Cranfill v. Aetna Life Ins. Co.

• Decision Date: 09 April 2002
• Docket Number: No. 96,843.,96,843.
• Citation: 49 P.3d 703,2002 OK 26
• Parties: Sandra W. CRANFILL, Surviving Spouse of Cortez L. Cranfill, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, Defendant.
• Court: Oklahoma Supreme Court

49 P.3d 703

2002 OK 26

Sandra W. CRANFILL, Surviving Spouse of Cortez L. Cranfill, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, Defendant.

No. 96,843.

Supreme Court of Oklahoma.

April 9, 2002.

George D. Davis, David A. Walls, Judy A. Walraven, Oklahoma City, Oklahoma, for Plaintiff.

Mark D. Spencer, Sheryl N. Young, Oklahoma City, Oklahoma, for Defendant. BOUDREAU, Justice:

¶ 1 Pursuant to the Uniform Certification of Questions of Law Act, 20 O.S.2001, §§ 1601 et seq., the United States District Court for the Western District of Oklahoma, Ralph G. Thompson, certified the following questions:¹

A. Under Oklahoma law, for purposes of an accidental death and dismemberment insurance policy, is an insured's death "accidental" or is it an "intentionally self-inflicted injury" when the insured intentionally consumes alcohol to a blood alcohol level more than two and one-half times the legal limit for operating a motor vehicle and then dies in a single-vehicle accident caused by the act of drinking and driving?

B. For purposes of coverage under an accidental death and dismemberment insurance policy, does Oklahoma public policy prohibit an insured or the insured's beneficiary from recovering accidental death benefits when the insured intentionally consumes alcohol to a blood alcohol level more than two and one-half times the legal limit for operating a motor vehicle and then dies in a single-vehicle accident caused by the act of drinking and driving?

¶ 2 We briefly recite the undisputed facts to place the certified questions in context. Cortez L. Cranfill was killed in a one-vehicle wreck while he was driving alone in Colorado.² He was driving a pickup truck and hauling a utility trailer from his home in Oklahoma to a cabin in Colorado. The traffic accident report states that about 9:00 p.m. the pickup ran off the right side of the road, overcorrected, ran off the left side of the road, hit a signpost, went airborne and ultimately collided with the ground. Mr. Cranfill was not wearing a seatbelt and was ejected out the back window. Several bottles of liquor were found in the pickup. Some were empty and some had not yet been opened. At the time of his death Mr. Cranfill's blood alcohol level was 254 mg/dL, more than two and one-half times the legal limit of 100 mg/dL for operating a motor vehicle in Colorado. The parties have stipulated that Mr. Cranfill's consumption of alcohol while driving the pickup resulted in his death.

¶ 3 Mr. Cranfill's surviving spouse, Sandra W. Cranfill, seeks insurance benefits for the death of her husband pursuant to an accidental death policy issued by the Oklahoma Conference of the United Methodist Church and underwritten by defendant Aetna Life Insurance Company (Aetna).³ The policy provides coverage for loss of life as a result of bodily injury suffered in an "accident." The policy excludes coverage for losses caused or contributed to by "intentionally self-inflicted injury." The policy does not define either "accident" or "intentionally self-inflicted injury." The policy does not contain an exclusion for a loss which occurs "while intoxicated" or "as a result of intoxication" or any similar exclusion relating to the use of alcohol.

¶ 4 After Aetna denied Mrs. Cranfill's claim on the grounds that Mr. Cranfill's death was not the result of an "accident" and/or was "intentionally self-inflicted," Mrs. Cranfill sued Aetna for breach of contract. The federal district court certified two questions to us concerning Oklahoma insurance law.

¶ 5 Oklahoma law governing insurance coverage disputes is well-established. The foremost principle is that an insurance policy is a contract. Parties are at liberty to contract for insurance to cover such risks as they see fit and they are bound by terms of the contract. Wiley v. Travelers Ins. Co., 1974 OK 147, 534 P.2d 1293, 1295. It necessarily follows that courts are not at liberty to rewrite the terms of an insurance contract. Id. When addressing a dispute concerning the language of an insurance policy our first step is to determine as a matter of law whether the policy language at issue is ambiguous. Wynn v. Avemco Ins. Co., 1998 OK 75, ¶ 17, 963 P.2d 572, 575. If it is not ambiguous, we accept the language in its plain, ordinary and popular sense. McDonald v. Schreiner, 2001 OK 58, ¶ 7, 28 P.3d 574, 577. If the language is ambiguous, we apply well-settled rules of construction to determine the meaning of the ambiguous language: we construe the policy to give a reasonable effect to all of its provisions, Wynn v. Avemco Ins. Co., 1998 OK 75, ¶ 16, 963 P.2d 572, 575, and we liberally construe words of inclusion in favor of the insured and strictly construe words of exclusion against the insurer. McDonald v. Schreiner, 2001 OK 58, ¶ 7 n. 11, 28 P.3d 574, 577 n. 11.

I. ACCIDENT AND/OR INTENTIONALLY SELF-INFLICTED INJURY

¶ 6 The policy provides coverage for loss of life as a result of bodily injury suffered in an accident but excludes coverage for intentionally self-inflicted injuries.

¶ 7 Mrs. Cranfill argues the word accident is ambiguous and must be construed against Aetna. Aetna argues the word accident is not ambiguous. Whether policy language is ambiguous is a question of law. Wynn v. Avemco Ins. Co., 1998 OK 75, ¶ 17, 963 P.2d 572, 575. The absence of an express definition of a word within the policy does not necessarily render the word ambiguous. Similarly, the fact that a word cannot be precisely defined to make clear its application in every factual situation does not mean the word is ambiguous. See, e.g, Allstate v. Humphrey, 246 Md. 492, 229 A.2d 70 (1967). Rather, the test to be applied in determining whether a word is ambiguous is whether the word "is susceptible to two interpretations" on its face. Littlefield v. State Farm Fire and Cas. Co., 1993 OK 102, 857 P.2d 65, 69.

¶ 8 This test for ambiguity is applied from the standpoint of a reasonably prudent lay person, not from that of a lawyer. Couch on Insurance 3d § 21:14 (1995). In our view the word accident is not, on its face, susceptible to two interpretations. A reasonably prudent lay person applying for accidental death insurance would understand what an accident is. Accordingly, we conclude the word accident as used in the policy is not ambiguous. Having made this determination, we must accept the word in its plain, ordinary and popular sense. Mc-Donald v. Schreiner, 2001 OK 58, ¶ 7, 28 P.3d 574, 577.

¶ 9 In Willard v. Kelley, 1990 OK 127, 803 P.2d 1124, 1128-29, we described an accident as an event that is "unexpected, unintended and unforeseen in the eyes of the insured" and said that the standard to be used is that of a reasonable person appraising the event from the insured's perspective. Aetna, relying on this language in Willard, argues that since Mr. Cranfill's death was a reasonably foreseeable consequence of his driving while intoxicated, his death was not accidental.

¶ 10 We reject this argument. In the context of life and accident insurance, contract terms are not analyzed under the tort principle of foreseeability. Otherwise, deaths resulting from almost any high-risk driving activity would be excluded from coverage under an accident insurance policy (e.g., driving at an excessive speed, failing to keep a proper lookout, failing to maintain brakes in good condition, changing lanes without using a proper turn signal, floating a stop sign). If one applied tort principles, death from such high-risk activity could be said to be reasonably foreseeable.

¶ 11 Foreseeability has a more specific meaning in the context of life and accident insurance. It is only when the consequences of the act are so natural and probable as to be expected by any reasonable person that the result can be said to be so foreseeable as not to be accidental. See Mid-Continent Life Ins. Co. v. Davis, 1935 OK 1019, 51 P.2d 319 Syllabus by the Court ¶ 1 ("Death of the insured is `accidental' within policy where it is unexpected and not [the] probable result of his conduct."). The mere fact that an insured's death may have resulted from his or her own negligence, or even gross negligence, does not prevent that death from being accidental under the plain meaning of the word accident. Id. Syllabus by the Court ¶ 2.

¶ 12 Aetna asserts there is a split of authorities on this issue and further asserts that the majority of jurisdictions, as well as the more recent decisions, support its denial of Mrs. Cranfill's claim. As it turns out, the split is between the federal courts on one hand and state courts on the other. Aetna urges us to adopt the federal rationale that is used to resolve insurance disputes that are governed by ERISA.⁴ We decline to do so for two reasons. First, federal courts are entirely free to choose the meaning that is to be given to the critical terms in contest (i.e., the word "accident" and the phrase "intentionally self-inflicted injury").⁵ We, in contrast, are bound by Oklahoma's common-law jurisprudence. Second, in most ERISA cases, the federal courts must affirm the denial of benefits unless the decision to deny benefits was arbitrary and capricious.⁶ We are not persuaded by the federal scheme. Instead, we are persuaded by the reasoning of other state courts which have overwhelmingly held that an insured's death, in circumstances similar to the circumstances of this case, is accidental and is not intentionally self-inflicted.⁷

¶ 13 Separate and apart from the issue of whether Mr. Cranfill's death is covered as an accidental death is whether it is excluded as an intentionally self-inflicted injury. Again, we do not view the phrase as susceptible to two interpretations on its face and therefore we conclude the phrase is not ambiguous.

¶ 14 Aetna argues that an intentionally self-inflicted death is any death that is the natural and probable consequence of an intentional act.⁸ Stated another way, Aetna's argument is that a court may infer an insured's intent to inflict...