246 P.3d 1
Or. Ct. App.2010Background
- Plaintiff had a disability policy with lifetime benefits for disability from accidental injury, but benefits end at 65 for disability from sickness or disease.
- Plaintiff's cognitive impairment was attributed to chronic nocturnal hypoxia from sleep apnea, worsened by episodes before treatment.
- Defendant terminated benefits at age 65 after treating the impairment as arising from sleep apnea (a disease) rather than an injury.
- Plaintiff sought reinstatement of total disability benefits and a lifetime declaratory judgment; defendant moved for summary judgment.
- The trial court ruled the disability stemmed from disease (sleep apnea) and granted summary judgment for defendant.
- The court of appeals analyzed whether the impairment could plausibly be an accidental bodily injury under the policy's definition of injury.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether brain damage from hypoxia is an accidental injury | Boly argues injury because hypoxia was an external consequence of an external event (breathing failure). | Revere contends impairment results from sleep apnea as a disease, not an accidental bodily injury. | No; brain damage not accidental injury under policy. |
| Whether the term 'accidental' should be construed against the insurer | Ambiguity could favor the insured; common understanding may treat the injury as accidental. | Accident term not defined; court should apply common understanding with restraint against broad coverage. | Ambiguity not shown; court adopts common-meaning interpretation and affirms denial. |
Key Cases Cited
- Botts v. Hartford Accident & Indem. Co., 284 Or. 95 (1978) (define accident by common understanding; not every unforeseen result qualifies)
- Holloway v. Republic Indemnity Co. of America, 341 Or. 642 (2006) (apply policy definition when provided; otherwise interpret term)
- Thompson v. Gen. Ins. Co. of America, 226 Or. 205 (1961) (assign to word 'accident' its common meaning)
- Botts v. Hartford Acc. & Indem. Co. (additional listing for clarity), 284 Or. 95 (1978) (see Botts for common-meaning framework)
- Totten v. New York Life Ins. Co., 298 Or. 765 (1985) (interpret terms in policy by ordinary use in context)