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Silverstein v. Metro. Life Ins. Co. - 254 N.Y. 81, 171 N.E. 914 (1930)

Rule:

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. Our guide is the reasonable expectation and purpose of the ordinary business man when making an ordinary business contract. A policy of insurance is not accepted with the thought that its coverage is to be restricted to an Apollo or a Hercules.

Facts:

Respondent-plaintiff 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 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. Appellant-defendant insurer denied him coverage, stating that his injuries were the result of a disease or bodily injury. At trial before the Supreme Court of New York, the jury found that the ulcer was not a disease or infirmity within the meaning of the policy. The appellate court affirmed the judgment for plaintiff insured. The insurer sought further review.

Issue:

Was the insured's death the result of an accident to the exclusion of other causes, including a disease or an infirmity within the meaning of the policy?

Answer:

Yes

Conclusion:

Affirming, the state's highest court (the Court of Appeals of New York) held that, left to itself, the ulcer was harmless, incapable of becoming harmful except through catastrophic causes. The Court found that the cause of death was the catastrophic incident, not the benign physical condition. The evidence sustained the finding that the ulcer was not a disease or an infirmity within the meaning of the policy. The Court further held that disease and bodily injury exclusions could not require an insured to be the perfect norm of health.

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