On June 4, 1953, the accused, a fraternal benefit association issued a certificate

Posted On: April 22, 2012 by Stephen Bilkis

On June 4, 1953, the accused, a fraternal benefit association issued a certificate of membership in the amount of $4,000 to a postal clerk member of the New York Branch of the Association. While alive, he is entitled to participate in the benefits of the Benefit Fund in case he sustained various bodily injuries through external violent and accidental means. The injuries should not be the result of his own vicious or intemperate conduct because it would wholly and continuously disable him from performing the duties of a Postal Transportation Clerk. If death shall result from such injuries alone within one year from the date of the injury, the Association will pay $4,000 to his step-daughter.

On March 31, 1962, while the contract was in force and effect, the postal clerk died. He was then 80 years of age and a patient at the Veterans Administration Hospital in New York. He had been confined for approximately 22 months prior to his death. Following notification of death and submission of proof by his stepdaughter and a refusal by the association to pay the benefit, the instant action was commenced. The association at trial conceded the existence of the contract and the status of postal clerk as its beneficiary. It denied and contested however the accidental death as defined in the policy.

Thus, the sole issue tried was whether or not the postal clerk’s death was caused by an accident within the meaning of the policy. The stepdaughter’s proof consisted of a death certificate and the testimony of a medical doctor. The death certificate issued by the Office of Vital Records of the Department of Health revealed that after an autopsy was performed, it was found out that the cause of death was Cerebral Arteriosclerosis caused by accidentally swallowing of sock. It was offered in evidence by the complainant to establish the cause of death of the postal clerk. In view of the association’s objection to accept the death certificate in evidence for such purpose, it was accepted by the Court only to establish the fact of death. A decision was reserved on its admissibility to show the cause of death. The medical doctor who testified had 36 years of practice and estimated treating about a thousand cases of cerebral arteriosclerosis during his career. He did not testify to treating the postal clerk during his lifetime or attending him at the time of his death or thereafter. However, the doctor stated that the death caused by suffocation due to the presence of a sock in a man’s pharynx is considered death by external and violent means.

Following this the stepdaughter rested her case. The association rested without offering any proof. It thereafter moved to dismiss on the ground that the stepdaughter failed to prove a case. The decision was reversed to await the submission of a memoranda which the court acknowledges and thanked the counsel for the scholarly excellence of their labors.

A threshold and crucial issue which the court must decide is whether or not a properly certified copy of a death certificate is admissible to establish the cause of death. If it is not admissible, the stepdaughter may not recover because of the failure of proof. If it is admissible, the stepdaughter has overcome the first and most formidable obstacle to obtain judgment.
Summarizing therefore, we see that if the death certificate is inadmissible in a given case to establish the cause of death, it is because of the rule of privileged communication which prevents disclosure of facts learned by a physician from a patient for the purpose of treatment or because of the hearsay rule. The former rule, however, may be waived in an appropriate case and the latter rule is profoundly affected by various statutes. In addition, it has been held that the facts disclosed on an autopsy are not subject to the privilege rule, since there is no confidential relationship between the autopsy surgeon and a deceased.

The association contends, however, that if the certificate is admissible to show the cause of death, it is equally admissible to establish other facts contained therein. While the Court do not quarrel with the proposition, it is subject to the limitation stated that such facts must be ones directly ascertained by the maker and of such a nature that a court is justified in accepting them. The association in Manhattan and Long Island claims that such facts appear in the certificate where it is indicated that cerebral arteriosclerosis was a contributing cause of death and such facts defeat the stepdaughter’s claim since an accident was not the sole cause. The finding of cerebral arteriosclerosis, which undoubtedly was ascertained as a result of autopsy which the certificate indicates was performed, appears on a part of the certificate not concerned with the immediate cause of death, but the secondary finding, which is held equally admissible, does not, however, militate against a conclusion that the sole cause of death was suffocation from a foreign body in the pharynx. It frequently happens that accident and disease are both present in cases arising under accident insurance policies, and the question arises as to whether death in such cases is caused by the accident or disease. The courts are agreed that, in the absence of any provision in the policy specifically controlling the matter, whether death is deemed caused by accident alone depends upon the factor of proximate cause. It follows from the general principle that if the insured is suffering from a pre-existing disease or infirmity at the time of an accident does not preclude recovery under the policy, and if the pre-existing disease has no causal connection with the harm suffered as a result of the accident and in no way produces the death or disability, or if the accidental injury has caused death or disability only and independently of the disease, then liability exists.

The stepdaughter was required to prove that since her status as beneficiary and the existence of the contract were conceded and the death certificate was admissible to prove the fact of death, she had to establish that her stepfather’s death by accident occurred within one year of the accident and not due to accidentally administered poison or any injury causing matter, that there are no visible external marks of injury and that death is not voluntary inflicted or a result of a surgical operation.

When death is shown to result from external violence, there is a presumption that it was due to accidental means, so as to support a recovery in the absence of affirmative proof to the contrary by the insurer since there is a presumption in the law against suicide. The policy denies coverage where death results from poison or other injurious matter taken or administered accidentally or otherwise. The clause like other exclusionary provisions is to be strictly construed, and in so doing there is no basis to deny recovery. A sock quite obviously does not come within the definition of injurious matter. Furthermore, the balance of the language used in this clause makes it clear that a sock was not intended to come within the definition of poison or other injurious matter since it could not be taken or administered.
In conclusion, the stepdaughter has met her burden of proof not contradicted by any evidence of the association. Judgment is in favor of the stepdaughter.

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