A claim for accidental death benefits was dismissed where the insured suffered a cardiac event and ultimately drowned while fishing.
Insurance law – Accident and sickness insurance – Benefits – Exclusions – Pre-existing condition – Interpretation of policy
Downey v. Scotia Life Insurance Co.,  A.J. No. 1118, 2020 ABQB 638, Alberta Court of Queen’s Bench, October 21, 2020, N.J. Whitling J.
The plaintiff sought judgment for payment of benefits under two policies of accidental death insurance issued by the insurer (the “Policies”) following the death of her husband. The plaintiff’s husband was the named insured and the plaintiff was a beneficiary on the Policies.
The Policies provided coverage for death caused by accidental bodily injury which was defined in the policy as bodily injury effected directly and independently of all other causes by an accidental, external, violent and visible means. The Policies excluded coverage for death resulting directly or indirectly from or in any manner or degree associated with or occasioned by “any naturally occurring condition, illness or disease or bodily or mental infirmity of any kind, or medical or surgical treatment for any such condition, illness, disease or infirmity”.
The Insured was on a boat fishing. He clutched his chest and stated he could not breathe. He slumped onto the side of the boat which caused the boat to capsize. The Insured was thrown into the water and was unable to swim despite being a competent swimmer. In the coroner’s report, the immediate cause of death was noted as asphyxia and drowning was noted as an antecedent cause. The coroner also noted myocardial infarction as a significant condition contributing to death.
The plaintiff’s expert was of the opinion that the only physiological cause of death was drowning as there was no evidence the Insured suffered a myocardial infarction. On cross-examination, the plaintiff’s expert acknowledged it was more probable than not that the Insured suffered an event related to ischemic heart disease. The insurer’s expert opined that the Insured suffered some cardiac event and as a result of this could not function sufficiently well to swim. While the terminal event was drowning, it was precipitated by a cardiac event.
The Court accepted that on a balance of probabilities the Insured died from drowning only. The Court also found that the Insured suffered some cardiac event which caused him to slump over, capsize the boat and be thrown into the water.
The Court reviewed relevant authorities for the principle that under an accident policy there must be a “mishap or untoward event” to which a death can be attributed. The mere presence of a disease or departure from a normal state of health leading to a loss does not necessarily negate the presence of an accident. The Court held that the Insured did not pass away due to a naturally occurring internal condition and thus was within the coverage provisions of the Policies. However, the Policies’ exclusion clause excluded coverage in this case as the Insured’s death was associated with or occasioned by his cardiac event.
The plaintiff’s claim was dismissed.
This case was digested by Dominic Wan, and first published in the LexisNexis® Harper Grey Insurance Law Netletter and the Harper Grey Insurance Law Newsletter. If you would like to discuss this case further, please contact Dominic Wan at firstname.lastname@example.org.
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