Dinkowitz v. Prudential Ins. Co.

216 A.2d 613, 90 N.J. Super. 181
CourtNew Jersey Superior Court Appellate Division
DecidedJanuary 14, 1966
StatusPublished
Cited by14 cases

This text of 216 A.2d 613 (Dinkowitz v. Prudential Ins. Co.) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dinkowitz v. Prudential Ins. Co., 216 A.2d 613, 90 N.J. Super. 181 (N.J. Ct. App. 1966).

Opinion

90 N.J. Super. 181 (1966)
216 A.2d 613

CELIA DINKOWITZ, PLAINTIFF,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, A NEW JERSEY CORPORATION, DEFENDANT.

Superior Court of New Jersey, Law Division.

Decided January 14, 1966.

*182 Mr. George S. Hochberg for plaintiff (Messrs. Waldor, Beckerman, Hochberg & Franzblau, attorneys).

Mr. H. Russell Morss, Jr. for defendant (Messrs. O'Connor, Morss & O'Connor, attorneys).

WEIDENBURNER, J.C.C. (temporarily assigned).

When Theodore Dinkowitz died on December 10, 1958, his life was insured by three policies issued by defendant, each of which provided for the payment of double benefits in the event of accidental death. Each policy provided for the payment of the increased benefits when death resulted from "bodily injuries effected solely through external, violent and accidental means." Defendant paid the face amount of each policy to the widow-beneficiary but has refused to pay the increased benefits on the ground that the cause of decedent's death was the negligence of a physician treating decedent for an illness, and that death from such cause is expressly excluded from the increased, accidental death benefit provisions of the policies by their exclusionary clauses. Plaintiff, who is the widow-beneficiary of the insured, instituted this action for the increased benefits on each of the policies, and defendant moves for summary judgment.

For the purposes of the motion only, the parties have stipulated that the insured's death resulted solely and exclusively from the negligence of the physician attending him at the time of his death; that the physician improperly and negligently diagnosed and treated the physical illness of the insured; and that had the insured's physical illness been properly diagnosed and treated, medical authorities would agree that it is probable that the insured would have survived and lived for a substantial length of time thereafter.

*183 The stipulated facts frame an issue of law, and the case is, therefore, a proper one for disposition by a motion for summary judgment. Felbrant v. Able, 80 N.J. Super. 587 (App. Div. 1963).

Two of the three insurance policies involved contain a bold-type paragraph in the increased benefits clause entitled "Conditions and Exceptions," which reads as follows:

"No such benefit shall be payable if such death results * * * directly or indirectly from bodily or mental infirmity or disease in any form, or medical or surgical treatment therefor."

The increased benefits clause of the third policy includes a paragraph designated "Exclusions and Reductions," which reads, in pertinent part, as follows:

"The Accidental Death and Dismemberment Insurance does not cover any loss which results from or is caused, directly or indirectly, by * * * disease or bodily or mental infirmity, or medical or surgical treatment thereof, * * *."

The decisive question of whether the stated exclusionary clauses, which are common to most life and accident insurance policies containing provisions for increased benefits in the event of accidental death, exempt the insuror from the payment of the increased benefits if death results from medical malpractice, appears to be one of novel impression in New Jersey. Its resolution, therefore, must depend upon the application of the fundamental principles of construction of insuring agreements to the facts of the instant case, with the aid of such illumination as decisions in other jurisdictions may provide.

In Kievit v. Loyal Protective Life Ins. Co., 34 N.J. 475 (1961), it is said

"When members of the public purchase policies of insurance they are entitled to the broad measure of protection necessary to fullfill their reasonable expectations. They should not be subjected to technical encumbrances or to hidden pitfalls and their policies should be construed liberally in their favor to the end that coverage is afforded *184 `to the full extent that any fair interpretation will allow.' Francis, J., in Danek v. Hommer, 28 N.J. Super. 68, 76 (App. Div. 1953), aff'd 15 N.J. 573 (1954)." (at p. 482)

We have been instructed that since insurance contracts are prepared by the insuror's experts, doubts as to the existence of coverage must be resolved in favor of the insured, and "if the clause in question is one of exclusion or exception, designed to limit the protection, a strict interpretation is applied." Mazzilli v. Accident & Casualty Ins. Co. of Winterthur, 35 N.J. 1, 7-8 (1961). The employment of these eminently fair principles of construction, however, is limited by another fundamental rule to which our attention has been directed by Kampf v. Franklin Life Ins. Co., 33 N.J. 36 (1960), where Mr. Justice Schettino said:

"The problem here is one of simple contract law. As was noted by Judge Parker in Sellars v. Continental Life Ins. Co., 30 F.2d 42, 45 (4 Cir. 1929) `Courts cannot make contracts for parties. They can only enforce the contracts which the parties themselves have made.' When the terms of an insurance contract are clear, it is the function of a court to enforce it as written and not to make a better contract for either of the parties. Kupfersmith v. Delaware Ins. Co., 84 N.J.L. 271, 275 (E. & A. 1913); James v. Federal Insurance Co., 5 N.J. 21, 24 (1950). The parties are entitled to make their own contracts. McCampbell v. New York Life Ins. Co., 288 F. 465, 469 (5 Cir. 1923), certiorari denied 262 U.S. 759, 43 S.Ct. 705, 67 L.Ed. 1219 (1923). Absent statutory prohibitions, an insurance company has the right to impose whatever conditions it desires prior to assuming its obligations and such provisions should be construed in accordance with the language used." (at p. 43)

The same principle is recognized most recently in Linden Motor Freight Co., Inc., v. Travelers Ins. Co., 40 N.J. 511 (1963), in the following language:

"But we have been equally insistent that clear basic terms and particular provisions of an insurance contract may not be disregarded at will and a new contract judicially made for the parties [citations omitted]." (at p. 525)

While plaintiff recognizes the restraining, fundamental principle that the court must enforce the insuring contract *185 as it is written when the terms are clear, she contends that although the average policyholder might well realize that accidental death benefits would not be paid by the insuror for a death resulting from unexpected contingencies during the course of proper medical treatment, he would expect the additional compensation to be payable if death resulted solely from medical malpractice. It is urged that the "reasonable appreciation, understanding and expectation of the average policy purchaser" (see Harris v. John Hancock Mutual Life Ins. Co., 41 N.J. 565, 568 (1964); requires the court to distinguish between "proper" and "improper" medical treatment in the construction of the standard exclusionary clauses.

Analysis of the definitions of what constitutes medical or surgical "treatment" does not justify the distinction sought by plaintiff. Webster's New International Dictionary (2d ed.

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216 A.2d 613, 90 N.J. Super. 181, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dinkowitz-v-prudential-ins-co-njsuperctappdiv-1966.