Labrecque v. Clarica Life Insurance Co.

[Indexed as: Labrecque v. Clarica Life Insurance Co.]

60 O.R. (3d) 223

[2002] O.J. No. 2354

Docket No. C36760

Court of Appeal for Ontario

McMurtry C.J.O., O'Connor A.C.J.O. and Borins J.A.

June 14, 2002 (orally)*

• Note: Reasons released June 19, 2002.

Insurance -- Life insurance -- Interpretation and construction -- Life insurance policy excluded coverage for accidental death "caused or contributed to, directly or indirectly, by physical or mental illness or treatment for the illness" -- Insured died during coronary bypass surgery due to failure of heart-lung pump -- Exclusion clause applied.

A life insurance policy excluded coverage for accidental death if the death was "caused or contributed to, directly or indirectly, by physical or mental illness or treatment for the illness". The insured died during coronary bypass surgery as a result of the failure of a heart-lung pump. The trial judge found that the exclusion clause did not apply. The insurer appealed.

Held, the appeal should be allowed.

The clear language of the exclusion applied to the circumstances of this case. Coronary bypass surgery cannot be performed without employing a heart-lung pump. Therefore, the "treatment for the illness" caused, or at least contributed to, the death of the insured. The insured's death, if not caused directly by the malfunction of the heart-lung machine, was contributed to indirectly by the machine's failure. [page224]

APPEAL from a judgment of Métivier J. (2001), 2001 28071 (ON SC), 54 O.R. (3d) 515 (S.C.J.) allowing an action against an insurer for payment of an accidental death benefit.

Alison A. Gilmour, for appellant.

Richard R. Marks, for respondent.

[1] Endorsement BY THE COURT (orally): -- The risk insured by the life insurance policy issued by the appellant was death "from an accident". However, the policy also provided that even though the insured died from an accident, there would be no coverage if the accidental death "is caused or contributed to, directly or indirectly, by physical or mental illness or treatment for the illness". It is the application of this exclusion to the circumstances of this case that is the focus of this appeal.

[2] The illness from which the insured suffered was coronary artery disease. He required urgent treatment for that illness consisting of coronary artery bypass surgery. To perform the surgery it was necessary for the surgeon to use a heart-lung pump. The insured died during the surgery as a result of the failure of this machine.

[3] The trial judge found that the cause of death was the unexpected failure of the heart-lung pump. She found that this was an accident. However, she found that the exclusion in the policy did not apply. It appears that in her view the death of the insured was not caused either directly or indirectly by the treatment for his illness. Accordingly, she required the appellant to pay the insured beneficiary the accidental death benefit contained in the insurance policy.

[4] Although the appellant takes no issue with the trial judge's finding that the insured's death was accidental, it takes the position that the trial judge erred in concluding that the exclusion did not apply to the circumstances of this case. We agree with the appellant's position.

[5] In our view, the trial judge erred in her interpretation and application of the exclusion in failing to recognize that an accidental death can be "caused or contributed to, directly or indirectly by . . . treatment for [an] illness". In finding that there was no causal relationship between the insured's death and his illness, or the treatment for his illness, the trial judge appears to have misapprehended both the evidence and the clear language of the exclusion. Thus, it cannot be said, as the trial judge did, that because the insured's death was accidental, the exclusion does not apply.

[6] In our view, the clear language of the exclusion applies to the circumstances of this appeal. The death of the insured [page225] occurred during the insured's surgical treatment for coronary artery disease. The death resulted from the malfunction of the heart-lung pump which was a necessary element of the surgical treatment. Coronary bypass surgery cannot be performed without employing a heart-lung pump. Therefore, the "treatment for the illness" caused, or at least contributed to, the death within the meaning of the exclusion.

[7] The exclusion is broadly drafted. If death is "caused or contributed to, directly or indirectly" by an accident while the insured is being treated for an illness, the risk is not covered. There can be no doubt that the insured's death, if not caused directly by the malfunction of the heart-lung machine, was contributed to indirectly by the machine's failure.

[8] Therefore, we would allow the appeal, set [aside] the judgment and order that the respondent's action be dismissed. The appellant is content that the appeal be allowed without costs, both of the trial and the appeal.

Appeal allowed.