Mutual Ben. Health and Acc. Ass'n v. Hudman

• Decision Date: 31 December 1965
• Docket Number: No. A-10594,A-10594
• Citation: 398 S.W.2d 110
• Parties: MUTUAL BENEFIT HEALTH & ACCIDENT ASSOCIATION, Petitioner, v. Mary Louise HUDMAN, Respondent.
• Court: Texas Supreme Court

Page 110

398 S.W.2d 110

MUTUAL BENEFIT HEALTH & ACCIDENT ASSOCIATION, Petitioner, v. Mary Louise HUDMAN, Respondent.

No. A-10594.

Supreme Court of Texas.

Dec. 31, 1965.

Brundidge, Fountain, Elliott & Churchill, Bobby D. Dyess, Dallas, for petitioner.

Hardeman, Smith & Foy, San Angelo, for respondent.

POPE, Justice.

The question presented is whether Mary Louise Hudman, the beneficiary of an accident policy which limited coverage to death from accidental injury 'independently of other causes,' may recover under the policy when the insured's death resulted from the combined effects of the injury and a pre-existing disease. She obtained a judgment in a case tried before the court without a jury and the intermediate court affirmed. 385 S.W.2d 509. We reverse those judgments and render judgment that the beneficiary take nothing.

Paul Hudman, a fifty-four year old pharmacist, was the insured under an accident policy issued by Mutual Benefit Health & Accident Association which limited recovery for accidental death by these two clauses:

'The applicable benefit amount shown below will be paid to the beneficiary named in the policy * * * if covered injuries result in your death, independently of other causes, within 90 days after the date of the accident.

"Covered injuries' mean accidental bodily injuries which you receive while you are driving or riding in any private passenger automobile. * * *'

Hudman worked on his farm outside of San Angelo during the afternoon of April 28, 1963. The evidence supports the trial court's findings that he died in his pickup truck of ventricular fibrillation after he had worked hard on a hot day that was marked by extreme fluctuations in humidity. One of the medical witnesses testified that Hudman's 'continued exertion of driving the pickup, after the extremely hard labor of the day, contributed to the onset of fibrillation.' Prior to his death he was in apparently good health and had never had a diagnosis of or treatment for heart trouble. The trial court also found that arteriosclerosis of Hudman's coronary artery was a predisposing condition and not a proximate cause of his death, and that of itself, the condition would not have caused Hudman's death.

All of the evidence shows that Hudman died from the effects of two concurring causes. The cause of death was proved by three medical experts, one called by the plaintiff and two by the defendant. Their testimony is in agreement that death resulted from fibrillation of Hudman's heart and the evidence shows that Hudman's overexertion and his diseased heart concurrently caused the fibrillation. The Court of Civil Appeals found from the facts that '(t)here is no question but that the diseased condition of Mr. Hudman's heart contributed to his death.' We shall briefly summarize the testimony.

Dr. Lloyd R. Hershberger testified about an autopsy he performed in the presence of two other doctors and the attorneys for the parties. His report described the anterior descending branch of the left coronary. It stated that '2 cm. below its origin, it becomes quite narrow and is reduced to a slit-like opening. * * * I would estimate that the diameter of the channel is about one-eight of that which is normal. This descending branch then returns to a more normal diameter as it is examined distal to this narrowing, but about 4 cm. distal to the origin, we again find a second area of extreme narrowing. This area shows eccentric thickening of the blood vessel wall with a very narrow lumen that I would again estimate at about one-eighth the normal diameter.' He testified that Hudman's heart disease was very significant and a contributing cause of the death. He said that the primary cause of death was 'a combination of pre-existing heart disease and the physical exercise performed the day of his death.' When questioned more specifically, he said that both causes were primary; neither was remote. He considered the two causes of death equal.

Dr. John L. Goforth was not present at the autopsy but testified as an expert about it. He said that a person with the kind of heart Hudman had, doing the heavy labot to which he was not accustomed and working on the hot humid day, overtaxed the function of his heart. He said that Hudman, in the absence of heart disease, probably would not have died by reason of the exertion. He expressed the opinion that one with the degree of Hudman's arteriosclerosis is in imminently serious trouble and the disease was alone sufficient cause for sudden death.

Dr. P. O. B. Montgomery, who was present at the autopsy, testified: 'In my opinion, his death was caused by ventricular fibrillation, and the cause of the ventricular fibrillation was the unusual amount of work that he did under the emotional pressure that he did it, on a day when the temperature was unseasonably hot, and the humidity showed an extraordinary variation. These factors, coupled with his coronary arteriosclerosis disease, caused his heart to fibrillate, and this was the immediate cause of his death.' He said that the decreased blood supply caused by the narrowing of the artery in and of itself would not have caused the death, but he also siad that the decreased blood supply and the increased demand for blood by reason of the exertion 'and the impinging of these two things caused his heart to fibrillate.' He said that the physical stress and the disease combined to cause Hudman's death.

Plaintiff, Mary Louise Hudman, argues that there is evidence that heart disease did not cause the death because an immediate heart massage would have restored the rhythm of the heart, that twenty-five to thirty per cent of all males have equally advanced arteriosclerosis as that of Hudman at his age, and the disease was dormant and only a predisposing condition. From this, she reasons that there was evidence to support the finding, that overexertion caused the fibrillation, which caused death. This, however, is not what the doctors unanimously testified. They said that it was overexertion and disease that caused fibrillation. It took two things to produce the fibrillating process which produced death. Overexertion or disease alone, they said, did not produce the fibrillation.

Plaintiff, Mary Louise Hudman, failed to prove an accidental bodily injury, 'independently of other causes.' This limitation upon the cause of death can not be ignored, because it was the basis of the agreement. Pan American Life Ins. Co. v. Andrews, 161 Tex. 391, 340 S.W.2d 787, 790 (1960); United American Ins. Co. v. Selby, 161 Tex. 162, 338 S.W.2d 160, 164, 84 A.L.R.2d 367 (1960). Plaintiff's argument is that the phrase means the same as mere proximate cause which can be a concurring cause. While it is true that the cause must be proximate rather than remote, the real question is whether the beneficiary must prove the accidental injury was a proximate cause or the sole proximate cause. 'Independently' means 'solely,' 'only,' 'standing alone.' North American Accident Ins. Co. v. Miller, 193 S.W. 750, 756 (Tex.Civ.App.1917, writ ref.); Western Indemnity Co. v. MacKechnie, 185 S.W. 615, 618, 619 (Tex.Civ.App.1916, no writ), 214 S.W. 456, 463 (TexCiv.App.1919, no writ); accord, continental Casualty Co. v. Fountain, 257 S.W.2d 338, 344 (Tex.Civ.App.1953 writ ref.).

The logical meaning of the policy terms limits the coverage to accidental bodily injuries which are the sole cause of death. We are dealing with death under an accident policy. It obligated the insurer to pay '* * * if covered injuries (accidental bodily injuries) result in your death, independently of other causes. * * *' The coverage is for accidental bodily injuries. The term 'other causes' would mean non-accidental causes. The policy does not purport to cover non-accidental bodily injuries such as Hudman's heart disease. A reasonable construction of the accident policy is that it covered accident-caused injuries rather than non-accident-caused injuries. We reach the same result when we look at the whole phrase 'independently of other causes.' The phrase does not mean that the insurer agreed to provide coverage for a death which results from accidental bodily injuries though 'dependent upon other causes.' Logically this is what the beneficiary here argues. Her argument would compel the result that overexertion (the accidental bodily injury), though dependent upon heart disease (the other cause) was yet 'independent of other causes.' The idea that one factor is independently a cause leaves no room for the idea that it yet may be dependently caused. An independent cause does not mean that it is a joint, contributing or concurring cause.

All of the evidence shows that two causes proximately concurred to produce death and the policy limited its coverage to one cause, accidental bodily injury. It solves nothing when applying a sole-cause test, to resort to a but-for test as the trial court did and as was done in Pyramid Life Ins. Co. v. Alexander, 337 S.W.2d 813 (Tex.Civ.App.1960, writ ref., n. r. e.). When we have two concurring factors which produce death, one within and the other without the policy coverage, results under such a test would depend upon the factor to which the test is applied. It is a true statement that Hudman's death would not have occurred but for his overexertion, the bodily injury and accidental cause. It is also true that his death would not have occurred but for the pre-existing heart disease, the non-accidental cause. If we apply the but-for test to the accidental bodily injury, we can say that the death would not have occurred but for the overexertion and the plaintiff would win. When we apply the same test to the other concurring cause, the non-accidental heart disease, we get an opposite result. This is so because the death would not have occurred but for the non-accidental heart disease, and the plaintiff would lose. It took both causes to produce death and but for both, death would probably not have...