Summary of Opinion: Mary Gorski v. New York Life Insurance Company (Supreme Judicial Court of Massachusetts, 1943)

Factual and Procedural Background

The plaintiff, Mary Gorski, the beneficiary named in two life insurance policies issued by New York Life Insurance Company on the life of her husband, sought to recover the double indemnity amounts provided by each policy. The policies (identical in form except for amounts) provided on their first page for payment of double indemnity "if such death resulted . . . from accidental means as defined in and subject to the provisions set forth under 'Double Indemnity.'" The double indemnity provision on the second page defined such accidental death as death resulting "directly and independently of all other causes from bodily injury effected solely through external, violent and accidental means and occurred within ninety days after such injury" and then contained a proviso excluding payment if death resulted, directly or indirectly, from nine enumerated causes (including self-destruction/suicide).

Each count of the plaintiff's declaration incorporated the policy abstracts but did not allege that the insured's death was not due to any of the specific causes listed in the proviso. The defendant demurred to the declaration. At a hearing on demurrer, the trial judge sustained the demurrer on the ground that the declaration failed to negative the excluded causes and reported the ruling to the Supreme Judicial Court. The only question presented on appeal was whether the declaration stated a good cause of action for double indemnity without negativing suicide and the other causes named in the proviso.

Legal Issues Presented

Whether a beneficiary's declaration seeking double indemnity under a life insurance policy that (1) references double indemnity on the first page and (2) defines and limits double indemnity on the second page by a single sentence that both defines covered accidental deaths and expressly excludes certain causes, is sufficient when the declaration does not allege that the insured's death was not the result of any of the specifically enumerated excluded causes (including suicide).

Arguments of the Parties

The opinion does not contain a detailed account of the parties' legal arguments.

Table of Precedents Cited

Precedent	Rule or Principle Cited For	Application by the Court
Sohier v. Norwich Fire Ins. Co. 11 Allen, 336.	Cited as authority supporting the court's rule of construction regarding insurance provisions and the necessity of negativing exceptions.	Relied on to support the conclusion that failure to allege that death did not result from excluded causes renders the declaration defective.
Leland v. United Commercial Travelers of America, 233 Mass. 558.	Cited as authority supporting the court's rule of construction regarding insurance provisions and the necessity of negativing exceptions.	Used with other authorities to affirm that the proviso-exceptions must be negatived in the pleading where the policy defines coverage and exclusions in the same clause.
Lunt v. Aetna Life Ins. Co. 253 Mass. 610.	Cited as authority supporting the court's rule of construction regarding insurance provisions and the necessity of negativing exceptions.	Included among cases supporting the ruling that the declaration was defective for failing to negative excluded causes.
Brown v. Boston Casualty Co. 295 Mass. 298.	Cited as authority supporting the court's rule of construction regarding insurance provisions and the necessity of negativing exceptions.	Relied upon as part of the body of authority affirming the court's interpretive approach and conclusion.
Sullivan v. Ward, 304 Mass. 614.	Cited as authority supporting the court's rule of construction regarding written instruments (including insurance policies).	Cited to bolster the proposition that the policy sentence defining coverage and exclusions must be read in its entirety and that excluded causes are not within coverage.
Williams v. Hingham Quincy Bridge Turnpike Corp. 4 Pick. 341.	Cited for the general rule of construction applicable to written instruments and statutes (not confined to insurance contracts).	Applied to justify reading the sentence as a whole to determine what risks were within and what were excluded from coverage.
Smith v. Hill, 232 Mass. 188.	Cited in support of the general rule of construction for written instruments.	Included among authorities that endorse the court's interpretive methodology and outcome.
Commonwealth v. Lee, 247 Mass. 107.	Cited in support of the general rule of construction for written instruments.	Used with other cases to confirm the rule that exceptions stated in a defining clause must be treated as exceptions to coverage.
Ansell v. Boston, 254 Mass. 208.	Cited in support of the general rule of construction for written instruments.	Relied on as part of the authority for the court's interpretive conclusion.
Commonwealth v. Sokorelis, 254 Mass. 454.	Cited in support of the general rule of construction for written instruments.	Included among precedents affirming the interpretive approach applied by the court.
Garvey v. Wesson, 258 Mass. 48.	Cited in support of the general rule of construction for written instruments.	Used to support the court's conclusion that the proviso enumerated causes outside the coverage.
Bramley v. White, 281 Mass. 343.	Cited in support of the general rule of construction for written instruments.	One of the authorities cited to sustain the court's interpretive ruling.
O'Reilly v. Irving, 284 Mass. 522.	Cited in support of the general rule of construction for written instruments.	Relied upon collectively to affirm that the exclusionary language must be negatived in the pleading where appropriate.
Frost v. Hunter, 312 Mass. 16.	Cited in support of the general rule of construction for written instruments.	Included among the authorities supporting the court's interpretive principle and disposition.
Murray v. Continental Ins. Co. 313 Mass. 557, 560.	Cited (by the plaintiff) for the proposition that where a general insuring clause creates broad coverage and exceptions appear later, the burden of proving an exception may lie with the insurer.	Distinguished by the court: held inapplicable because, unlike Murray, the present policy did not create a broad general coverage on the first page and then carve out exceptions; instead the single sentence in the double indemnity clause both defined covered risks and excluded specified causes.

Court's Reasoning and Analysis

The court's analysis focused on contract interpretation and the allocation of pleading burden given the language and structure of the policies. The court observed that the promise of double indemnity on the first page did not by itself specify the scope of the risk assumed; that scope is defined only in the double indemnity provision appearing on the next page. The double indemnity sentence both defined the covered accidental death (death "directly and independently of all other causes from bodily injury effected solely through external, violent and accidental means" occurring within ninety days) and immediately, in the same sentence, excluded payment where death resulted, directly or indirectly, from certain enumerated causes (including self-destruction).

Because the same sentence defined what deaths were within the coverage and expressly excluded other causes, those excluded causes were never within the risk assumed by the company. The court held that the sentence must be read in its entirety and that the proviso enumerating exceptions operates as exceptions to the coverage defined in the clause. Consequently, where a claimant seeks recovery under the double indemnity clause, the claimant must allege and ultimately prove that the insured's death was not the result of any of the expressly excluded causes. The plaintiff's declaration failed to allege that the insured's death was not due to any of those excluded causes; therefore, the declaration did not state a good cause of action.

The court distinguished Murray v. Continental Ins. Co., 313 Mass. 557, on which the plaintiff relied, because in Murray the general insuring clause broadly covered losses subject to specified exceptions, placing the burden to prove exception upon the insurer; here, by contrast, the coverage and exclusions were contained within a single defining sentence, so that the policy never extended coverage to deaths resulting from the excluded causes.

Holding and Implications

Holding: The judgment of the trial court sustaining the demurrer to the declaration is affirmed. Order sustaining demurrer affirmed.

Implications: The immediate effect is that the plaintiff's declaration was held insufficient because it failed to allege that the insured's death was not the result of any of the causes expressly excluded in the double indemnity clause; as a result, the plaintiff may not recover on the pleadings as they stood. The opinion applies established rules of contract construction to insurance policy language and distinguishes prior authorities (notably Murray) where the structure of the policy placed the burden differently. The opinion does not announce a broader novel rule beyond applying the established principle that exclusions expressed within the defining clause of coverage must be negatived when necessary in pleading.

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MARY GORSKI vs. NEW YORK LIFE INSURANCE COMPANY.

Insurance, Coverage; Accident insurance; Life insurance: double indemnity. Pleading, Civil, Declaration. Evidence, Presumptions and burden of proof.

To recover under a policy of insurance providing on its first page for double indemnity if the death of the insured resulted "from accidental means as defined in and subject to the provisions set forth under `Double Indemnity,'" which provisions were set forth on the second page and provided in a single sentence for the payment of double indemnity upon proof of death resulting from accidental bodily injury as there defined, "provided, however, that such double indemnity . . . shall not be payable if the insured's death resulted, directly or indirectly, from" nine enumerated causes, the beneficiary, among other things, must allege and prove that the insured's death was not the result of any of such nine causes.

RONAN, J.

The plaintiff, the beneficiary named in two policies of insurance issued by the defendant upon the life of her husband, seeks to recover the amount named as double indemnity in each policy. The policies except as to amounts were identical in form. Each provided for the payment of a certain amount upon receipt of due proof of the death of the insured and twice that amount "if such death resulted . . . from accidental means as defined in and subject to the provisions set forth under `Double Indemnity.'" The next page of the policy contained the following provision: "The Double Indemnity Benefit specified on the first page hereof shall be payable upon receipt of due proof, on forms prescribed by the Company, that the death of the Insured resulted directly and independently of all other causes from bodily injury effected solely through external, violent and accidental means and occurred within ninety days after such injury . . . provided, however, that such Double Indemnity Benefit shall not be payable if the Insured's death resulted, directly or indirectly, from (a) self-destruction, whether sane or insane," or eight other specifically enumerated causes.

Each count of the declaration was based upon one of these policies and set forth the abstracts from the policies which have just been quoted, but neither count alleged that the death of the insured was not due to any of the specific causes mentioned in the proviso clause to which we have already referred. At a hearing upon a demurrer, the judge ruled in effect that the declaration was defective on account of the failure to allege that the death of the insured did not result from any of the causes included in the proviso clause and ordered the demurrer sustained. He then reported his ruling to this court.

The only question presented is whether the declaration sets forth a good cause of action upon the double indemnity provisions of these policies without negativing suicide and the other causes included in the proviso clause as the cause of the death of the insured.

The defendant agreed in the insuring clause on the first page of each policy to pay twice the face of the policy if death resulted from accidental means as defined in and subject to the provisions contained in that part of the policy which dealt with the double indemnity. Nothing more appeared upon the first page of the policy with reference to double indemnity. This provision did not impose any general or absolute obligation to pay double indemnity in every instance where the death of the insured resulted either immediately or remotely from accident. The scope of the company's liability to pay for an accidental death was not fixed by this provision. It did not agree to pay double indemnity for a death arising from any kind of an accident. It agreed to pay only when death was caused by accidental means as defined in the double indemnity clause. The provision appearing upon the first page of the policy designated the amount the defendant would pay, but it did not purport to establish therein the specific risk that the defendant assumed. The defendant did not undertake to cover all risks of accidental death, and then by a subsequent provision carve out of this coverage risks arising from certain causes. Here the coverage could not be ascertained without considering the double indemnity provision, which in fact is the only place in the policy where the extent and nature of the risk covered by the policy are stated and defined. The liability of the company is limited to a death resulting directly and independently of all other causes "from bodily injury effected solely through external, violent and accidental means . . . provided, however," that such indemnity shall not be payable if "death resulted, directly or indirectly," from suicide and other expressly enumerated causes. These particular causes are in terms excluded from the coverage of the risks. They were never included in that coverage, and it never applied to a death that might be caused by any of them. They never came within the scope of the defendant's liability. They are a part of the same sentence which completely and accurately defined the risks that were included in and those that were outside the double indemnity coverage. That sentence must be read in its entirety. It dealt with only a single subject. It drew the line separating risks that were within from those that were outside the field covered by the policy. The language and the structure of the sentence show that the risks that were enumerated and designated to be beyond the scope of the policy were exceptions to the coverage defined by the first part of the sentence. There was no error in ruling in effect that, because of the failure to allege that the death of the insured did not result from a cause not covered by the policy, neither count in the declaration set forth a good cause of action. Sohier v. Norwich Fire Ins. Co. 11 Allen, 336. Leland v. United Commercial Travelers of America, 233 Mass. 558. Lunt v. Aetna Life Ins. Co. 253 Mass. 610. Brown v. Boston Casualty Co. 295 Mass. 298. Sullivan v. Ward, 304 Mass. 614. This is in accord with the general rule of construction which applies to written instruments and statutes and is not confined to contracts of insurance. Williams v. Hingham Quincy Bridge Turnpike Corp. 4 Pick. 341. Smith v. Hill, 232 Mass. 188. Commonwealth v. Lee, 247 Mass. 107. Ansell v. Boston, 254 Mass. 208. Commonwealth v. Sokorelis, 254 Mass. 454. Garvey v. Wesson, 258 Mass. 48. Bramley v. White, 281 Mass. 343. O'Reilly v. Irving, 284 Mass. 522. Frost v. Hunter, 312 Mass. 16.

The instant case is distinguishable from Murray v. Continental Ins. Co. 313 Mass. 557, 560, and cases cited therein, upon which the plaintiff relies. In the Murray case the risk assumed by the company was stated in the general insuring clause to be "against all direct loss and damage by `sprinkler leakage,' except as herein provided." The company there undertook in general terms to indemnify the insured against all loss and damage due to leakage from the sprinkler system, and the burden of proving that the damage arose from a cause that was excepted from this general coverage by a subsequent clause in the policy was held to be upon the company. Here, as already pointed out, the limitations of the risk were settled by a single sentence which separated the causes of death that were within from those that were without the policy.

Order sustaining demurrer affirmed.

GORSKI v. NEW YORK LIFE INS. CO