Estate of Dumoulin Ex Rel. Dumoulin v. Cuna Mutual Group, 248 P.3d 1252

In 2007, Judy Dumoulin purchased a $40,000 group accidental death and dismemberment policy from CUNA Mutual Group.
Ms. Dumoulin died in March 2008 after hospitalization for respiratory failure and pneumonia with subsequent anoxic brain injury; death proceeded from natural illness and complications.
Estate filed breach of contract and bad-faith claims against CUNA; CUNA moved for summary judgment asserting policy unambiguous and no coverage.
District court granted summary judgment, concluding death was not an accident under the policy and not caused solely by external injury; excluded losses from medical treatment were inapplicable.
Estate appealed; Supreme Court affirmed, holding death was not an ‘accidental death’ as defined by the policy because it was not caused by an injury effected solely through external means.
Rule on attorney fees: court declined to award fees to either side.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Dumoulin's death qualifies as accidental death under the policy	Dumoulin's death resulted from an accident within policy terms	Death did not meet ‘injury’ and ‘external means’ requirements	Not an accident under the policy
Whether death was caused by an injury effected solely through external means	Death was caused by medical negligence as external injury	Death resulted from natural internal processes, not external harm	Death not caused solely by external means; not an injury under policy
Whether the illness/medical-treatment exclusions apply to bar coverage	Exclusions should not bar recovery for an accidental death	Exclusions may preclude coverage where death results from illness or treatment	Court did not reach exclusions since no accident found
Whether attorney-fee awards are appropriate under I.C. § 41-1839(4)	Estate seeks fees under the statute	No frivolous or improper action; no fees awarded	No attorney fees awarded to either party

O'Neil v. N.Y. Life Ins. Co., 65 Idaho 722 (Idaho 1944) (common-sense contract interpretation of ‘accident’)
Prudential Prop. & Cas. Ins. Co. v. Swindal, 622 So.2d 467 (Fla. 1993) (accident scope and fortuity in medical contexts)
Farm Bureau Ins. Co. of Idaho v. Kinsey, 149 Idaho 415 (Idaho 2010) (plain meaning rule for unambiguous policy language)
Allstate Ins. Co. v. Mocaby, 133 Idaho 593 (Idaho 1999) (ambiguous vs. unambiguous contract interpretation)
Mut. of Enumclaw Ins. Co. v. Roberts, 128 Idaho 232 (Idaho 1996) (ambiguity construed against insurer)
Clark v. Prudential Prop. & Cas. Ins. Co., 138 Idaho 538 (Idaho 2003) (special canons of construction for insurance contracts)
Arreguin v. Farmers Ins. Co. of Idaho, 180 P.3d 500 (Idaho 2008) (tools for evaluating insurance contract interpretation)