Sanders v. Oregon Pacific States Insurance

821 P.2d 1119, 110 Or. App. 179, 1991 Ore. App. LEXIS 1865
Court of Appeals of Oregon·Decided December 11, 1991·No. 89-08-32835; CA A65627·Published·Cited by 5 cases

Opinions

[181] RICHARDSON, P. J.

Plaintiff is the beneficiary of Shannon Sanders, who was an insured under a group insurance policy issued by defendant insurer. The policy contained a term life benefit of $10,000 and, under a separate coverage schedule for accidental death, dismemberment and loss of sight, it also insured Shannon for an additional $10,000 in case of accidental death. On April 1,1989, she changed jobs and ceased to be eligible for inclusion in the group. Under ORS 743.333 and ORS 743.339, she had 31 days within which to exercise the right to convert from the group to an individual policy. If she were to die within the 31-day period, the same coverage would be available as if she had fully exercised her conversion rights. On April 12, before the 31-day period had expired, she was killed in an accident.

Plaintiff made claims for both the term life benefit and the accidental death benefit. Defendant allowed the former but denied the latter, asserting that the conversion rights under the statutes and the policy did not include the accidental death benefit. Plaintiff then brought this action to recover that benefit, and the trial court entered judgment in his favor. Defendant appeals. The question is close, and the arguments for both answers have been ably presented by the parties. We conclude that neither the statutes nor the policy provide for the conversion of the accidental death coverage, and we therefore reverse.

ORS 731.170 provides:

“(1) ‘Life insurance’ means insurance on human lives and every insurance appertaining thereto and includes the granting of endowment benefits, additional benefits in event of death or dismemberment by accident or accidental means, additional benefits in event of the insured’s or premium payor’s disability and optional modes of settlement of proceeds of life insurance including annuity benefits payable under such a settlement provision. ‘Life insurance’ does not include workers’ compensation coverages.
“(2) For convenience, reference to ‘life insurance’ in the Insurance Code includes fife insurance as defined in subsection (1) of this section and annuities as defined in ORS 731.154, except if the inclusion of annuities obviously is [182] inapplicable or if the context requires, or the Insurance Code provides, otherwise.”

ORS 743.333 provides, as material:

“A group life insurance policy shall contain a provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within 31 days after such termination * * *.”

Under ORS 743.339, if a person with conversion rights dies during the 31-day period and before a conversion policy has been issued, the insurer must pay the “amount of life insurance which the person would have been entitled to have issued under such individual policy.”

Plaintiff argues, and the trial court concluded, that accidental death benefits constitute “insurance on human lives” within the meaning of ORS 731.170 and, as such, are subject to the conversion rights delineated in ORS 743.333 and ORS 743.339. Defendant argues that accidental death coverage is among the “supplementary benefits” that ORS 743.333 provides need not be included in a converted individual life insurance policy. Plaintiff responds, inter alia, that ORS 743.333 expressly excludes the disability coverage under group life policies from an insured’s conversion rights; that, because accidental death coverage as well as disability coverage are mentioned in ORS 731.170 as species of life insurance, ORS 743.333 would also have been express in excluding accidental death coverage if that had been the legislature’s intent; and that accidental death coverage cannot be understood to be a “supplementary benefit” in the context of a statute that pertains to insurance against the loss of human life, because it is insurance against the loss of human life. Neither party relies on or points to legislative history that might assist in resolving the question.

Plaintiffs argument emphasizes the logical connection between the nature and purpose of accidental death benefits and the definitional label “life insurance.” However, [183] the Insurance Code is not as logical — or as compartmentalized — as plaintiffs argument is. For example, disability and dismemberment are included in ORS 731.170 as coverages that may be included in “life insurance” policies, and accidental death coverage is a form of “health insurance” under ORS 731.162, as well as a form of life insurance under ORS 731.170. See also ORS 731.150.

Free access — add to your briefcase to read the full text and ask questions with AI

Sanders v. Oregon Pacific States Insurance, 821 P.2d 1119, 110 Or. App. 179, 1991 Ore. App. LEXIS 1865 (Or. Ct. App. 1991).

821 P.2d 1119 (Sanders v. Oregon Pacific States Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Tualatin Valley Housing Partners v. Truck Insurance Exchange
144 P.3d 991 (Court of Appeals of Oregon, 2006)
State v. Walker
86 P.3d 690 (Court of Appeals of Oregon, 2004)
State v. Mayorga
62 P.3d 818 (Court of Appeals of Oregon, 2003)
Sanders v. Oregon Pacific States Insurance
840 P.2d 87 (Oregon Supreme Court, 1992)
Sanders v. Oregon Pacific States Insurance
821 P.2d 1119 (Court of Appeals of Oregon, 1991)