246 P.3d 1
Or. Ct. App.2010Background
- Boly insured under a disability policy with lifetime benefits for disability from an accidental injury, but benefits end at 65 for disabilities due to sickness or disease.
- Boly’s cognitive impairment stemmed from nocturnal hypoxia linked to sleep apnea, occurring prior to diagnosis and treatment.
- On Boly’s 65th birthday, the insurer discontinued benefits, treating the impairment as arising from disease (sleep apnea).
- Boly sought reinstatement of total disability benefits and a lifetime declaratory judgment; insurer moved for summary judgment.
- The trial court held the impairment due to sleep apnea (disease) and granted summary judgment for the insurer.
- On appeal, the issue is whether Boly’s disability results from an “injury” (accidental bodily injury) or from a disease, under the policy terms.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does sleep apnea–related cognitive impairment constitute an injury | Boly argues impairment arose from accidental brain injury due to hypoxia. | Reinsurance contends impairment is disease, not injury, under policy. | Disability not an injury; ends at 65. |
| Is the term 'accidental' ambiguous, and how should it be interpreted | Dictionary-based view makes 'accidental' broad; plausible injury. | Policy terms and common understanding limit accidental to external-events injuries. | Ambiguity resolved against insured; common meaning supports non-accident classification. |
| Does the policy definition of 'injury' as 'accidental bodily injury' control over the disease-based classification | If injury can be shown, Boly should receive lifetime benefits. | Definition governs; hypoxia from sleep apnea is not an accidental injury. | Policy definition controls; no injury finding. |
Key Cases Cited
- Botts v. Hartford Accident & Indemnity Co., 284 Or. 95 (Or. 1978) (policy ambiguity and common understanding of accident)
- Holloway v. Republic Indemnity Co. of America, 341 Or. 642 (Or. 2006) (apply policy definition to determine injury)
- Thompson v. Gen. Ins. Co. of America, 226 Or. 205 (Or. 1961) (assign common meaning to 'accident')
- Botts and related discussion of accident's meaning, 585 P.2d 657 (Or. 1978) (foreseeability and insured expectations in accident terms)
- St. Paul Fire & Marine Ins. Co. v. McCormick & Baxter Creosoting, 324 Or. 184 (Or. 1996) (accident interpretation under policy language)