Community Life & Health Insurance Co. v. McCall

497 S.W.2d 358, 1973 Tex. App. LEXIS 2262
CourtCourt of Appeals of Texas
DecidedJune 25, 1973
Docket8381
StatusPublished
Cited by9 cases

This text of 497 S.W.2d 358 (Community Life & Health Insurance Co. v. McCall) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Community Life & Health Insurance Co. v. McCall, 497 S.W.2d 358, 1973 Tex. App. LEXIS 2262 (Tex. Ct. App. 1973).

Opinion

REYNOLDS, Justice.

A jury-verdict judgment was rendered decreeing recovery by the legal beneficiary of the premiums paid for a hospitalization insurance policy, and the death benefits designated payable in an accidental death and dismemberment insurance policy, together with statutory penalties and a total sum for attorney’s fees. The appellant-insurer has appealed from the judgment on points of error addressed to the appellee-beneficiary’s failure to discharge her burden of proof by admissible evidence. Affirmed in part; reversed and rendered in part; and reversed and remanded in part.

Appellant Community Life & Health Insurance Company issued two insurance policies insuring R. P. McCall, whose wife, appellee Pauline McCall, is the legal beneficiary. Policy No. 46349 is a hospitalization insurance policy of limited benefits payable for loss due to hospital confinement and other specified expenses resulting from accidental bodily injury or sickness, with the provision that

“In the event of accidental death the Company will pay . . . without interest an amount equal to one times the amount of premiums paid ... on this policy, but *360 not to exceed an aggregated amount of $5,000.00.”

Policy No. 246349 is an accidental death and dismemberment insurance policy of scheduled specific benefits for loss resulting from policy defined accidental bodily injury, the scheduled death benefit being $5,000.00,

“If such accidental bodily injury shall, independent of all other causes . result in . . . LOSS OF LIFE

Under the heading “DEFINITIONS” in the policy, there appears this statement:

“ ‘Accidental Bodily Injury’, wherever used in this policy, shall mean an injury that occurred after the effective date of this policy as the direct result of accident as evidenced by a visible contusion or wound, broken bones revealed by X-Ray, or internal injuries revealed by X-Ray or autopsy.”

Both policies were in force at the material times.

In mid-afternoon of February 9, 1972, R. P. McCall left his home driving his pickup truck. On the next morning of February 10th, between the hours of six and seven o’clock, the body of McCall was found floating near his pickup in a shallow playa lake located six-tenths of a mile east of Littlefield, Texas, adjacent to Farm Road 94. The pickup was submerged in the lake up to the top of the hood and the left front door was open. The ignition key was in the “on” position, but the engine was not running. There was a wind out of the north or northeast, the weather was extremely cold, and the chill factor was between eighteen and twenty-two degrees below zero. Although there were no eye witnesses to the event, there is no dispute that the evidence established that the pickup had veered off the asphalt surface of the road at a forty-five degree angle, gone over a metal delineator post causing a sight dent in the vehicle’s front chrome strip, travelled more than ninety feet in a straight line down an embankment into the lake, and stopped some twenty-five feet into the lake.

Justice of the Peace Stanley Doss ordered an autopsy, which was performed by Dr. H. P. Clifton, Jr., a medical doctor specializing in pathology. In performing the autopsy after the body had been embalmed, Dr. Clifton reported that no external evidence of trauma was found; 1 the only abnormal external finding recorded was the hemorrhage present in the area of embalming. The autopsy protocol recorded “ . . . the heart to be slightly enlarged . . . ” and in “ . . . the coronary vessels ... a moderate to severe degree of atherosclerosis with an area of recent occlusion of the anterior descending branch of the left coronary artery.” As a result of his autopsy, Dr. Clifton’s pathological diagnosis was “CORONARY ATHEROSCLEROSIS WITH RECENT THROMBOTIC OCCLUSION AND OLD MYOCARDIAL INFARCTION”; the cause of death was stated to be “CORONARY ATHEROSCLEROSIS WITH THROMBOTIC OCCLUSION.” Dr. Clifton reported to Justice Doss by telephone that he had found no evidence of trauma or drowning and that McCall “ . . . died of a heart attack.”

Justice of the Peace Doss conducted an inquest. After the inquest and having been furnished with a copy of the autopsy report, Justice Doss completed the certificate of death to show the immediate cause of death as “Cardiac arrest” due to “Automobile accident,” and described how the injury occurred by inserting the words “heart attack caused by an automobile accident.”

*361 Mrs. McCall’s claims to the amount of premiums paid under policy No. 46349 and to the death proceeds specified in policy No. 246349 were denied. The reason given for denial was that the circumstances of Mr. McCall’s death do not come within the policy provisions defining loss of life as the result of accidental bodily injury. This suit resulted.

The issues were joined on the contrary contentions of the parties. It was and is Mrs. McCall’s contention that her husband’s death resulted from an accidental bodily injury independent of all other causes. She testified that her husband had been in good health the last year or so before his death, he was not taking medication, there had been no complaints about his physical, mental or emotional state, and he had been working without any limitations on his activities. The theory advanced is that the accident occurred because McCall fell asleep while driving his pickup and it ran into the lake. Awakened, McCall opened the door, at which point he had to be alive and healthy to exert the pressure required to open the submerged door, and stepped into the water to walk back to dryland. This reconstruction of events, so the investigating highway patrolman testified, is consistent with his investigation of the accident. Proceeding, the theory is that the extreme cold and the extremely cold water were such a violent shock to McCall’s system that he suffered bodily injury and died from a heart attack, the sole cause of death, after ventricular fibrillation, the immediate cause of death, developed. This reconstitution is maintained supportable by Dr. Clifton’s testimony and the certificate of death admitted in evidence, although appellant objected to the admission. The basic reliant testimony of Dr. Clifton is his statements that ventricular fibrillation was the immediate cause of McCall’s death, 2 the heart attack was the sole cause of death, and his response of “Right” when asked if it was true that a person can derive ventricular fibrillation from sudden shock of ice cold water, irrespective of whether a person is an exact medical replica of McCall or not as he existed at the time of the autopsy. The certificate of death is asserted to be, by virtue of Rules 40a and 54a under Article 4477, 3 and Article 3731a, admissible prima facie evidence of the deceased’s accidental death. The conclusion drawn is that the theory is sufficiently supported by the evidence to require jury determination of, and to sustain its findings with respect to, the fact issues submitted.

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Bluebook (online)
497 S.W.2d 358, 1973 Tex. App. LEXIS 2262, Counsel Stack Legal Research, https://law.counselstack.com/opinion/community-life-health-insurance-co-v-mccall-texapp-1973.