The Ontario Court of Appeal overturned the finding of the motions judge on a Rule 21 procedure and ruled that the death of an insured during childbirth from an amniotic fluid embolism did not result from an “accident”. For this reason, and because amniotic fluid embolism was found to be a physical illness which constituted an exclusion, coverage under the terms of the accidental death benefit rider was denied.

31. August 2004 0

Wang v. Metropolitan Life Insurance Co., [2004] O.J. No. 3525, Ontario Court of Appeal

The first issue was whether the motions judge erred in her interpretation of the case law on what constitutes “an accident”. The Court of Appeal found that the motions judge was correct in her conclusion that the ratio in Smith v. British Life Insurance Co., [1965] S.C.R. 434, had been overturned by the Supreme Court of Canada in Martin v. American International Assurance Life Co., [2003] 1 S.C.R. 158; however, she erred in concluding that the Supreme Court of Canada expressly rejected the distinction between an accidental death and a death from natural causes upon which Metlife relied in this case. The Court of Appeal held that the expectation test is not appropriate in a case where death results from a natural cause. Such a death is not one “in which death appears to be accidental.”

The second issue was whether Mrs. Lin’s death as a result of amniotic fluid embolism was an “accident” according to the terms of the policy. The Court of Appeal concluded that an ordinary person would not describe what happened to Mrs. Lin as an “accident” and that therefore her death was determined not to be the result of an accident.

The third issue was whether the motions judge erred in restricting her analysis on whether the death resulted from a physical illness to the question of whether pregnancy was an illness. The Court of Appeal held that the motions judge’s analysis on this issue was flawed because pregnancy was not a cause of death. The proper question was therefore whether amniotic fluid embolism is an illness. This led to the fourth issue.

The fourth issue was whether, based on the totality of the evidence, the death was caused or contributed to by a physical illness within the exclusion contained in the policy. The Court of Appeal held that the expert evidence indicated that amniotic fluid embolism is one of the most common causes of maternal death and is recognized as a physical illness. An ordinary person would characterize this condition as a physical illness. It is an event created by a process within our body and therefore cannot be considered an accident. In conclusion, amniotic fluid embolism is a physical illness and since it “caused or contributed to” Mrs. Lin’s death, the occurrence falls within the scope of the exclusion.

The majority of the Court of Appeal allowed the appeal and set aside the motions judge’s order substituting an order in accordance with these reasons.

The facts underlying this action were agreed upon. Stacey Chiu Lin suffered a cardiac arrest shortly after undergoing an elective caesarean section and died as a result of “amniotic fluid embolism”. The coroner’s investigation characterized the means of death as “natural”.

Mrs. Lin’s husband Mr. Wang and Mrs. Lin’s daughter were the beneficiaries of a life insurance policy issued by the respondent Metropolitan Life Insurance Company (“Metlife”). The policy provided for an additional Accidental Death Benefit in the amount of $200,000.00 in addition to the payment of a Basic Death Benefit in the amount of $480,000.00.

Basic Death Benefit coverage was not disputed; however, Metlife took the position that the additional Accidental Death Benefit was not payable under the terms of the accidental death benefit rider in the policy because Mrs. Lin had died from a natural cause not an accident and because the rider specifically excluded death caused or contributed to by an illness.

Neither “accident” nor “physical illness” were defined terms in the policy.

Mr. Wang commenced this action and succeeded in a motion pursuant to Rule 21 for the determination of a question of law before trial that his wife’s death resulted from an “accident” and not from an “illness.”

Metlife appealed the finding of the motions judge. The Court of Appeal stated that the appeal raised four issues.

The first issue was whether the motions judge erred in her interpretation of the case law on what constitutes “an accident”. The Court of Appeal found that the motions judge was correct in her conclusion that the ratio in Smith v. British Life Insurance Co., [1965] S.C.R. 434, had been overturned by the Supreme Court of Canada in Martin v. American International Assurance Life Co., [2003] 1 S.C.R. 158; however, she erred in concluding that the Supreme Court of Canada expressly rejected the distinction between an accidental death and a death from natural causes upon which Metlife relied in this case. The Court of Appeal held that the expectation test is not appropriate in a case where death results from a natural cause. Such a death is not one “in which death appears to be accidental.”

The second issue was whether Mrs. Lin’s death as a result of amniotic fluid embolism was an “accident” according to the terms of the policy. The Court of Appeal concluded that an ordinary person would not describe what happened to Mrs. Lin as an “accident” and that therefore her death was determined not to be the result of an accident.

The third issue was whether the motions judge erred in restricting her analysis on whether the death resulted from a physical illness to the question of whether pregnancy was an illness. The Court of Appeal held that the motions judge’s analysis on this issue was flawed because pregnancy was not a cause of death. The proper question was therefore whether amniotic fluid embolism is an illness. This led to the fourth issue.

The fourth issue was whether, based on the totality of the evidence, the death was caused or contributed to by a physical illness within the exclusion contained in the policy. The Court of Appeal held that the expert evidence indicated that amniotic fluid embolism is one of the most common causes of maternal death and is recognized as a physical illness. An ordinary person would characterize this condition as a physical illness. It is an event created by a process within our body and therefore cannot be considered an accident. In conclusion, amniotic fluid embolism is a physical illness and since it “caused or contributed to” Mrs. Lin’s death, the occurrence falls within the scope of the exclusion.

The majority of the Court of Appeal allowed the appeal and set aside the motions judge’s order substituting an order in accordance with these reasons.

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