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Silverstein v. Metropolitan Life Ins. Co.

Court of Appeals of the State of New York
Jun 3, 1930
254 N.Y. 81 (N.Y. 1930)

Summary

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, 915, Chief Judge Cardozo said: "A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules."

Summary of this case from Prudential Ins. Co. of America v. Carlson

Opinion

Argued May 14, 1930

Decided June 3, 1930

Appeal from the Supreme Court, Appellate Division, First Department.

Dean Potter, Charles B. LaVoe, Edward M. Grout and Paul Grout for appellant.

B.B. Fensterstock, Bernard Gordon and Isidor Block for respondent.


Defendant issued its policy of insurance whereby it insured plaintiff's husband against the results of bodily injuries "caused directly and independently of all other causes by accidental means," the insurance in the event of his death to be payable to his wife. The policy was not to "cover accident, injury, disability, death or other loss caused wholly or partly by disease or bodily or mental infirmity or medical or surgical treatment therefor."

The insured, while lifting a milk can into an ice box, slipped and fell, the can striking him on the abdomen and causing such pain that he was unable to get up. A surgeon, opening the abdomen, found a perforation at the junction of the stomach and the duodenum, through which the contents of the stomach escaped into the peritoneum, causing peritonitis and, later, death. At the point of perforation there had been a duodenal ulcer, about the size of a pea. The existence of this ulcer was unknown to the insured, and were it not for the blow, would have had no effect upon his health, for it was dormant, and not progressive, or so the triers of the facts might find. Even so, there had been a weakening of the wall in some degree, with the result that the impact of the blow was followed by perforation at the point of least resistance. The question is whether death was the result of an accident to the exclusion of other causes.

We think the evidence sustains a finding that the ulcer was not a disease or an infirmity within the meaning of the policy. Left to itself, it would have been as harmless as a pimple or a tiny scratch. Only in the event that it was progressive would it become a source of pain or trouble. If dormant, as it was found to be, it was not only harmless in itself, but incapable of becoming harmful except through catastrophic causes, not commonly to be expected. In a strict or literal sense, any departure from an ideal or perfect norm of health is a disease or an infirmity. Something more, however, must be shown to exclude the effects of accident from the coverage of a policy. The disease or the infirmity must be so considerable or significant that it would be characterized as disease or infirmity in the common speech of men ( Eastern Dist. Piece Dye Works v. Travelers Ins. Co., 234 N.Y. 441, 453). "Our guide is the reasonable expectation and purpose of the ordinary business man when making an ordinary business contract" ( Bird v. St. Paul F. M. Ins. Co., 224 N.Y. 47, 51; Goldstein v. Standard Acc. Ins. Co., 236 N.Y. 178, 183; Van Vechten v. American Eagle Fire Ins. Co., 239 N.Y. 303). A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules.

A distinction, then, is to be drawn between a morbid or abnormal condition of such quality or degree that in its natural and probable development it may be expected to be a source of mischief, in which event it may fairly be described as a disease or an infirmity, and a condition abnormal or unsound when tested by a standard of perfection, yet so remote in its potential mischief that common speech would call it not disease or infirmity, but at most a predisposing tendency ( Leland v. Order of U.C. Travelers, 233 Mass. 558, 564; Collins v. Casualty Co., 224 Mass. 327; Mutual Life Ins. Co. v. Dodge, 11 Fed. Rep. [2d] 486; cert. denied, 271 U.S. 677; Taylor v. N Y Life Ins. Co., 176 Minn. 171, 174). There will be no recovery under a policy so written where an everyday act, involving ordinary exertion, brings death to an insured because he is a sufferer from heart disease ( Allendorf v. Fid. Cas. Co., 250 N.Y. 529; Leland v. Order of U.C. Travelers, supra). On the other hand, a recovery will not be denied to the sufferer from hernia who has had a predisposition to rupture because the inguinal canal was not closed as it ought to have been ( Collins v. Cas. Co., supra), or to one whose hip has been fractured because his bones have become brittle with the advent of old age (cf. Taylor v. N.Y. Life Ins. Co., supra). "If a man with an abnormally thin skull be struck a blow which would not seriously injure a normal man, but which causes his death, it is perfectly plain that the cause of death is not the thinness of the skull, but the receipt of the blow" ( Mutual Life Ins. Co. v. Dodge, supra, p. 489). An appendix already gangrenous is one thing ( Stanton v. Travelers Ins. Co., 83 Conn. 708), and quite another is an appendix, not presently malignant, though a potential source of infection in the future if left within the body. The governing principle has been stated by RUGG, C.J., with clearness and precision: "If there is no active disease, but merely a frail general condition, so that powers of resistance are easily overcome, or merely a tendency to disease which is started up and made operative, whereby death results, then there may be recovery even though the accident would not have caused that effect upon a healthy person in a normal state" ( Leland v. U.C. Travelers supra, at p. 564). An ulcer as trivial and benign as an uninfected pimple, is at most a tendency to an infirmity, and not an infirmity itself.

Any different construction would reduce the policy and its coverage to contradiction and absurdity. The infinite interplay of causes makes it impossible to segregate any single cause as operative at any time and place to the exclusion of all others, if cause is to be viewed as a concept of science or philosophy ( Schwarz v. Commercial Travelers Mut. Acc. Assn., 254 N.Y. 523, affg. 227 App. Div. 711; 132 Misc. Rep. 200; Lewis v. Ocean Acc. G. Corp., 224 N.Y. 18, 20). The courts have set their faces against a view so doctrinaire, an estimate of intention so headed toward futility. "We are to follow the chain of causation so far, and so far only, as the parties meant that we should follow it. `The causes within their contemplation are the only causes that concern us'" ( Goldstein v. Standard Acc. Ins. Co., supra).

The judgment should be affirmed with costs.

POUND, CRANE, KELLOGG, O'BRIEN and HUBBS, JJ., concur; LEHMAN, J., not sitting.

Judgment affirmed.


Summaries of

Silverstein v. Metropolitan Life Ins. Co.

Court of Appeals of the State of New York
Jun 3, 1930
254 N.Y. 81 (N.Y. 1930)

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, 915, Chief Judge Cardozo said: "A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules."

Summary of this case from Prudential Ins. Co. of America v. Carlson

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, an ulcer had weakened the wall of the insured's duodenum so that a blow suffered by him resulted in a puncture of the intestine.

Summary of this case from Preferred Acc. Ins. Co. of New York v. Combs

In Silverstein, the court held that "[t]here will be no recovery... where an everyday act, involving ordinary exertion, brings death to an insured...."

Summary of this case from McCarthy v. Am. Int'l Grp., Inc.

In Silverstein, the insured slipped and fell; the fall caused a perforation in the insured's stomach, "through which the contents of the stomach escaped into the peritoneum, causing peritonitis and, later, death."

Summary of this case from Ajnoha v. JC Penney Life Insurance

allowing recovery

Summary of this case from Sugarman v. New England Mutual Life Insurance Co.

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914 (quoted from with approval in First National Bank v. Equitable Life Assur. Soc., supra), the policy did not cover death "caused wholly or partly by disease or bodily or mental infirmity."

Summary of this case from Fidelity Service Ins. Co. v. Jones

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, the insured was lifting a milk can into an icebox and slipped and fell, the can striking him in the abdomen causing great pain and an operation revealed that he had a duodenal ulcer which had been previously unknown, the blow to the ulcer resulting in peritonitis which caused the injured's death.

Summary of this case from Williams v. Benefit Trust Life Ins. Co.

In Silverstein v. MetropolitanLife Ins. Co., supra [ 254 N.Y. 81, 171 N.E. 915], the insured had a small duodenal ulcer of which he was unaware and which was perforated when he fell and was struck in the abdomen; he obtained a judgment on the accident policy issued by the defendant and it was sustained by the New York Court of Appeals.

Summary of this case from Kievit v. Loyal Protect. Life Ins. Co.

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, 915, Chief Judge Cardozo said: "A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules."

Summary of this case from Kilgore v. Reserve Life Ins. Co.

In Silverstein v. Metropolitan Life Insurance Co., 254 N.Y. 81, 171 N.E. 914, cited by respondent, the evidence was that the insured, while lifting a milk-can into an ice-box, slipped and fell, the can striking him on the abdomen.

Summary of this case from Seater v. Penn. Mut. Life Ins. Co.

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, the policy contained general and special clauses to like effect as the case at bar.

Summary of this case from First Nat. Bank v. Equitable Life Assur. Soc.

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, the question was whether or not a duodenal ulcer was a contributing cause to a perforation of the stomach and consequent death.

Summary of this case from Life Assur. Soc. v. Gratiot

In Silverstein v. Metropolitan Life Insurance Co. (254 N.Y. 81) the insured fell while lifting a milk can which struck his abdomen.

Summary of this case from Berkowitz v. New York Life Insurance Co.

In Silverstein v. Metropolitan Life Ins. Co. (254 N.Y. 81, 84, 85) the Court of Appeals stated: "in a strict or literal sense, any departure from an ideal or perfect norm of health is a disease or an infirmity.

Summary of this case from Weiner v. Continental Cas. Co.

In Silverstein v. Metropolitan Life Ins. Co. (supra) the court said at page 84: "In a strict or literal sense, any departure from an ideal or perfect norm of health is a disease or an infirmity.

Summary of this case from Novick v. Commercial Travelers Mut. Accident Assn

In Silverstein v. Metropolitan Life Ins. Co., 254 N.Y. 81, 171 N.E. 914, 915, it was laconically declared: "A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules."

Summary of this case from Cramer v. John Hancock Mut. Life Ins. Co. of Boston
Case details for

Silverstein v. Metropolitan Life Ins. Co.

Case Details

Full title:IDA SILVERSTEIN, Respondent, v. METROPOLITAN LIFE INSURANCE COMPANY…

Court:Court of Appeals of the State of New York

Date published: Jun 3, 1930

Citations

254 N.Y. 81 (N.Y. 1930)
171 N.E. 914

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