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Gottfried v. Prudential Insurance Co.

Decided: September 9, 1977.

LEONORA R. GOTTFRIED, PLAINTIFF,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA AND THE PENN MUTUAL LIFE INSURANCE COMPANY, DEFENDANTS



Gaynor, J.c.c. (temporarily assigned).

Gaynor

In this action the plaintiff seeks to recover accidental death benefits provided by several policies issued by the defendants upon the life of plaintiff's husband, Stanley Gottfried. The defendants have refused payment of such benefits on the ground that the insured's death did not occur under such circumstances as to entitle plaintiff to the accidental death benefits under the policies.

The facts giving rise to this controversy are not in dispute. The insured died suddenly at the age of 44 on May 5, 1974 as a result of a heart attack. He had no indication of any heart disease prior to the fatal attack and, in the summer of 1973 had been pronounced in sound physical condition, except for slightly elevated blood sugar, after undergoing a complete physical examination. While a youth, the insured had been an active participant in sports and for some years prior to his death regularly played tennis, as well as engaging in other athletic activities. At the time of his death, Mr. Gottfried was employed by The Singer Company as the Comptroller of one of the company's plants. However on the morning of May 4th, 1974 he had informed his superior that he was resigning because of his dissatisfaction with his progress in the company.

On the evening of May 4, 1974, he attended an informal dinner party in the company of his wife at the home of friends in Bridgewater Township. He had a drink or two and a light supper. After dinner, three of the men, including Mr. Gottfried, decided to play basketball with a group of teenagers in attendance utilizing the tennis court owned by the host. The game commenced about 11:00 p.m. and continued for a half hour or more. It was a vigorous game, with the three men competing against three boys. After the game the decedent upon returning to the residence, appeared to be perspiring profusely. He sat down, asked for a towel to wipe his perspiration and, while the towel was being obtained, slumped over unconscious. Physicians in the area promptly responded, and Gottfried was

transported directly to the Somerset Hospital where he was pronounced dead at 12:03 a.m. on May 5, 1974.

No autopsy was performed, and the death certificate indicated the cause of death as an acute myocardial infarction due to arteriosclerotic cardiovascular disease. This cause of death was confirmed by the opinion testimony of a physician, Dr. D. Goodman Rowland. It was also Dr. Rowland's opinion that the precipitating factors of the insured's death were an underlying coronary arteriosclerotic condition and the exertion experienced in the basketball game. Dr. Rowland opined that it was the stress of the physical activity superimposed upon the underlying condition which resulted in the fatal occlusion, and it was only because of such stress that the insured met his death on May 5th. He also admitted that, without the existing arteriosclerotic condition, the physical stress of the basketball game would not have caused the insured's death.

Mr. Gottfried was insured under a Group Policy issued by Prudential Insurance Company of America to The Singer Company. This policy contained an Employee Group Accident Loss Insurance Rider which provides:

ACCIDENT LOSS BENEFITS

If an employee, while insured under this Rider, sustains accidental bodily injuries and within the period of ninety consecutive days following the date upon which such injuries are incurred (said period hereinafter referred to as the 'Accident Loss Period'), suffers the loss of life as a direct result of such injuries and independently of all other causes, the Insurance Company will, subject to the provisions hereinafter stated, pay in one sum to the Employee's Beneficiary, the amount provided for such loss.

EXCLUSIONS

THE INSURANCE PROVIDED HEREUNDER DOES NOT COVER ANY LOSS WHICH RESULTS . . . (b) DIRECTLY OR INDIRECTLY FROM BODILY OR MENTAL INFIRMITY OR DISEASE OR MEDICAL ...


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