Weil v. Federal Kemper Life Assurance Co.

• Decision Date: 31 January 1994
• Docket Number: No. S029652,S029652
• Citation: 27 Cal.Rptr.2d 316,866 P.2d 774,7 Cal.4th 125
• Court: California Supreme Court
• Parties: , 866 P.2d 774, 62 USLW 2505, 32 A.L.R.5th 789 Lola Brown WEIL et al., Plaintiffs and Respondents, v. FEDERAL KEMPER LIFE ASSURANCE COMPANY, Defendant and Appellant.

Page 316

27 Cal.Rptr.2d 316

7 Cal.4th 125, 866 P.2d 774, 62 USLW

2505, 32 A.L.R.5th 789

Lola Brown WEIL et al., Plaintiffs and Respondents, v. FEDERAL KEMPER LIFE ASSURANCE COMPANY, Defendant and Appellant.

No. S029652.

Supreme Court of California In Bank.

Jan. 31, 1994.

Daniel W. Maguire, argued, Galton & Helm, Los Angeles, for defendant and appellant.

Richard A. Cohn, argued, Law Offices of Wylie A. Aitken, Santa Ana, for plaintiffs and respondents.

GEORGE, Justice.

In this case we must determine whether a life insurance policy covering loss of life occurring as the direct result of bodily injury inflicted solely by "external, violent and accidental means" provides coverage when the insured's voluntary ingestion of cocaine resulted in a lethal overdose. Plaintiffs, beneficiaries of the insured, contend that the drug overdose was accidental and therefore that the policy provides coverage. Because the insured's voluntary ingestion of an illegal and dangerous substance caused his death, defendant insurer contends death did not result from bodily injury inflicted solely by "accidental means," within the terms of the insurance policy.

We conclude, first, that the distinction in policy language between "accidental means" and "accidental results," recognized in our prior decisions, should be preserved, and second, that the voluntary ingestion of a known hazardous and illegal substance does not provide a basis for coverage within the terms of an insurance policy affording coverage for death by "accidental means." Accordingly we reverse the judgment of the Court of Appeal affirming the trial court's entry of summary judgment in favor of plaintiffs, and direct the Court of Appeal to remand this action to the trial court.

I

On April 14, 1975, defendant Federal Kemper Life Assurance Company issued a life insurance policy to the employer of Michael P. Weil, the deceased, naming Weil as the insured. The policy provided insurance on Weil's life, affording a benefit of $100,000. The policy included an "Additional Accidental Death Benefit" supplementary rider, affording an additional benefit of $100,000 in the event the insured's death occurred solely by accidental means and no other terms in the "rider" excluded coverage based upon the circumstances of the death. ¹ Plaintiffs Lola and Michelle Weil (Michael Weil's mother and sister, respectively) are the beneficiaries named in the policy.

The supplementary rider to the policy provides in pertinent part as follows: "BENEFITS--The Company agrees, subject to the provisions of this Policy, to immediately pay to the Beneficiary or Beneficiaries, in addition to the other benefits provided by this Policy, the amount of additional accidental death benefit specified in the Policy Specifications, if due proof is furnished to the Company at its Home Office that the Insured, while this Policy is in full force and effect, has suffered the loss of life as the direct result of bodily injury, independent of all other causes, effected solely through external, violent and accidental means, as evidenced by a visible contusion or wound on the exterior of the body (except in the case of drowning or internal injuries revealed by an autopsy), and that the date of death occurred within ninety days after such injury." (Italics added.) In another section, the rider also provides in relevant part: "RISKS NOT ASSUMED--The Company shall not be liable for any payment hereunder if the Insured's death: ... [p] B. Results directly or indirectly from any of the following causes: [p] ... [p] (2) suicide, sane or insane, or any attempt thereat; [p] ... [p] (4) committing an assault or felony; [p] ... or [p] (6) disease or bodily or mental infirmity or medical or surgical treatment therefor...." ²

Michael Weil died on August 17, 1985, in a hotel room in San Francisco. The cause of death was described on the death certificate as acute cocaine poisoning. Defendant paid the $100,000 basic benefit provided in the policy to plaintiffs as beneficiaries, but denied plaintiffs' claim for the additional $100,000 benefit, described in the accidental death supplementary rider, on the grounds that Mr. Weil's death did not occur solely by accidental means within the meaning of the policy, and fell within the policy exclusion for a death resulting directly or indirectly from the commission of a felony.

On March 31, 1987, plaintiffs brought an action against defendant, seeking declaratory relief as well as damages for breach of contract, breach of the implied covenant of good faith and fair dealing, and violation of Insurance Code section 790.03, subdivision (h).

On June 30, 1989, plaintiffs moved for summary judgment or summary adjudication of issues. In contending that Mr. Weil's death constituted death by accidental means as a matter of law, plaintiffs advanced alternative factual positions. They asserted that, even if the cause of death had been acute cocaine poisoning from voluntary ingestion of cocaine, as indicated by the statements in the death certificate and other reports produced by defendant, Mr. Weil's death occurred by accidental means within the meaning of the policy, because he did not intend to injure himself or cause his own death. Alternatively, they asserted, a probability existed that "unforeseen acts" intervened to cause Mr. Weil's death, in view of the following circumstances: (1) near the time of his death, Mr. Weil had been prescribed and may have been taking the drug Darvocet (to ameliorate pain caused by gum disease), (2) after death his body was identified by an individual (whom the police subsequently were unable to locate) who was unknown to Mr. Weil's family and coworkers, and (3) Mr. Weil's condominium (located in Santa Clara) had been burglarized during the weekend of his death. Plaintiffs also contended that Mr. Weil's death was caused not by possession of cocaine, a felony (Health & Saf.Code, §§ 11054, subd. (f)(1), 11350), but by ingestion or use of cocaine, a misdemeanor (Health & Saf.Code, § 11055, subd. (b)(4)).

Defendant filed an opposition and, upon obtaining leave of the court, filed its own motion for summary judgment or summary adjudication of issues, on the theories that, as a matter of law, Mr. Weil's death did not result from "accidental means," and, furthermore, that his death resulted directly or indirectly from the commission of a felony. In support of its motions, defendant presented evidence that on the afternoon of Mr. Weil's death, a female prostitute summoned to his hotel room observed that he appeared to be under the influence of drugs, inquired whether that was the case, but received his assurance that he "would be all right." Approximately one hour later, she observed him ingest cocaine from a dish in the bathroom of the hotel room. He then suffered shortness of breath and collapsed, and subsequent attempts by paramedics to revive him proved to be unsuccessful. The medical examination performed on his body revealed no evidence of trauma. Chemical analyses disclosed the presence of cocaine in his system, but no Darvocet. A sample apparently taken from the dish recovered from the hotel bathroom tested positive for cocaine.

The motions were heard and taken under submission on August 25, 1989. In a minute order entered September 19, 1989, the superior court summarily adjudicated that the subject life insurance policy had been issued to the decedent, that its supplementary rider provided an additional benefit of $100,000, and that plaintiffs were entitled to that additional benefit. The court determined as a matter of law that Mr. Weil's death, from an unintentional overdose of cocaine, resulted from accidental means within the meaning of the policy. The court also determined that Mr. Weil's death did not result directly or indirectly from the commission of a felony, possession of cocaine, but rather from misdemeanor use of cocaine. Nonetheless, the court denied plaintiffs' motion for summary judgment on the ground that triable issues of fact remained as to whether defendant, in denying the supplemental accidental death benefit, breached the implied covenant of good faith and fair dealing. The court also denied defendant's motion for summary judgment.

Thereafter, plaintiffs dismissed with prejudice their causes of action for breach of the implied covenant of good faith and fair dealing and for violation of Insurance Code section 790.03, subdivision (h). On February 6, 1991, the parties filed a stipulation with the court, requesting that it enter judgment on the remaining cause of action for breach of the insurance agreement and on the request for declaratory relief. That stipulation includes the statement: "All motions were heard on August 25, 1989. At the hearing, all parties stipulated that the motions presented pure questions of law and that the facts were undisputed." The court on February 6, 1991, entered judgment in favor of plaintiffs, declaring their entitlement to the $100,000 additional death benefit under the supplementary rider, and further declaring that no exclusion applied, because Mr. Weil's death did not result directly or indirectly from the commission of a felony.

Defendant appealed, contending that the superior court erred in its interpretation of the coverage clause of the supplementary rider, because the death of an insured caused by his or her voluntary ingestion of an illegal and dangerous substance, such as cocaine, is not the result of an injury occurring solely by "accidental means" within the meaning of such an insurance policy. Defendant also urged that plaintiffs had not established that acts other than Mr. Weil's voluntary ingestion of cocaine had intervened to cause his death, and additionally contended that the exclusion for commission of a felony applied. In a divided decision that produced three separate opinions, the Court of Appeal affirmed the judgment, and we subsequently granted defendant's petition...