Moore v. Central American Life Ins. Co.

535 So. 2d 773, 1988 La. App. LEXIS 1749, 1988 WL 85573
CourtLouisiana Court of Appeal
DecidedAugust 17, 1988
Docket19715-CA
StatusPublished
Cited by4 cases

This text of 535 So. 2d 773 (Moore v. Central American Life Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Moore v. Central American Life Ins. Co., 535 So. 2d 773, 1988 La. App. LEXIS 1749, 1988 WL 85573 (La. Ct. App. 1988).

Opinion

535 So.2d 773 (1988)

James M. MOORE, Plaintiff-Appellant,
v.
CENTRAL AMERICAN LIFE INSURANCE COMPANY, Defendant-Appellee.

No. 19715-CA.

Court of Appeal of Louisiana, Second Circuit.

August 17, 1988.

*774 Hamilton & Carroll by O.N. Hamilton, Jr., Oak Grove, for plaintiff-appellant.

Blackwell, Chambliss, Hobbs & Henry by Sam O. Henry, III, West Monroe, for defendant-appellee.

Before HALL, SEXTON and LINDSAY, JJ.

LINDSAY, Judge.

The plaintiff, James M. Moore, appeals from a trial court judgment which denied his claim for death benefits under an accident policy issued to his late wife by the defendant, Central American Life Insurance Company. The trial court found that recovery was barred by an exclusionary provision in the policy which precluded the payment of benefits if the decedent was under the influence of intoxicating beverages at the time of injury. For the following reasons, we reverse the judgment of the trial court.

FACTS

Lilly Moore, the plaintiff's wife, took out an accident policy on herself which provided for death benefits of $5,000. The policy was issued by the defendant on May 1, 1983, and designated Mrs. Moore's husband as beneficiary.

The record reveals that on April 18, 1985, while shopping in the Big Star Supermarket in Bastrop, Mrs. Moore fell and hit her head on a shelf. She was admitted to Morehouse General Hospital in a semi-comatose state with a scalp laceration and hematoma. She was transferred to St. Francis Medical Center in Monroe on April 19, 1985, where she died the following day.

Mr. Moore testified that his wife had been ill with diarrhea for several days before her fall. This was corroborated by a prescription for Paregoric Kaopectate written for Mrs. Moore and filled on April 11, 1985. Mr. Moore further testified that his wife was of German extraction and was accustomed to drinking beer. Mr. Moore testified that he was unaware of any alcoholic consumption by his wife on the day of her fall. He also stated that he had not consumed any alcohol for a week prior to his wife's fall.

The manager of the Big Star Supermarket, Jerry D. Moore, testified that Mrs. Moore was a frequent customer. He stated that on the day of the accident he saw her in the store prior to her fall. He stated that "[t]hat day I didn't know is [sic] she was just real sick or what it was but she was staggering real bad." He also indicated that he was aware that she "walked peculiar almost all the time." (Mrs. Moore, in fact, walked with a limp.) He admitted that Mrs. Moore exhibited no other possible signs of intoxication that day.

While Jerry Moore did not actually see Mrs. Moore fall, he said that he heard the sound of her head striking the shelf. He and another man rushed to her aid. Mrs. *775 Moore was unconscious and bleeding from a head wound. Jerry Moore noticed blood on the bottom shelf where she had struck her head. He immediately summoned an ambulance.

Another supermarket customer who observed Mrs. Moore prior to her fall was Bobby Wayne Lucas. He testified that he knew the Moores because the plaintiff is a stepbrother of his father's cousin. He stated that he was aware that Mrs. Moore walked with a limp. He and his wife observed Mrs. Moore in the parking lot prior to entering the store. He testified that he had not seen Mrs. Moore in a while and wondered if she had been drinking. He further stated that his observation of her in the parking lot convinced him that she had not. He testified that he had seen Mrs. Moore stagger while intoxicated in the past. When he saw her in the parking lot moments before her fall, she was walking "straight," albeit with her usual limp.

Later, Mr. Lucas became aware of a commotion in the store and learned that Mrs. Moore had fallen. He stated that when he knelt down to see if he could assist in her care, he did not smell any odor of alcohol. Like Jerry Moore, he observed blood and hair on the shelf where she struck her head.

Mrs. Moore's fall occurred at about 5:00 p.m. Her medical records from Morehouse General Hospital indicate that she arrived at its emergency room at 5:25 p.m. She was in a confused, semi-comatose state. Although she was able to speak, she was incoherent.

Her husband arrived at the hospital shortly after her admission, but he left soon thereafter. Mr. Moore testified that he left after being reassured of his wife's condition by her physician. In his notes, Dr. Joe B. Williams stated: "Attendant who reportedly was her husband was inebriated and seemed disinterested in her condition. He left the hospital soon after she was admitted."

After her arrival at Morehouse General Hospital, testing revealed that Mrs. Moore had a blood alcohol level of 0.09 percent. While the laboratory slip was stamped 7:48 p.m., it is unknown whether that time signifies when the blood sample was drawn from the patient, when the blood sample was received in the laboratory, or when the testing was completed.

During the evening hours following Mrs. Moore's admission, she became deeply comatose. The next morning, her physicians decided to move her to a facility where neurosurgical treatment would be available. She was promptly transferred to St. Francis Medical Center in Monroe, Louisiana.

By the time of Mrs. Moore's transfer to St. Francis Medical Center on April 19, 1985, she was already displaying signs of impending brain death. On April 20, 1985, Mrs. Moore was pronounced dead after all the criteria for brain death had been met.

Dr. James W. Geisler, a pathologist, performed an autopsy. The doctor reported his final pathological diagnosis as extensive intracerebral, intracerebellar, intrapontine, and intraventricular hemorrhage. He testified that the extensive hemorrhage was in excess of what might be expected from the trauma she sustained. However, he further testified that it would be impossible to tell whether the hemorrhage was due to trauma or if it was spontaneous. (Mrs. Moore's medical records reveal that she was also examined by Dr. D. Hammett at St. Francis Medical Center. Dr. Hammett's report states that it was his impression that the degree of intercerebral injury appeared to be in proportion to the degree of trauma found.)

Secondary findings of Dr. Geisler's autopsy revealed that Mrs. Moore had severe nutritional cirrhosis and acute and chronic pancreatitis. Dr. Geisler testified that the cirrhosis had been present for several years, but it was "quite likely" that Mrs. Moore was unaware of its presence when she obtained the instant policy in 1983. He testified that persons suffering from cirrhosis "might be under the influence of alcohol" at a lower blood level than persons not so afflicted. He further stated that the pancreatitis was secondary to either alcoholism or gall stones.

*776 Following Mrs. Moore's death, the plaintiff filed a claim with Central American Life Insurance Company as the beneficiary under her accident policy. Mr. Tex Kilpatrick, president of the defendant insurance company, declined to pay the claim because the company had information indicating: (1) that Mrs. Moore had died of a seizure or stroke, not of external, violent or accident means as covered by the accident policy; (2) that Mrs. Moore had falsely answered health questions on her application for insurance; and (3) that Mrs. Moore was under the influence of intoxicating beverages at the time of her injuries.

Mr. Moore filed suit against the insurance company on April 3, 1986. He sought the $5,000 death benefits, together with legal interest.

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Bluebook (online)
535 So. 2d 773, 1988 La. App. LEXIS 1749, 1988 WL 85573, Counsel Stack Legal Research, https://law.counselstack.com/opinion/moore-v-central-american-life-ins-co-lactapp-1988.