Love v. American Casualty Co. of Reading, Pennsylvania

• Decision Date: 05 July 1962
• Docket Number: No. 16866.,16866.
• Parties: Frances F. LOVE et al., Appellants, v. AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, Appellee.
• Court: U.S. Court of Appeals — District of Columbia Circuit

113 US App. DC 195, 306 F.2d 802 (1962)

Frances F. LOVE et al., Appellants, v. AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, Appellee.

No. 16866.

United States Court of Appeals District of Columbia Circuit.

Argued May 16, 1962.

Decided July 5, 1962.

Mr. Robert E. Lynch, Washington, D. C., with whom Mr. Joseph A. McMenamin, Washington, D. C., was on the brief, for appellants.

Mr. Albert E. Brault, Washington, D. C., with whom Mr. Denver H. Graham, Washington, D. C., was on the brief, for appellee.

Before DANAHER, BASTIAN and WRIGHT, Circuit Judges.

BASTIAN, Circuit Judge.

Appellants plaintiffs, the beneficiaries named in an accident insurance policy isued by appellee defendant, filed a complaint in the District Court seeking to recover payments for the death of the insured, in accordance with the terms of the policy. Cross motions for summary judgment were filed by the respective parties, and the District Court granted appellee's motion. This appeal followed.

The insurance policy in question is styled a "Tripmaster Policy." It is a limited policy in the sense that it is intended to be effective for only the short period of time during which the insured is on a trip or trips (in this case three days). On the other hand, it is a very broad policy in the sense that it is routinely sold to the general traveling public without the necessity of a physical examination or other special investigation of the type that usually precedes the issuance of, for example, a life insurance policy. The Tripmaster Policy was taken out by the deceased prior to her departing on an automobile trip from Washington, D. C., to Atlantic City, New Jersey. There were no representations in the policy as to condition of health nor was a physical examination required before its issuance. At the time the policy was issued, the deceased was suffering from diabetes and coronary sclerosis; moreover, approximately three years earlier, she had also suffered a cerebral thrombosis, which had left her partially crippled on the right side. However, upon examination just prior to the trip, her doctor found her physical condition to be such as not to render the proposed trip inadvisable from a medical standpoint.

The deceased and her husband left Washington for Atlantic City on a clear day. While en route they encountered an exceptionally severe thunderstorm, with heavy rain, hail, and high winds. With sections of the highway often entirely flooded because of the storm, their car frequently went off the highway and onto the adjoining rough roadside, thus causing deceased to be jostled and jolted considerably as her husband eased the car back onto the flooded pavement of the highway. Moreover, in order to prevent steam from blurring visibility through the windshield, it became necessary to roll down the car windows. This resulted in deceased's being drenched by the rain blown in through the open windows. This ordeal lasted a little over two hours, until they finally reached their destination, at which time deceased had a fever and was suffering from a backache. When these signs of illness continued, a doctor was summoned and, thereafter, deceased was returned to Washington for further medical treatment to be given by her personal physician. A little over two weeks later she died.

An autopsy was performed upon the deceased. It disclosed that the immediate cause of death was acute myocardial infarction; it also disclosed that the deceased was suffering from arteriosclerotic heart disease, generalized arteriosclerosis, and diabetes.

When the case came before the District Court on cross motions for summary judgment, the court noted a conflict in the medical evidence but granted appellee's motion on the ground that there had been no accident which would bring deceased's death within the coverage of the insurance policy.

The law construes an insurance policy most favorably to the insured, on the theory that, since the insurance company initially drafts the policy, then the insurance company should be charged with any deficiencies arising as a result of the language embodied therein. Cf. Hayes v. Home Life Ins. Co., 83 U.S.App. D.C. 110, 168 F.2d 152 (1948).

The instant policy provides for payment for "loss resulting directly and independently of all other causes from accidental bodily injury. * * *"¹ It contains no "disease exclusionary clause" such as is found in the policies reviewed in Landress v. Phoenix Mutual Life Insurance Co., 291 U.S. 491, 54 S. Ct. 461, 78 L.Ed. 934 (1934); Shulman v. Mutual Benefit Health & Accident Ass'n, 105 U.S.App.D.C. 350, 267 F.2d 627 (1959); and Railway Mail Ass'n v. Stauffer, 80 U.S.App.D.C. 278, 152 F.2d 146 (1945). Nor is it the same kind of policy as those involved and interpreted in those cases. It is a short term policy drafted in the broadest language to provide coverage for a specific factual event: accidental injury sustained while the insured is on a trip, or death or other loss resulting from such injury within 180 days after the date of the accident. With these...