MAMSI LIFE & HEALTH INSURANCE COMPANY v. John W. CALLAWAY.
No. 98, Sept. Term, 2002.
Court of Appeals of Maryland.
June 11, 2003.
825 A.2d 995
JUDGMENT OF COURT OF SPECIAL APPEALS AFFIRMED, WITH COSTS.
Argued before BELL, C.J., ELDRIDGE, RAKER, WILNER, CATHELL, HARRELL, BATTAGLIA, JJ.
HARRELL, J.
I.
A.
What is autoerotic asphyxiation? Also known also as hypoxyphilia, it is classified as a mental disorder falling into the category of “Sexual Masochism” and involves “sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemicals.” Diagnostic and Statistical Manual of the American Psychiatric Association, § 302.83, at 529 (4th ed.) (“DSM-IV“). Suffocation devices are employed for the purpose of “limiting the flow of oxygen to the brain during masturbation in an attempt to heighten sexual pleasure.” Todd v. AIG Life Ins. Co., 47 F.3d 1448, 1450 (5th Cir.1995). Nerve centers in the brain are stimulated by asphyxia, which “produces a state of hypercapnia (an increase in carbon dioxide in the blood) and a concomitant state of hypoxia (a decrease in oxygen in the blood), all of which result in an increased intensity of sexual gratification.” Padfield v. AIG Life Ins. Co., 290 F.3d 1121, 1125 (9th Cir.2002).
The medical literature also informs that, although those who habitually practice autoerotic asphyxiation utilize escape mechanisms to protect against terminal suffocation in the event of a loss of consciousness, unintended deaths sometimes occur, primarily as a consequence of errors in the placement of the noose or ligature or other mistakes. DSM-IV, § 302.83, at 529 (estimating that “two hypoxyphilia-caused deaths per million population are detected and reported each year“). Autoerotic asphyxiation more likely than not, however, results in a nonfatal outcome. Todd, 47 F.3d at 1457.
B.
On 5 July 2000, David B. Callaway (sometimes referred to here as the “Insured“) was found dead in his home in Wicomico County, Maryland. The circumstances of his death are not in dispute. At the time of his death, he was engaged in an act of autoerotic asphyxiation. The detective investigating the death found his nude body lying on its back. His hands were tied behind his back and his feet were bound together at the ankles with rope. A plastic bag covered his head and a brown belt was tightened around his neck. The wall opposite the body was covered “with a large amount of centerfold pictures of naked females.”1
Mr. Callaway, at the time of his death, owned a life insurance policy (the “Policy“) issued by MAMSI Life and Health Insurance Company (“MAMSI“). The designated beneficiaries of the Policy were his brother, John W. Callaway, and his nephews, John Callaway, Jr. and Bennett J. Callaway (the “Beneficiaries“). When the Beneficiaries sought to recover the death benefits under the Policy, MAMSI denied payment. MAMSI claimed that the Insured‘s death was not the result of an accident, but was instead the result of intentional self-injury.
The Policy provided for the payment of death benefits if the Insured sustained a loss of life “because of an injury caused by an accident.” Among the policy exclusions from coverage was one for death resulting from “intentional self-injury.” The Policy provided in relevant part:
Accidental Death and Dismemberment Benefits.
Benefit Payable—If an Insured suffers a covered loss because of an injury caused by an accident, the loss must occur within 90 days after the date of the accident. Notice
of the loss must be received by us within 30 days after the start of the covered loss. We will pay the benefit amount when we receive proof, satisfactory to us, of a covered loss within 90 days of the date of the loss.
A covered loss means:
loss of life;
....
Benefit Amounts—We will pay the full benefit amount as shown in the Schedule of Benefits for loss of:
life;
....
Exclusions—No benefit will be paid for any loss that results from or is caused directly, indirectly, wholly or partly by:
intentional self-injury, suicide or attempted suicide, while sane or insane; ....
(Emphasis added).
On 16 October 2000, the Beneficiaries instituted suit against MAMSI in the Circuit Court for Wicomico County, alleging breach of the insurance contract. MAMSI filed a Motion to Dismiss or, In the Alternative, Motion for Summary Judgment, in response to the complaint. MAMSI asserted that the Insured‘s intentional act of depriving his brain of oxygen injured it, thereby rendering it incapable of functioning which caused his unintended death. The Insured‘s death was therefore the result of self-inflicted injury and not covered under the Policy.
The Beneficiaries responded to MAMSI‘s Motion for Summary Judgment with one of their own. The Beneficiaries argued that the insurance policy provided coverage for death resulting from asphyxiation while voluntarily engaged in autoerotic activity and that the death resulting from such activity was not a “self-inflicted” injury because of the existence of the escape mechanism, indicating the Insured‘s intent not to injure himself. His injury, therefore, was an accident.
The hearing on the dueling motions was held on 20 February 2001. At the hearing, the parties stipulated that the
[I]t appears to this Court as both counsel agree that the policy involved in this case is unambiguous. It provides for the payment of benefits if an insured suffers a covered loss because of an injury caused by an accident. A covered loss is loss of life. So, therefore, if death occurs because of an injury caused by an accident, then there would be the payment of benefits from the Defendant to the Plaintiff. However, if death was not due to an injury caused by an accident, then the policy does not provide coverage.
The Court believes that this case, the policy language is for legal purposes basically the same as the policies that covered death as a result of an accidental means.
I have a great deal of difficulty finding any difference between that language and the language used in this case.
The issue was dealt with in Consumers Life Insurance Company versus Smith, and there, the Court found that when somebody got drunk and drove an automobile and ran into a tree or something of that nature, then the bodily injury was caused by accident.
The Court made the distinction between accidental death and death by accidental means, and the Court used the language, the direct and proximate cause of the death of the insured was an automobile accident. He did not die from intoxication. Had he died from intoxication, then at least in my opinion, there would have been no coverage in that case, and had he died from intoxication, the Court believes that the facts in that case would have been analogous to the facts in this case.
In this case, the insured intended to cut off his air supply. The cutting off of the air supply caused his death. The Court believes that that is not a death caused because of an injury caused by an accident. He intended the act that resulted in his death. So the Court is going to grant the Defendant‘s Motion for Summary Judgment.
C.
The Beneficiaries appealed to the Court of Special Appeals. They argued that the trial court failed to view the facts in a light most favorable to the Beneficiaries and failed to draw reasonable inferences in their favor from the undisputed facts. The determinations by law enforcement officers and medical personnel that the death was an accident should not have been given such short shrift, the Beneficiaries argued. Furthermore, the Beneficiaries contended that the Insured‘s death was the result of an injury caused by an accident within the meaning of the Policy. They relied on a statement in Consumers Life Ins. Co. v. Smith, 86 Md.App. 570, 587 A.2d 1119 (1991), to support their assertion that “accident” is an unambiguous word with a singular meaning. MAMSI argued in reply that the Insured‘s death was not the result of an injury caused by an accident and that even if it were, the Beneficiaries would be precluded from recovering benefits because the Insured‘s death was the result of intentional self-injury.
The Court of Special Appeals, in a reported opinion (Callaway v. Mamsi, 145 Md.App. 567, 806 A.2d 274 (2002)), reversed the lower court, holding that: (1) the death resulted from an accident, and (2) a brief intentional reduction in the flow of oxygen to the brain was not an “injury” within the meaning of the intentional injury exclusion. Applying principles of contract construction, the intermediate appellate court concluded that it was required to interpret the terms “accident” and “injury” in order to properly construe the coverage of the Policy. 145 Md.App. at 591, 806 A.2d at 288. The court noted that “accident” and “injury” were ambiguous terms because they may have more than one meaning and were not defined in the Policy. Id. Thus, the court turned to extrinsic sources in aid of interpreting the Policy. It claimed to
The court also relied on the definition of “accident” utilized in Cole v. State Farm Mut. Ins. Co., 359 Md. 298, 753 A.2d 533 (2000). 145 Md.App. at 592, 806 A.2d at 288-89. Cole involved an insured who was shot and killed as she sat in the passenger seat of her idling van, while the vehicle was parked in a third party‘s driveway. The insured‘s husband had driven the van there to pick up for visitation his child by a former marriage. The husband‘s ex-father-in-law came out of the house and, while shooting at Mr. Cole, shot and killed Ms. Cole. Ms. Cole‘s automobile liability policy covered the death of an insured caused by an “accident,” but the insurer denied benefits on the ground that her death was not the result of an accident. This Court disagreed with the insurer. We referred to the definition of “accident” in one of our earlier cases, Harleysville Mut. Cas. Co. v. Harris & Brooks, Inc., 248 Md. 148, 150, 235 A.2d 556 (1967): “a happening; an event
In the absence of reported Maryland cases specifically addressing death by autoerotic asphyxiation in a life insurance policy context, the intermediate appellate court looked to cases from other jurisdictions for guidance. Based on our reasoning in Cole and the recent federal Ninth Circuit Court of Appeals‘s decision in Padfield, the court found Callaway‘s death to be accidental pursuant to the terms of the Policy. 145 Md.App. at 601-02, 806 A.2d at 294. Applying the two-part Cole test,
II.
We granted MAMSI‘s petition for certiorari, 372 Md. 429, 813 A.2d 257 (2002), to consider the following issues, notwithstanding the “Serbonian bog” warning sometimes attached to the subject matter of insurance policy interpretations of this general type2:
- Whether the Court of Special Appeals erred in concluding as a matter of law that the policy at issue was
II. Whether the Insured‘s death, caused by autoerotic asphyxiation, was an accidental death within the terms of the insurance policy.
III. Whether death resulting from autoerotic asphyxiation was death from intentional self-injury as described in the insurance policy.
We find Question III to be dispositive of this case. Accordingly, we shall not reach or decide the other questions.
III.
MAMSI asserts that the appellate courts of Maryland have not directly addressed an insurance policy with a self-inflicted injury exclusion and that those courts from other states that have interpreted insurance policies containing an exclusion for death caused by intentional self-injury have concluded that the act of autoerotic asphyxiation constitutes self-injury. MAMSI begins by referring us to a case from the U.S. District Court for the Southern District of Iowa, Sigler v. Mut. Benefit Life Ins. Co., 506 F.Supp. 542 (S.D.Iowa), aff‘d, 663 F.2d 49 (8th Cir. 1981). That court explained that the act of engaging in autoerotic asphyxiation constituted a self-inflicted injury because the insured voluntarily acted with the intent to temporarily restrict his air supply. 506 F.Supp. at 545. The U.S. Court of Appeals for the Fifth Circuit found on similar facts that, although the insured only intended partial strangulation and did not intend to kill himself, partial strangulation in the absence of death would have been an injury in and of itself. Sims v. Monumental Gen. Ins. Co., 960 F.2d 478 (5th Cir. 1992). The U.S. District Court for the Western District of New York likewise entered summary judgment in favor of an insurer, reasoning that by the insured constricting his windpipe and reducing the flow of oxygen to his brain, he caused himself to asphyxiate leading to his death, which was logically the “injury” suffered in terms of the insurance policy. Critchlow v. First UNUM Life Ins. Co., 198 F.Supp.2d 318 (W.D.N.Y.2002).
MAMSI responds to the Court of Special Appeals‘s analogy between autoerotic asphyxiation and more openly known forms of extreme recreational activities, such as skydiving and rockclimbing, with a quotation from the Critchlow court:
Skydivers and rockclimbers do not set out to injure themselves, believing that they can stop the progress of the injury before it becomes severe enough to kill them. In contrast, by constricting the flow of oxygen to his brain, to the point where loss of consciousness and death were certain to occur if the pressure were not released in a relatively short time, the decedent did injure himself.
Critchlow, 198 F.Supp.2d at 327 (footnote omitted).
MAMSI claims that the language in the Policy providing coverage for death, “because of an injury caused by an acci-
The Beneficiaries, Respondents here, argue that the Insured‘s death was not the result of intentional self-injury. They assert rather that the record demonstrates that the manner of death was accidental and not the result of self-inflicted injury. The medical experts and investigating officers rendering an opinion as to the cause of the Insured‘s death uniformly concluded that his death was accidental. The experts found it significant that escape mechanisms had been incorporated into the Insured‘s elaborate system of self-asphyxiation. The escape mechanisms indicated that he recognized the danger of what he was doing and neither intended nor expected injury to his person. His goal was self-sexual gratification rather than self-destruction. The Beneficiaries commend the Court of Special Appeals‘s interpretation of the term “injury,” not defined in the Policy, according to its ordinary meaning.
The Beneficiaries support the interpretation of the word “injury” to mean “physical damage or harm to the body, whether permanent or temporary,” as adopted by the intermediate appellate court. They agree with the statement made by that court that the goal of autoerotic asphyxiation, “fleeting hypoxia,” is intended and “does not, in our view, constitute an injury with the meaning of the Policy.... [t]hose who survive the experience show no signs of physical injury or harm.” 145 Md.App. at 603, 806 A.2d at 295. The Beneficiaries refer to the assertedly undetectable nature of autoerotic asphyxiation as evidence that engaging in such activity does not necessarily result in “injury.” The Report of the Chief Medical Examiner does not present any evidence of physiological injury independent of the fact of death. Common knowledge, they claim, also defeats MAMSI‘s assertion that the partial strangulation
The Beneficiaries also look outside of Maryland to jurisdictions addressing the circumstance of an insured‘s death from autoerotic asphyxiation. They claim that reviews undertaken by both the Padfield majority and the Court of Special Appeals in this case should lead us to conclude that entitlement to recovery in a given case is dependant upon the language of the policy at issue as well as the facts underlying the claim. The Beneficiaries, for example, caution that Runge v. Metro. Life Ins. Co., 537 F.2d 1157 (4th Cir.1976), Patch v. Metro. Life Ins. Co., 733 F.2d 302 (4th Cir.1984), and Bennett v. Am. International Life Assurance Co., 956 F.Supp. 201 (N.D.N.Y.1997), applied Virginia law and that those decisions would not be valid necessarily under the laws of another state. Maryland does not follow Virginia law in its peculiar definition of accidental death and it is the language of the insurance contract that controls the rights and obligations of the contracting parties and beneficiaries.
In its reply brief, MAMSI reiterates that the only way to interpret the Policy to give meaning and effect to both the intentional self-injury exclusion and the suicide exclusion is to recognize that the intentional self-injury exclusion precludes recovery for intentional actions that have a high likelihood of resulting in an injury, although the injury was not necessarily intended nor recognized by the insured as highly likely to result in death. MAMSI urges us to recognize that the focus
IV.
A.
The scope of our review of a judgment based on the grant of summary judgment is de novo. Green v. H & R Block, Inc., 355 Md. 488, 502, 735 A.2d 1039, 1047 (1999); Heat & Power v. Air Products, 320 Md. 584, 590-92, 578 A.2d 1202, 1205-06 (1990). The appellate court has the same facts from the record before it and considers the same issues of law as the trial court and is tasked with determining whether the trial court reached the correct result as a matter of law. Tyma v. Montgomery Co., 369 Md. 497, 504, 801 A.2d 148, 152 (2002); Murphy v. Merzbacher, 346 Md. 525, 530-31, 697 A.2d 861, 864 (1997).
When both sides file cross-motions for summary judgment, as in the present case, the judge must assess each party‘s motion on its merits, drawing all reasonable factual inferences against the moving party. Taylor v. NationsBank, N.A., 365 Md. 166, 174, 776 A.2d 645, 650 (2001). Where, as
B.
Our interpretation of insurance contracts to determine the scope and limitations of the insurance coverage, like any other contract, begins with the language employed by the parties. Kendall v. Nationwide Ins. Co., 348 Md. 157, 165, 702 A.2d 767, 771 (1997). In our interpretation of the contract, we seek to give the words their “customary, ordinary, and accepted meaning.” Lloyd E. Mitchell, Inc. v. Maryland Casualty Co., 324 Md. 44, 56, 595 A.2d 469, 475 (1991). When the terms of a contract are ambiguous, courts look to extrinsic sources to ascertain the meaning of the terms. Cole, 359 Md. at 305, 753 A.2d at 537. If the terms are unambiguous, the court may construe the insurance contract as a matter of law. Id. A contract term is determined to be ambiguous if “a reasonably prudent person” would understand the term as susceptible to more than one possible meaning. 359 Md. at 306, 753 A.2d at 537. The determination of whether language is susceptible to more than one meaning includes consideration of “the character of the contract, its purpose, and the facts and circumstances of the parties at the time of execution.” Pacific Indem. v. Interstate Fire & Cas., 302 Md. 383, 388, 488 A.2d 486, 488 (1985). Although Maryland law does not construe
C.
Regardless of whether we were to agree that the Insured did not cause his death intentionally, the insurance policy limits recovery of accidental death benefits when death is the result of intentional self-injury. If the Insured did not intend to cause his death, the question becomes whether he intended to cause the injury that led to his death and whether asphyxiation is an “injury” within the Policy terms. The vast majority of cases from other jurisdictions discussing whether death by autoerotic asphyxiation is the result of an intentional self-inflicted injury have found that it is and denied payment of benefits on the basis of such an exclusion in the insurance policies.
Unlike our intermediate appellate court colleagues, we do not think it appropriate to collapse the analysis of “accident” and “injury” into a single inquiry. The language and structure of the Policy establish two separate and independent inquiries: first, whether the Insured‘s death was an accident under the Policy; and, if so, second, whether the death resulted from a self-inflicted injury pursuant to the exclusion. The first addresses the nature of the overall event, whereas the second addresses only causation. It is possible therefore to find the death itself to have been accidental although the Insured may have intended the events that eventually led to his death.
The U.S. Court of Appeals for the Fifth Circuit, in Sims v. Monumental Gen. Ins. Co., 960 F.2d at 479, found that partial strangulation engaged in as part of autoerotic activity was an “injury” triggering the exclusion for intentionally self-inflicted injury contained in an accidental death insurance policy. The
The court in Cronin v. Zurich Am. Ins., 189 F.Supp.2d 29 (S.D.N.Y.2002) further described the nature of autoerotic asphyxiation noting: “The effect on the brain produced by this activity is abnormal; the higher cerebral functions of thought, consciousness and awareness are compromised; and a dangerous loss of coordination and self-control results. Temporary cell damage results, and reduced brain activity occurs.” 189 F.Supp.2d at 38. That court held that the “purposefully self-inflicted injury” exclusion contained in the accidental death insurance policy at issue in Cronin encompassed the insured‘s act of hanging himself by the neck intending to deprive himself of oxygen in order to achieve a sexual “high.” 189 F.Supp.2d at 39.
The Critchlow court also rejected the beneficiary‘s suggestion that intentional constriction of the insured‘s windpipe was not an “injury” under a self-inflicted injury exclusion to an accidental death policy. Critchlow, 198 F.Supp.2d at 323. That court plainly stated that the insured‘s actions “certainly did cause him injury, however; it led directly to his death.” Id. The court reasoned “that it [asphyxiation] is possible to do so for a short period without causing lasting injury, or that injury or death does not immediately occur upon constriction of the trachea, does not mean that decedent‘s intentional act caused him no injury.” Id.
The Court of Special Appeals reasoned that the brief intentional reduction in the flow of oxygen was not an “injury” as that term is used in the Policy. The court determined that the layperson would understand “injury” to mean “physical damage or harm to the body, whether permanent or temporary.” 145 Md.App. at 603, 806 A.2d at 295. The court concluded that “the fleeting hypoxia that is intended and achieved with a successful autoerotic experience does not, in our view, constitute an injury with the meaning of the Policy.” Id. The court appealed to “common knowledge” to support its conclusion, observing that “[i]t is generally believed that one can safely go without oxygen for a brief period of time, without sustaining what is perceived as an injury.” Id. Ac-
We take issue with the intermediate appellate court‘s attributions to the layperson described in its analysis. We conclude that a layperson would understand partial strangulation to be an injury as that term is commonly used. As the Sigler court observed, if another person had partially strangled the Insured there would be no argument that the strangulation was not an injury. 506 F.Supp. at 545. A layperson would consider hypoxia caused by partial strangulation to be an injury regardless of whether visible marks were left on the body. That the injured party also derived pleasure from the self-inflicted injury does not mean there was no injury. Hypoxia is widely defined as “a deficiency of oxygen reaching the tissues of the body.” Injury may embrace internal or external damage or harm. The temporary deprivation of oxygen to the brain is a harm albeit only a temporary one in the case of successful autoerotic asphyxiation. We therefore resolve on the undisputed facts of this case that, by depriving his brain of oxygen, the Insured injured his brain and rendered it incapable of functioning, which eventually led to his death. The trial court correctly granted MAMSI‘s Motion for Summary Judgment on the basis of the exclusion in the Policy for intentional self-injury.
JUDGMENT OF THE COURT OF SPECIAL APPEALS REVERSED. CASE REMANDED TO THAT COURT WITH DIRECTIONS TO AFFIRM THE JUDGMENT OF THE CIRCUIT COURT FOR WICOMICO COUNTY; RESPONDENT TO PAY ALL COSTS IN THIS COURT AND IN THE COURT OF SPECIAL APPEALS.
BATTAGLIA J., dissenting.
I respectfully dissent for the reasons so well expressed by Court of Special Appeals Judge Hollander in her opinion in
Chief Judge BELL has authorized me to state that he joins in this dissent.
Notes
There was also a yellow 1/4” synthetic rope attached to the loop binding the hands with a quick release knot secured by a wooden clothes pin. This rope was attached to a pulley to the above-mentioned leather belt around the neck and, according to the investigation reports, was strung through two additional pulleys attached to the ceiling of the room with a 25-pound weight at the end. Reportedly, an additional piece of rope was tied to the line at the ceiling between the pulleys. Pulling of this rope would cause lifting of the attached weight, releasing the tension applied to the neck loops and wrists. The legs were tied at the level of the malleoli [ankle bones] with four loops of 1/4” cotton rope tied between the legs, with transverse loops forming a Figure “8” knot.... The deceased held a 4-1/2 foot long strap in his right hand.
We expand, where Cardozo apparently felt no need for his assumptively more literate readership, a bit on the literary and geographic etiology and practical connotation of the “Serbonian bog” reference. Judge Karwacki, in his dissent in Sheets v. Brethren Mut. Ins. Co., 342 Md. 634, 661-62, 679 A.2d 540, 553 (1996), observed that the description emanated from Book 2 of Paradise Lost:
Beyond this flood a frozen Continent
Lies dark and wilde, beat with perpetual storms
Of Whirlwind and dire Hail, which on firm land
Thaws not, but gathers heap, and ruin seems
Of ancient pile; all else deep snow and ice,
A gulf profound as that SERBONIAN Bog
Betwixt DAMIATA and mount CASIUS old,
Where Armies whole have sunk: the parching Air
Burns frore, and cold performs th’ effect of Fire.
Thither by harpy-footed Furies hail‘d,
At certain revolutions all the damn‘d
Are brought: and feel by turns the bitter change
Of fierce extreams, extreams by change more fierce,
From Beds of raging Fire to starve in Ice
Thir soft Ethereal warmth, and there to pine
Immovable, infixt, and frozen round,
Periods of time, thence hurried back to fire.
John Milton, Paradise Lost, bk. 2, l. 592 (1667). Judge Karwacki also pointed out that Lake Serbonis, which the bog apparently bordered, was situated in lower ancient Egypt, near Palestine. Sheets, 342 Md. at 662, 679 A.2d at 553.
Although the reference is perhaps more obscure today than it was in Justice Cardozo‘s time, the message is clear in context. It refers to a “mess from which there is no way of extricating oneself.” E. Cobham Brewer, Dictionary of Phrase and Fable, 1121-22 (1898).