out of the specific hazards named in page 2 hereof" should
    be read as if it said "arising out of driving in or alighting from an automobile."
    But the specific hazard named on page 2 is injury while the insured is
    alighting. We are not free to rewrite the policy in the insurer's interest. Indeed

    the rule of construction is to the contrary. The insurer's choice of language


    should be construed liberally in favor of coverage.
    16

    The judgment appealed from will be reversed and the case remanded to the
    district court for the entry of a judgment for the plaintiffs.

    17

    SEITZ, Chief Judge, dissenting.

    18

    The contract states that the company only insures against loss which arises out
    of the enumerated "specific hazards." The problem is what the phrase "specific
    hazards" means. If the specific hazard here is injury while alighting from an
    automobile, the insurance company must be held liable, since Mrs. Hensley's
    death arose from injuries she sustained while alighting from an automobile. On
    the other hand, if the specific hazard is alighting from an automobile, plaintiffs
    may not recover, since they have not demonstrated that their mother's death
    stemmed from the fact that she was alighting from an automobile.

    19

    The word "hazard" itself offers little assistance, since it can mean either the risk
    created by an activity here the risk is injury while alighting or the activity
    which creates the risk alighting. Webster's New International Dictionary (3d
    ed.1968). However, the contract read as a whole gives evidence that the insured
    should expect coverage only against risks created by virtue of the fact that he
    engages in activities such as alighting from an automobile.

    20

    The contract says that the company insures against "loss . . . resulting . . . from
    bodily injuries . . . arising out of the specific hazards named . . ." If the specific
    hazard here were injury while alighting, the company would be deemed to
    insure against "loss . . . resulting . . . from bodily injuries . . . arising out of"
    injury while alighting. This reading of the contract, with its recapitulation of the
    word "injury", strains common sense. On the other hand, it makes perfect sense
    for the company to state that it will provide insurance against "loss . . . resulting
    . . . from bodily injuries . . . arising out of" alighting from an automobile.

    21

    The majority emphasize the fact that this is a casualty policy, and not a liability
    policy. But while a requirement of causal connection may be standard with
    liability policies, it is not out of place in the area of casualty insurance. A
    purchaser of insurance might very well want to insure only against such risk of
    accident as is created by virtue of engaging in a particular activity.

    22

    The majority also rely on the rule that insurance contracts, where ambiguous,
    are to be construed against the insurer. This rule, however, does not relieve the

    courts from giving a reasonable construction to insurance agreements.

    A.

    (S)ubject to all the exclusions, provisions and other terms of this policy, the
    Company hereby insures the person named above (herein called the Insured)
    against loss indicated as covered in the following Schedule of Coverages
    resulting directly and independently of all other causes from bodily injuries
    (herein called "such injuries") caused by accident occurring during the term of
    this policy and arising out of the specific hazards named in page 2 hereof
    Coverage
    Accidental Loss of Life
    *

    1.

    2.

    Amount
    Principal Sum
    $50,000.00
    *
    *
    CONVEYANCE HAZARDS

    Premium
    $62.50
    * *

    Specific Hazards
    The insurance afforded with respect to such injuries
    applies only while the Insured is
    (a) . . . alighting from, any land . . . conveyance
    *
    *
    *
    *
    *
    * *
    Exclusions
    The insurance afforded with respect to the hazards
    described above shall not cover loss caused by or
    resulting from (specified activities or hazards, none of which
    are applicable to this case).

    It is well established that an intentional shooting which occurs without fault of


    the insured is an accident within the meaning of an accident and health policy.
    10 Couch on Insurance 2d 41:13, 41:35 (1962)

    The Court referred to Westchester Fire Ins. Co. v. Continental Ins. Co., 126
    N.J.Super. 29, 312 A.2d 664 (1973); Ins. Co. of North America v. Royal
    Indemnity Co., 429 F.2d 1014 (6th Cir.1970); Wirth v. Maryland Cas. Ins. Co.,
    368 F.Supp. 789 (W.D.Ky.1973); Mason v. Celina Mut. Ins. Co., 161 Colo.
    442, 423 P.2d 24 (1967); United States Fidelity & Guaranty Co. v. Western
    Fire Ins. Co., 450 S.W.2d 491 (Ky.1970); Indiana Lumbermens Mut. Ins. Co.
    v. Statesmen Ins. Co., 291 N.E.2d 897 (Ind.1973). But see, e.g., Fidelity &
    Casualty Co. of New York v. Lott, 273 F.2d 500 (5th Cir.1960); Red Ball
    Motor Freight v. Employees Mut. Liab. Ins. Co., 189 F.2d 374 (5th Cir.1951);
    Allstate Ins. Co. v. Valdez, 190 F.Supp. 893 (E.D.Mich.1961)

    You might also like