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Gomez v. Life Insurance Co.

January 13, 1997

NANCY GOMEZ, APPELLANT,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, RESPONDENT.



Appeal from Superior Court of King County. Docket No: 93-2-08319-0. Date filed: 09/02/94.

Authored by C. Kenneth Grosse. Concurring: Ann L. Ellington, Ronald E. Cox.

The opinion of the court was delivered by: Grosse

GROSSE, J. -- After Steven Gomez committed suicide, his spouse, Nancy Gomez, sought recovery under a policy insuring for loss of life, limb, or eyesight caused by accidents. Because the policy specifically exempted injuries caused by suicide, the Life Insurance Company of North America (LINA) denied her claim. Gomez brought suit and now appeals the trial court's grant of summary judgment in favor of the insurer. Although suicide exclusions are generally prohibited in life insurance policies, we disagree with her contention that by extension the exclusion in this accident policy is void. The Washington insurance code provides for both life insurance and disability insurance. Disability policies containing an accidental death benefit are not precluded by statute from containing an exclusion for suicide.

FACTS

Steven Gomez died after he jumped out of his third floor hospital window. After he jumped, Steven Gomez lived for a short time and he told a paramedic he had been in the hospital for drug and alcohol treatment, "he couldn't take it any more," and he "did this" to kill himself.

At the time of his death, Boeing employed Nancy Gomez and covered her under "Accident Policy SGL-747" issued by LINA. As a spouse of a Boeing employee, Steven Gomez was also covered against losses "resulting directly and independently of all other causes from bodily injuries caused by accident occurring while this policy is in force[.]" The policy provided various amounts to be paid for loss of life, limb, or eyesight that occurred within one year from the date "of accident." The policy expressly excluded "loss caused by or resulting from . . . intentionally self-inflicted injuries, suicide or any attempt thereat, while sane [or] insane."

LINA denied coverage based on the suicide exclusion. Gomez sought a declaration that she was entitled to recover, claiming (1) that the "suicide exclusion" in the LINA policy was void under state life insurance statutes, and (2) that Steven Gomez did not commit suicide because he lacked the requisite intent to take his life. The trial court granted partial summary judgment on the suicide exclusion issue, ruling that LINA's policy was not a life or group life policy and the suicide exclusion was effective because it did not violate state statute.

Reserving the ability to appeal the suicide exclusion issue, Gomez did not oppose entry of an order that Steven Gomez took his own life. On September 2, 1994, the trial court ruled "that under the uncontroverted facts, Steven Gomez took his own life," and granted summary judgment in favor of LINA. Gomez appeals.

ANALYSIS

Gomez argues that the life insurance statute prohibiting suicide exclusions *fn1 applies to this policy, contending that the policy's "death by accident" coverage is life insurance. A suicide exclusion in individual life policies *fn2 is permitted for only two years and is not a permitted exclusion in a group life policy. *fn3 LINA insured Nancy and Steven Gomez for more than two years. If the policy is not controlled by the life insurance provisions, the suicide statute would not apply because the disability chapters do not forbid an insurer to deny coverage in the event of suicide.

The definition of disability insurance is "insurance against bodily injury, disablement or death by accident, against disablement resulting from sickness[.]" *fn4 The policy provides coverage for "specified loss [life, limb or sight] . . . from bodily injuries caused by accident[.]" Thus, this accident policy is disability insurance within the meaning of RCW 48.11.030. Because the policy also insures "human lives," it can also be considered a life insurance policy under a general application of the definition of life insurance: "'Life insurance' is insurance on human lives and insurance appertaining thereto or connected therewith." *fn5

Washington courts have not considered the problem presented here under the current statutory scheme. *fn6 Other jurisdictions, while noting the overlapping character of the two types of insurance, determine the nature of the insurance by the dominant purpose of the policy as reflected by the risk or contingency insured against: *fn7

The distinguishing feature, generally recognized, between such contracts is the risk primarily insured against. . . . "The distinction is that in a life policy, the death is the contingency primarily insured against, the accident being an incidental matter, whereas in an accident policy, the accident is the thing insured against, death, perhaps, being one of the contingencies upon which benefits are payable." *fn8

We choose to follow courts that find that if the risk insured against is accidents, the inclusion of accidental death benefits does not make a policy one of life insurance. *fn9 These courts have been ...


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