Gottfried v. Prudential Insurance Co. of America

414 A.2d 545, 173 N.J. Super. 370
CourtNew Jersey Superior Court Appellate Division
DecidedSeptember 9, 1977
StatusPublished
Cited by3 cases

This text of 414 A.2d 545 (Gottfried v. Prudential Insurance Co. of America) 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
Gottfried v. Prudential Insurance Co. of America, 414 A.2d 545, 173 N.J. Super. 370 (N.J. Ct. App. 1977).

Opinion

173 N.J. Super. 370 (1977)
414 A.2d 545

LEONORA R. GOTTFRIED, PLAINTIFF,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA AND THE PENN MUTUAL LIFE INSURANCE COMPANY, DEFENDANTS.

Superior Court of New Jersey, Law Division — Somerset County.

Decided September 9, 1977.

*371 Richard H. Thiele, Jr., for plaintiff (Wharton, Stewart & Davis, attorneys).

William L. Dill, Jr., for defendant (Stryker, Tams & Dill, attorneys).

*372 GAYNOR, J.C.C. (temporarily assigned).

In this action the plaintiff seeks to recover accidental death benefits provided by several policies issued by the defendants upon the life of plaintiff's husband, Stanley Gottfried. The defendants have refused payment of such benefits on the ground that the insured's death did not occur under such circumstances as to entitle plaintiff to the accidental death benefits under the policies.

The facts giving rise to this controversy are not in dispute. The insured died suddenly at the age of 44 on May 5, 1974 as a result of a heart attack. He had no indication of any heart disease prior to the fatal attack and, in the summer of 1973 had been pronounced in sound physical condition, except for slightly elevated blood sugar, after undergoing a complete physical examination. While a youth, the insured had been an active participant in sports and for some years prior to his death regularly played tennis, as well as engaging in other athletic activities. At the time of his death, Mr. Gottfried was employed by The Singer Company as the Comptroller of one of the company's plants. However on the morning of May 4th, 1974 he had informed his superior that he was resigning because of his dissatisfaction with his progress in the company.

On the evening of May 4, 1974, he attended an informal dinner party in the company of his wife at the home of friends in Bridgewater Township. He had a drink or two and a light supper. After dinner, three of the men, including Mr. Gottfried, decided to play basketball with a group of teenagers in attendance utilizing the tennis court owned by the host. The game commenced about 11:00 p.m. and continued for a half hour or more. It was a vigorous game, with the three men competing against three boys. After the game the decedent upon returning to the residence, appeared to be perspiring profusely. He sat down, asked for a towel to wipe his perspiration and, while the towel was being obtained, slumped over unconscious. Physicians in the area promptly responded, and Gottfried was *373 transported directly to the Somerset Hospital where he was pronounced dead at 12:03 a.m. on May 5, 1974.

No autopsy was performed, and the death certificate indicated the cause of death as an acute myocardial infarction due to arteriosclerotic cardiovascular disease. This cause of death was confirmed by the opinion testimony of a physician, Dr. D. Goodman Rowland. It was also Dr. Rowland's opinion that the precipitating factors of the insured's death were an underlying coronary arteriosclerotic condition and the exertion experienced in the basketball game. Dr. Rowland opined that it was the stress of the physical activity superimposed upon the underlying condition which resulted in the fatal occlusion, and it was only because of such stress that the insured met his death on May 5th. He also admitted that, without the existing arteriosclerotic condition, the physical stress of the basketball game would not have caused the insured's death.

Mr. Gottfried was insured under a Group Policy issued by Prudential Insurance Company of America to The Singer Company. This policy contained an Employee Group Accident Loss Insurance Rider which provides:

ACCIDENT LOSS BENEFITS
If an employee, while insured under this Rider, sustains accidental bodily injuries and within the period of ninety consecutive days following the date upon which such injuries are incurred (said period hereinafter referred to as the `Accident Loss Period'), suffers the loss of life as a direct result of such injuries and independently of all other causes, the Insurance Company will, subject to the provisions hereinafter stated, pay in one sum to the Employee's Beneficiary, the amount provided for such loss.
EXCLUSIONS
THE INSURANCE PROVIDED HEREUNDER DOES NOT COVER ANY LOSS WHICH RESULTS ... (b) DIRECTLY OR INDIRECTLY FROM BODILY OR MENTAL INFIRMITY OR DISEASE OR MEDICAL OR SURGICAL TREATMENT THEREOF ...

*374 Mr. Gottfried was also the insured under four policies issued by the Penn Mutual Life Insurance Company. The provisions of these policies applicable to the subject action provide:

THE PENN MUTUAL LIFE INSURANCE COMPANY agrees, subject to the terms and conditions of this agreement, to pay the Accidental Death Benefit upon a receipt of due proof that the death of the insured resulted directly and independently of all other causes from accidental bodily injury evidenced by a visible contusion or wound on the exterior of the body (except in the case of a drowning or internal injury revealed by an autopsy) and that such death occurred within 90 days after such injury was sustained and before termination of this agreement .. .
Provided further however, that no benefit shall be payable under this agreement if death results directly or indirectly from (1) illness or disease of any kind or from physical or mental infirmity ...

It is the plaintiff's contention that the circumstances of the insured's death are such as to bring it within the terms of the above quoted provisions of the subject policies and accordingly she is entitled to the supplemental benefits payable thereunder.

The defendants assert that the death of Mr. Gottfried was brought on by reason of exertion from activity voluntarily pursued, without any unexpected or unforeseen event occurring beyond the injury itself, and therefore the fatal myocardial infarction which he suffered was not within the coverage of the policies providing benefits for death resulting from accidental bodily injury.

Plaintiff's position is based upon an asserted distinction between the controlling words in the accident benefit clauses of the subject policies, i.e., "accidental bodily injury" and policy provisions conditioning accident benefits upon "bodily injuries effected through accidental means." Plaintiff acknowledges that when the insuring contract contains the "accidental means" language, coverage is intended only where the injury is the result of some unforeseen or unexpected event producing the injury, and that a heart attack brought about by exertion from activity voluntarily engaged in, and in which nothing unexpected or unforeseen occurs beyond the injury itself, would not be *375 covered for accidental benefits under a policy containing such language. However, plaintiff asserts that the key language contained in the subject policies, namely "accidental bodily injuries" provides coverage for accidental results, and that an unexpected heart attack consequent upon physical exertion is a resulting accidental injury to the body. Thus, it is argued that such coverage is not dependent upon some unusual or untoward event occurring beyond the injury itself. Plaintiff equates "accidental bodily injury" with "accidental result," and suggests that prior decisions, which denied recovery in factual circumstances similar to the case sub judice

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Bluebook (online)
414 A.2d 545, 173 N.J. Super. 370, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gottfried-v-prudential-insurance-co-of-america-njsuperctappdiv-1977.