Interpretation of Insurance Contract Terms. Martha Frances purchased insurance coverage from Nationwide Mutual Insurance Co prior to going on a cruise. The policy covered "accidental bodily injury occurring anywhere in the world which arises solely from

Question

accident" and "is not contributed to by sickness, disease or bodily or mental infirmity." The policy also stated that if the injury resulted in the loss of life "within 180 days after the date of the accident," the company would pay the beneficiary $75,000. While on the cruise, Frances fell and broke her hip. She was immediately taken to a Florida hospital for surgery, during which she had a fatal heart attack. The death certificate described the cause of death as "terminal cardiac arrest due to or as a consequence of arteriosclerotic cardiovascular disease due to or as a consequence of previous

Answer 1

Interpretation of insurance contract terms
The trial court construed Frances's death as an "injury" (rather than a "loss from an injury") un-der the Nationwide insurance policy. The court noted that for payment, the policy required that an injury (1) "arises solely from accident" and (2) "is not contributed to by sickness, disease, or bodily or mental infirmity." Because Allison conceded that the death was in part caused by a bodily infirmity (arteriosclerosis), the court held that the death was not covered by the policy and granted summary judgment in favor of Nationwide. The appellate court reasoned that because the injury "was accidental, was not contributed to by disease or sickness, and occurred while the insured was riding as a passenger on an ocean liner," it constituted an "injury" under the policy. Frances's death was thus a "loss resulting from injury," because the death occurred within 180 days of the injury, as required by the policy, and was a result of the injury (Frances would not have died but for the surgery). Consequently, the appellate court held that "under the clear language of the policy" the death benefit should have been paid.