Franklin v. Mutual Life Ins. Co. of New York

45 So. 2d 624, 216 La. 1062, 1950 La. LEXIS 940
CourtSupreme Court of Louisiana
DecidedMarch 20, 1950
Docket39112
StatusPublished
Cited by9 cases

This text of 45 So. 2d 624 (Franklin v. Mutual Life Ins. Co. of New York) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Franklin v. Mutual Life Ins. Co. of New York, 45 So. 2d 624, 216 La. 1062, 1950 La. LEXIS 940 (La. 1950).

Opinion

HAWTHORNE, Justice.

The plaintiffs have appealed from a judgment denying them recovery under the double indemnity provision of a life insurance policy on the life of their brother, Jesse J. Franklin. The insurance company paid the face amount of the policy, but denied liability under the double indemnity provision.

The provision for double indemnity benefits, insofar as pertinent, reads as follows :

“The Double Indemnity will be paid upon receipt of the proof that the Insured died as a direct result of bodily injury effected solely through external, violent, and accidental means, independently and exclusively of all other causes, and of which, except in the case of drowning or asphyxiation, there is evidence by a visible contusion or wound on the exterior of the body * * * provided that the Double Indemnity shall not be payable if death resulted * * * directly or indirectly from disease or bodily or mental infirmity.. * * *” (Italics ours.)

On December 20, 1945, Jesse J. Franklin was found lying on the sidewalk on a principal thoroughfare of the Town of Lees-ville, bleeding from the left ear and the nostrils, with a bruised and abraised condition of the chin, one hand, and the side of his head. He was taken to the hospital and remained totally unconscious for about 48 hours, and was conscious only momentarily from that time until his death on December 27.

The physician who first saw the decedent at or near the scene where he was found, and who attended him until his death, signed the certificate of death on December 27, in which he gave the immediate cause of death as “diabetic coma” of 48 hours’ duration due to “chronic diabetes” of 20 years’ duration. This certificate also stated that other conditions were “hypertension — fall to sidewalk — fracture right lower jaw”. "Jhe record discloses that at the time of death the decedent was suffering from diabetes in its advanced stages, hypertension, and Bright’s .disease, and was drawing total and permanent disability benefits due to his physical condition from the defendant insurance company.

The appellants take the position that they have proved that the injuries received by the deceased were the predominant cause of his death, and that they are entitled to recover under the policy even though disease contributed to his death.

The appellee contends that it is encumbent upon the plaintiffs to prove that death was caused solely by accidental means, and that in this case they have not produced any evidence whatsoever to show an accident. It further contends that the record *1065 does not show that the injuries were the direct cause of death, or that the injuries were the predominant cause of death. The argument is made that the decedent’s fall was caused in all probability by disease, and ■the doctors concede that hypertension could at any time cause dizziness resulting in a ■fall.

The first question for our consideration is whether the fall of the deceased was an •accident within the meaning of the policy if, as contended by the insurance company, it was induced by disease — that is, if the decedent fell because he was overcome by diabetic coma or hypertension.

Although we have found no cases directly in point in this state, the following cases support the insurer’s contention that a fall induced by disease would not be an accident, so that injuries suffered thereby would not be by accidental means under the provision of the policy relating to double indemnity: Illinois Commercial Men’s Ass’n v. Parks, 7 Cir., 179 F. 794; Wallace v. Standard Acc. Ins. Co. of Detroit, Mich., 6 Cir., 63 F.2d 211; Harrison v. New York Life Ins. Co., 6 Cir., 78 F.2d 421; New York Life Ins. Co. v. Roufos, 6 Cir., 83 F.2d 620; New England Mut. Life Ins. Co. v. Flemming, 9 Cir., 102 F.2d 143; Phillips v. Travelers’ Ins. Co. of Hartford, Conn., 288 Mo. 175, 231 S.W. 947. On the other hand, our research reveals that there is also authority to the effect that, even though a fall is induced by disease, it would nevertheless be an accident within the meaning of the provision. Provident Life & Accident Ins. Co. v. Watkins, 256 Ky. 645, 76 S.W.2d 889, and cases therein cited; 5 Couch on Insurance, sec. 1142, at pp. 4007-4008, and cases cited therein.

No proof whatever was introduced by plaintiffs to show what caused the fall, or to show how the deceased came to be lying on the sidewalk. So far as the record discloses, there were no witnesses to the fall, and we have no way of knowing what caused it, but, like counsel’s, ^our conclusions can only be the result of surmise, conjecture, and speculation.

Under the facts and circumstances of this case, however, we are inclined to agree with the insurer that the fall in all probability was induced by disease; but, even if we concede for the sake of argument only and without deciding the matter that it would nevertheless be an accident within the meaning of the policy — a view most favorable to the plaintiffs — ,the question remains whether the injuries sustained in the accident were the cause of death within the meaning of the policy.

This court in De Blieux v. Travelers Ins. Co., 185 La. 620, 170 So. 14, 16, had occasion to consider a similar double indemnity provision in a life insurance policy. The provision in that case, insofar as it is pertinent here, read: “ ‘If death should result from bodily injuries, effected directly and independently of all other causes through external> violent and accidental means, * * * which shall cause such *1067 injuries, and of which * * * there is a visible contusion or wound on the exterior of the body, provided, that such (death) does not result, directly or indirectly, from diseases in any form, defendant will pay on receipt of due proof thereof * * ” (Italics ours.) In the cited case this court quoted at length and with approval from the case of Carnelious v. Louisiana Industrial Life Ins. Co., 18 La.App. 739, 138 So. 533, 535. In the Carnelious case, in answer to the insurance company’s contention that no recovery could be had because the accident must be the sole and independent cause of the disability, the court said:

“ * * * Our understanding of the meaning of this clause, as interpreted by the courts generally, is that it suffices if the cause of injury or death be the efficient or predominant cause. The phrase ‘resulting directly, independently and exclusively in death,’ refers to the efficient, or, as some courts speak of it, the predominant cause of death at the time it occurs. Illinois Commercial Men’s Ass’n v. Parks, 7 Cir., 179 F. 794.” See other authorities therein cited, and Jones v. Washington Nat. Ins. Co., La.App., 2 So.2d 696.

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45 So. 2d 624, 216 La. 1062, 1950 La. LEXIS 940, Counsel Stack Legal Research, https://law.counselstack.com/opinion/franklin-v-mutual-life-ins-co-of-new-york-la-1950.