F Anson, C. J.,
delivered the opinion of the court.
[209]*209Frances Kirby Atkinson, plaintiff, brought this action against The Life Insurance Company of Virginia (insurer) to recover as beneficiary under the accidental death provisions of a life insurance policy issued to her husband, Darrell Lee Atkinson (decedent or Atkinson).1 The case was tried without a jury, and the trial judge, in a letter opinion, found that Atkinson’s death was not caused by accidental means, as contended by the plaintiff, but resulted from self-destruction or self-inflicted injury within the terms of one of the policy exclusions. Judgment was accordingly entered for the insurer.
Section 6, Part B, of the insurance policy, as relevant here, provides:
“[I]f any employee, while insured hereunder for accidental death . . . shall have sustained bodily injuries solely through violent, external and accidental means, and . . . shall have suffered [death] ... the Company will pay, subject to the terms and limitations hereof, the amount of the insurance specified . . .; provided, however, that in no case shall any payment of accidental death . . . insurance be made for death . . . resulting directly or indirectly, wholly or par-from:
“(1) Self-destruction or self-inflicted injury, while, sane or insane. . . .”
The evidence shows that on November 19, 1971, Atkinson, an employee of the Wythe County School Board, was admitted to Roanoke Memorial Hospital for treatment of regional enteritis, an inflammatory bowel disease. Surgery was performed on December 10, 1971, and he was thereafter placed in a room on the eighth floor of the hospital. Atkinson progressed normally from the surgery until December 15, 1971. During that day it was noted that Atkinson appeared confused and began hallucinating. He told his nurses, physicians, and wife that he was being gassed by the hospital staff. He believed the gas was coming through the vents in his room. His condition was diagnosed by his physician as toxic psychosis. Body restraints were applied to prevent decedent from getting out of his bed, and he was given medication to quiet him. Approximately 4:00 o’clock the next morning, Atkinson telephoned his wife and asked her to come and get him because “they were gassing him and trying to kill him.” At that point, a nurse came into his room, took the telephone receiver, told the wife that he was confused and not to worry about him.
Atkinson was last seen alive just before 7:00 a.m. Shortly thereafter, he was discovered dead, lying on the ground outside of the hos[210]*210pital under an open window to the eighth story stairwell. The evidence shows that the window was closed when seen about five minutes before the decedent’s body was discovered. Decedent’s hospital gown was found on a radiator in the stairwell. Photographs showing the location of the window and radiator were introduced in evidence.
An examination of decedent’s room showed the bed restraints were still intact. A trail of blood extended from his room, down the hall, into the stairwell, and onto the radiator and window sill.
Decedent’s physician testified it was his opinion that Atkinson went out of the window of his own volition, because he feared he was being gassed or “done in” by the hospital staff, and he wanted to escape this imaginary peril.
Plaintiff contends that decedent’s death was caused by violent, external, and accidental means, while insurer argues that death was by self-destruction.
A beneficiary under an accident policy, or a double indemnity clause of a life policy, has the burden of proving that injury or death was caused by violent, external, and accidental means. When the evidence presented shows, as here, that an insured’s death was caused by violent and external means, a presumption arises that death was accidental. There is also a presumption against suicide. However, both presumptions are rebuttable and may be overcome by “clear and satisfactory” evidence which excludes “any reasonable hypothesis consistent with death from natural or accidental causes.” Life and Casualty v. Daniel, 209 Va. 332, 341, 163 S.E.2d 577, 584 (1968).
The issue, under the evidence presented here, turns upon the meaning and applicability of the clause in the policy excluding recovery if death results from “self destruction or self inflicted injury, while sane or insane.” This is a question of first impression in Virginia, and decisions in other jurisdictions are not harmonious.
Plaintiff argues that consciousness of the physical nature and consequences of the act and an intention by an insured to kill himself must be shown before the exclusion clause of self-destruction or self-inflicted injury, while sane or insane, can be invoked. She relies on Christensen v. New England Mut. Life Ins. Co., 197 Ga. 807, 30 S.E.2d 471 (1944). For other authorities supporting plaintiff’s argument see Annot., 9 A.L.R.3d 1015, 1025-32 (1966), and the cases there collected.
In Christensen, the Court of Appeals of Georgia certified to the Supreme Court of that state the following question:
[211]*211“Where a life insurance policy provides as follows: ‘Suicide. If the insured, whether sane or insane, shall die by his own hand or act within two years from the date of issue of this policy, the liability of the company under this policy shall be limited to the payment in one sum of the amount of premiums paid, less any indebtedness to the company.’ Is the company liable for the face amount of the policy, where it would be liable therefor unless the above quoted provision became applicable, where the insured, within two years from the date of the issue of the policy, comes to his death by jumping from a sixth story window of a hotel and landing on the roof of another part of the hotel forty-three and one half feet below, when the insured, by reason of an hallucination, jumped to escape injury from imaginary enemies and did not realize that his act would as a natural consequence produce his death?”
The Supreme Court answered the question by holding that, where an insured did not realize the physical nature and consequences of his act, and did not intend thereby to take his own life, his act did not constitute self-destruction, while sane or insane within the meaning of the exclusion clause of the policy. In so holding the court rejected the reasoning of the majority in De Gogorza v. Knickerbocker Life Insurance Co., 65 N.Y. 232 (1875) and followed the dissent there.
However, a strong dissent was filed in Christensen. We think it appropriate to quote a portion of it here:
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F Anson, C. J.,
delivered the opinion of the court.
[209]*209Frances Kirby Atkinson, plaintiff, brought this action against The Life Insurance Company of Virginia (insurer) to recover as beneficiary under the accidental death provisions of a life insurance policy issued to her husband, Darrell Lee Atkinson (decedent or Atkinson).1 The case was tried without a jury, and the trial judge, in a letter opinion, found that Atkinson’s death was not caused by accidental means, as contended by the plaintiff, but resulted from self-destruction or self-inflicted injury within the terms of one of the policy exclusions. Judgment was accordingly entered for the insurer.
Section 6, Part B, of the insurance policy, as relevant here, provides:
“[I]f any employee, while insured hereunder for accidental death . . . shall have sustained bodily injuries solely through violent, external and accidental means, and . . . shall have suffered [death] ... the Company will pay, subject to the terms and limitations hereof, the amount of the insurance specified . . .; provided, however, that in no case shall any payment of accidental death . . . insurance be made for death . . . resulting directly or indirectly, wholly or par-from:
“(1) Self-destruction or self-inflicted injury, while, sane or insane. . . .”
The evidence shows that on November 19, 1971, Atkinson, an employee of the Wythe County School Board, was admitted to Roanoke Memorial Hospital for treatment of regional enteritis, an inflammatory bowel disease. Surgery was performed on December 10, 1971, and he was thereafter placed in a room on the eighth floor of the hospital. Atkinson progressed normally from the surgery until December 15, 1971. During that day it was noted that Atkinson appeared confused and began hallucinating. He told his nurses, physicians, and wife that he was being gassed by the hospital staff. He believed the gas was coming through the vents in his room. His condition was diagnosed by his physician as toxic psychosis. Body restraints were applied to prevent decedent from getting out of his bed, and he was given medication to quiet him. Approximately 4:00 o’clock the next morning, Atkinson telephoned his wife and asked her to come and get him because “they were gassing him and trying to kill him.” At that point, a nurse came into his room, took the telephone receiver, told the wife that he was confused and not to worry about him.
Atkinson was last seen alive just before 7:00 a.m. Shortly thereafter, he was discovered dead, lying on the ground outside of the hos[210]*210pital under an open window to the eighth story stairwell. The evidence shows that the window was closed when seen about five minutes before the decedent’s body was discovered. Decedent’s hospital gown was found on a radiator in the stairwell. Photographs showing the location of the window and radiator were introduced in evidence.
An examination of decedent’s room showed the bed restraints were still intact. A trail of blood extended from his room, down the hall, into the stairwell, and onto the radiator and window sill.
Decedent’s physician testified it was his opinion that Atkinson went out of the window of his own volition, because he feared he was being gassed or “done in” by the hospital staff, and he wanted to escape this imaginary peril.
Plaintiff contends that decedent’s death was caused by violent, external, and accidental means, while insurer argues that death was by self-destruction.
A beneficiary under an accident policy, or a double indemnity clause of a life policy, has the burden of proving that injury or death was caused by violent, external, and accidental means. When the evidence presented shows, as here, that an insured’s death was caused by violent and external means, a presumption arises that death was accidental. There is also a presumption against suicide. However, both presumptions are rebuttable and may be overcome by “clear and satisfactory” evidence which excludes “any reasonable hypothesis consistent with death from natural or accidental causes.” Life and Casualty v. Daniel, 209 Va. 332, 341, 163 S.E.2d 577, 584 (1968).
The issue, under the evidence presented here, turns upon the meaning and applicability of the clause in the policy excluding recovery if death results from “self destruction or self inflicted injury, while sane or insane.” This is a question of first impression in Virginia, and decisions in other jurisdictions are not harmonious.
Plaintiff argues that consciousness of the physical nature and consequences of the act and an intention by an insured to kill himself must be shown before the exclusion clause of self-destruction or self-inflicted injury, while sane or insane, can be invoked. She relies on Christensen v. New England Mut. Life Ins. Co., 197 Ga. 807, 30 S.E.2d 471 (1944). For other authorities supporting plaintiff’s argument see Annot., 9 A.L.R.3d 1015, 1025-32 (1966), and the cases there collected.
In Christensen, the Court of Appeals of Georgia certified to the Supreme Court of that state the following question:
[211]*211“Where a life insurance policy provides as follows: ‘Suicide. If the insured, whether sane or insane, shall die by his own hand or act within two years from the date of issue of this policy, the liability of the company under this policy shall be limited to the payment in one sum of the amount of premiums paid, less any indebtedness to the company.’ Is the company liable for the face amount of the policy, where it would be liable therefor unless the above quoted provision became applicable, where the insured, within two years from the date of the issue of the policy, comes to his death by jumping from a sixth story window of a hotel and landing on the roof of another part of the hotel forty-three and one half feet below, when the insured, by reason of an hallucination, jumped to escape injury from imaginary enemies and did not realize that his act would as a natural consequence produce his death?”
The Supreme Court answered the question by holding that, where an insured did not realize the physical nature and consequences of his act, and did not intend thereby to take his own life, his act did not constitute self-destruction, while sane or insane within the meaning of the exclusion clause of the policy. In so holding the court rejected the reasoning of the majority in De Gogorza v. Knickerbocker Life Insurance Co., 65 N.Y. 232 (1875) and followed the dissent there.
However, a strong dissent was filed in Christensen. We think it appropriate to quote a portion of it here:
“Therefore, the question is, where one laboring under an hallucination and in order to escape an imaginary peril commits an act which to a sane person would naturally result in his death, but which to the insane mind would not and did not suggest the natural consequences but did in fact result as a natural consequence in his death, does the contract provide that he, as an insane person, is to be held accountable for the natural consequences of his act just as though he were sane? We think that it does, else the provision of the policy as to insanity is without effect, and the floodgates are left wide open for fraud. . .. Thus, whether sane or insane, the act was still the exercise of volition, and under the terms of the policy he is held accountable for his voluntary act just as though he were sane.”
The numerical weight of authority supports the view that in order for an insurer to avoid liability under the exclusion of death from self-destruction, while sane or insane, it is not necessary for the insured to [212]*212realize the physical nature or consequence of his act or to form a conscious purpose to take his life. If the act of self-destruction would be regarded as suicide in the case of a sane person, it would be so treated as to an insane insured, regardless of whether the insured decedent realized or was capable of realizing that such act would cause his death or whether he was capable of entertaining an intention to kill himself. Among the cases supporting this rule are: Bigelow v. Berkshire Life Ins. Co., 93 U.S. 284 (1876); Johnson v. Metropolitan Life Ins. Co., 404 F.2d 1202 (3d Cir. 1968); United States Fidelity & G. Co. v. Blum, 258 F. 897 (9th Cir. 1919); Aetna Life Ins. Co. v. McLaughlin, 380 S.W.2d 101, 9 A.L.R.3d 1005 (Tex. 1964); Moore v. Northwestern Mutual Life Ins. Co., 192 Mass. 468, 78 N.E. 488 (1906). See also Annot., 9 A.L.R.3d 1015, 1032-40 (1966) and the cases there collected; 9 Couch on Insurance (2d), § 40:42 at 673-674. In Aetna, supra, the court said:
“In our opinion, the minority rule would lead to confusion and attempts by courts to define varying degrees' or aspects of insanity. . . . The broader exclusion afforded to the exclusionary clause by the majority rule is in no way obnoxious to public policy. . . . [F]urther, and of most importance, we think the majority construction gives to the clause in the light of its history, a plain common sense meaning of the words employed.” 380 S.W.2d at 106, 9 A.L.R.3d at 1013-14.
In Blum, supra, the court said:
“If the insured fell out of the window by accident or in a faint, and was killed by the fall, of course there could be a récovery. But if he, of his own physical motion, went through the window and so destroyed himself, then under the contract, the insurer can avoid liability, and it would matter not what the mental condition of the insured was. The effect of the qualification to the instruction quoted was a direction that, although death may have resulted from the physical act of going through the window, suicide could not be found unless the deceased intended to kill himself, and knew his act would probably result in death. And this we hold was a material error.” 258 F. at 901.
We think the better rule is the one adopted by the numerical majority of the courts dealing with the issue presented here.
In the case at bar, the trial court, as the trier of fact, found that the presumptions favoring accidental death and against suicide were over[213]*213come by the evidence. The court’s findings of fact are supported by clear and convincing evidence that decedent’s death was not caused by accidental means, but by self-destruction or self-inflicted injury while laboring under a mental aberration, although decedent did not actually intend to take his life. The trial court was justified in concluding from the evidence that Atkinson, in order to escape an imaginary peril, extricated himself from the bed restraints, left his room, went down the hall to the stairwell, took his hospital gown off, placed it on the radiator, and purposely and by his own volition went through the open window, which caused his death. The plain language of the exclusionary clause comprehends all purposeful self-destruction whether the suicidal act shall emanate from a sane person or one suffering from a mental aberration. Thus, it was not necessary that Atkinson comprehend the consequences of his act and intend to take his life in order for his death to come within the self-destruction exclusion.
For the reasons stated, the judgment is
Affirmed.