Martin v American International Assurance Life Co [2003] SCC [accidental death benefit]

Martin v American International Assurance Life Co [2003] SCC [accidental death benefit]

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  SCC held that death is accidental even if insured can prevent death by greater care, if mishap was reasonably foreseeable according to tort law, if insured is engaged in risky activity
  
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  Case law assigns generous meaning to “accidental”, in the absence of language to the contrary in the insurance contract itself
  
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    i.e. almost everything is an accident, and insurer must create a more strenuous definition in the policy if they want the definition altered
    
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  Rationale for the definition of accident
  
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    When an event is unlooked for, unexpected or unintended by insured, it is fortuitous
    

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  Kate found this case a bit off, she sees insured as courting the risk
  
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    Insured was a doctor, he would have known the risks of using the drug
    

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  Insured contracted rare form of herpes from unprotected sex, he was paralyzed from waist down, he was aware he might contract some STD but not aware his partners had any disease, he argued that herpes was an accident since it was unexpected. He claimed under his group insurance policy. Insured also argued that Martin did away with the need to deal with “accidental means”
  
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    TJ held that to determine whether given means is accidental, must consider whether consequences were unexpected. Insured’s sexual conduct was risky, but did not preclude consequences of the activity. Court held that diseases that do not result from an accidental cause are not accidental.
    
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    CA held that accident is distinct from a disease, the way insured got the disease was not accidental. Court followed the principle of “if there is no accident in the means, there was no accident in the result”
    
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      But this didn’t mean that diseases can’t be accidental – e.g. when viscitudes of climate cannot properly be said to be accidental, unless exposure itself is brought upon by circumstances that give it a character of an accident.
      
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      If mariner catches a cold and dies, death is not accidental. But if mariner was obliged by shipwreck to depart the ship, and be exposed to open seas, then died, his death might be held to be the result of an accident
      

English case

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  Man died after working with wool in D’s factory, in contact with bacteria that developed into anthrax. HL held that the fact that accident causes injury in shape of disease doesn’t render the cause something that is not an accident
  
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  Dissent held that if man dies of infectious disease, doctor only has to prove that the bacteria caused the death to make it an accident
  

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  Deals with misrepresentation, ambiguity, and materiality
  
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  Important takeaways from this case
  
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    Test for misrepresentation
    
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    Ambiguity
    
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    Materiality: established for insurance by asking the question on the insurance application
    
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    What kind of evidence can you bring in litigation?
    
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    Courting the risk
    

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  Facts: D is named beneficiary, K is life insured. D argued that policy couldn’t be voided since questions on policy were ambiguous, which influenced K’s answers. On July 4, 2001, K saw her fam doctor (in background, she had history of hypertension and fam history was significant for heart attacks). Doctor diagnosed a cough, she was sent off for chest x-ray. X-ray revealed she had a large heart. On July 30, 2001 she went over result of x-rays, she was advised that heart was slightly large but would be monitored. On May 27, 2002 K gets second x-ray, showed her heart was upper limits of normal but no other evidence of heart disease, then sent her for ECG on Aug 4, 2002. Results of ECG showed that K had a heart attack, but doctor didn’t follow up with K. One month after ECG, K applied for life insurance (Kate says this raises the issue of coming to the risk). In Oct 2002, application accepted and policy issued after insurer had doctor examine her. She died a few weeks later. On the application, K disclosed ECG, but not both x-rays. Policy was voided on basis that K didn’t disclose her enlarged heart and both x-rays.
  
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  At trial, insurer had doctor testify as to risk w.r.t. x-ray, TJ accepted the doctor’s evidence, but then said that questions were ambiguous, and accordingly, questions weren’t material. Held that beneficiary should receive coverage
  
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  On appeal, TJ’s decision overturned
  
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    Evidence called came from fam doctor who was sympathetic to K, insurer’s senior underwriter (doctor) who testified if insurer knew K’s real state of health insurance would be denied.
    
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    Note: underwriter who approved the policy didn’t testify at trial