Carroll v. CUNA Mut. Ins. Soc., 94SC161

• Decision Date: 24 April 1995
• Docket Number: No. 94SC161,94SC161
• Citation: 894 P.2d 746
• Parties: Lyman CARROLL, Petitioner, v. CUNA MUTUAL INSURANCE SOCIETY, Respondent.
• Court: Colorado Supreme Court

Page 746

894 P.2d 746

Lyman CARROLL, Petitioner, v. CUNA MUTUAL INSURANCE SOCIETY, Respondent.

No. 94SC161.

Supreme Court of Colorado,

En Banc.

April 24, 1995.

Braden, Frindt, Stinar, Stimple & Stageman, L.L.C., Daniel B. Stageman, Colorado Springs, for petitioner.

Sherman & Howard, L.L.C., Leanne B. De Vos, Doran L. Matzke, Denver, for respondent.

Justice LOHR delivered the Opinion of the Court.

We granted certiorari to review the decision of the Colorado Court of Appeals in Carroll v. CUNA Mut. Ins. Society, 876 P.2d 75 (Colo.App.1994). The plaintiff, Lyman Carroll, sought declaratory relief determining that benefits were payable to him as the sole beneficiary under a policy of accidental death insurance issued by the defendant, CUNA Mutual Insurance Society (CUNA), and insuring Mr. Carroll's wife, Marie Carroll. At issue was whether Mrs. Carroll's death, which resulted from a massive intracranial hemorrhage caused in turn by the rupture of a preexisting cerebral aneurysm during sexual intercourse with her husband, was a covered event under the policy. The district court determined that Mrs. Carroll's death was not caused by an accident as required by the policy and entered judgment for CUNA. The court of appeals affirmed on a different rationale, noting that the policy language required not only that death be caused by an accident but also that it must result directly and independently of all other causes. The court of appeals held that the circumstances of Mrs. Carroll's death did not meet this latter requirement because under the court's construction, the requirement is not satisfied "when the injury or death is due, even in part, to a preexisting bodily infirmity." Id. at 76. Although we interpret the relevant language in the policy more narrowly than did the court of appeals, we agree that as properly construed, CUNA's policy does not provide coverage for Mrs. Carroll's death. We therefore affirm the judgment of the court of appeals.

I.

This case arises from Lyman Carroll's claim for insurance benefits under a group accidental death and dismemberment policy issued by CUNA and covering Mr. Carroll's wife, Marie Carroll, as an "Insured Person." The insurance policy provided benefits for "bodily injury caused by an accident occurring while the Group Policy is in force as to the Insured Person and resulting directly and independently of all other causes in loss covered by the Group Policy." Upon review of the circumstances of Mrs. Carroll's death, CUNA refused payment. CUNA asserted that Mrs. Carroll's death was not caused by an "accident" and did not result "directly and independently of all other causes," as required by the terms of the insurance policy. Mr. Carroll then filed the present suit in El Paso County District Court. He requested a declaratory judgment establishing his entitlement to benefits for Mrs. Carroll's death under the terms of the insurance policy. The case was tried to the court without a jury.

The circumstances of Mrs. Carroll's death are taken from the testimony of Mr. Carroll at trial. On March 22, 1990, Marie Carroll was a sixty-seven year old woman of generally good health who suffered from hypertension. ¹ At approximately 9:00 in the evening of March 22, Marie Carroll and her husband began to engage in sexual intercourse. A short time later, as Marie Carroll approached orgasm, she leaned forward and fell to the floor. When Mrs. Carroll was arising from the floor she stated that she felt as if her head had exploded and that it was burning. She told her husband she was suffering from a severe headache.

That night and the next day Mrs. Carroll had trouble verbalizing and continued to feel unwell. Mrs. Carroll, however, went about her regular activities throughout the day. At approximately 9:00 in the evening on March 23, 1990, Mr. Carroll took Mrs. Carroll to the hospital. The attending physician determined that Mrs. Carroll was suffering from a massive hemorrhage in the left side of her brain. Later that evening, Marie Carroll slipped into a coma. The next morning, after examination, Mrs. Carroll was declared brain dead.

Dr. Randall Bjork, a neurologist, testified at the trial regarding the medical causes of Mrs. Carroll's death. He stated that Marie Carroll had died from a massive intracerebral hemorrhage. According to Dr. Bjork, Mrs. Carroll suffered this hemorrhage due to the rupture of an aneurysm ² in her brain. The rupture occurred in part as a result of Marie Carroll's elevated blood pressure during intercourse. Dr. Bjork explained that hemorrhages occurring at the point of orgasm are a known phenomenon in the medical literature and occur at a frequency of approximately one in every 300,000 people each year. Dr. Bjork further testified that the aneurysm probably had been present in Mrs. Carroll's brain for many years prior to the time of the rupture. He described an aneurysm as something like a "powder keg" or "time bomb." Almost anything, including ordinary events such as interviewing a baby-sitter or playing chess, can trigger its rupture. Dr. Bjork also testified that Marie Carroll's existing hypertension could have increased the likelihood that the aneurysm would rupture and the amount of hemorrhage resulting.

After Mr. Carroll had presented his case, CUNA moved for a judgment in its favor on the ground that Mr. Carroll had not proved his case by a preponderance of the evidence. The trial court granted CUNA's motion. The trial court found that Mrs. Carroll suffered from hypertension and an aneurysm in her brain prior to the incident in question. In addition, the trial court found that on the evening of March 22, 1990, during intercourse, Mrs. Carroll sustained elevated blood pressure on top of her existing hypertension. The court further found that the ruptured aneurysm occurred as part of Mrs. Carroll's orgasm and not as a result of her fall. The trial court determined that the rupture of the aneurysm had caused Mrs. Carroll's death and that the rupture could have occurred at any point during normal, reasonable, everyday activity. After noting that the insurance policy did not define the term "accident," the trial court relied on the case of Bobier v. Beneficial Standard Life Ins. Co., 40 Colo.App. 94, 570 P.2d 1094 (1977), for a definition of that term. Bobier interpreted the term "accident" to include situations in which an unusual or unanticipated result flows from a commonplace cause. Id. 570 P.2d at 1096. The trial court found that the circumstances of Mrs. Carroll's death did not constitute an accident. In particular, the trial court held that "the rupture of the aneurysm is a totally separate intervening cause which could have occurred at any time. It does not flow in any sense of the imagination from the commonplace cause of intercourse." Thus, the trial court ruled that Mr. Carroll had failed to meet his burden of proving by a preponderance of the evidence that Mrs. Carroll's death was a covered event under the insurance policy.

Mr. Carroll appealed the trial court's judgment to the Colorado Court of Appeals. The court of appeals affirmed the trial court but did so on the basis of a different rationale. The court of appeals acknowledged that the Bobier definition of accident was controlling and that the definition could encompass the circumstances of the present case. The court of appeals noted, however, that the insurance policy, besides requiring that the injury be caused by an accident, also required that the injury "result directly and independently of all other causes." Carroll, 876 P.2d at 76. The court of appeals held that this requirement precluded coverage "when the injury or death is due, even in part, to a preexisting bodily infirmity." Id. Thus, because Mrs. Carroll's death was caused in part by her preexisting aneurysm and hypertension, the court of appeals held that her death was not caused "directly and independently of all other causes."

Mr. Carroll sought review of the court of appeals' decision by this court. We granted certiorari to determine:

Whether the court of appeals erred in interpreting the clause in an accidental death and dismemberment insurance policy, "directly and independently of all other causes," to preclude coverage for any injury or death that is "due, even in part, to a preexisting bodily infirmity" such as Mrs. Carroll's condition.

We now hold that the court of appeals' construction of the phrase "directly and independently of all other causes" to preclude coverage when the injury or death is due even in part to a preexisting bodily infirmity was unduly narrow. Instead, we conclude that this phrase means that the accident must be the predominant cause of injury in order for the injury to be compensable. Because the trial court's findings establish that Mrs. Carroll's death was predominantly caused by her preexisting aneurysm, we hold that the insurance policy did not cover Mrs. Carroll's death. Therefore, we affirm the court of appeals' judgment but do so by adopting a different construction of the language of the policy.

II.

The accidental death policy that CUNA issued to Mr. Carroll defines a covered "injury" as follows:

Injury means bodily injury caused by an accident occurring while the Group Policy is in force as to the Insured Person and resulting directly and independently of all other causes in loss covered by the Group Policy.

For an injury to be compensable under this policy it must be caused by an accident and result directly and independently of all other causes. We first address whether Mrs. Carroll's injury was caused by an accident. ³

The CUNA policy does not define the term "accident." Relying on the Colorado Court of Appeals' decision in Bobier v. Beneficial Standard Life Ins. Co., 40 Colo.App. 94, 96, 570 P.2d 1094, 1096 (1977), Mr. Carroll maintains that his wife's death was caused by accident because it was an "unusual or unanticipated result [flowing] from a commonplace cause."...