## Facts

- Franklin issued Bartholomew Burne a $15,000 life insurance policy with a double-indemnity rider for an additional $15,000 if death resulted from accidental means.
- The rider required that death occur within 90 days of the accident to qualify for accidental-death benefits.
- The rider also excluded accidental-death benefits if death occurred while premiums were being waived under a disability benefit attached to the policy.
- Mr. Burne was struck by a car on January 30, 1959, suffered severe brain injury, and underwent extensive surgery.
- For approximately four and a half years after the accident, Mr. Burne remained in a vegetative, totally disabled condition requiring constant care and medical intervention to remain alive.
- The parties conceded the accident-related injuries were the direct and sole cause of Mr. Burne’s eventual death.
- Franklin paid the $15,000 face amount but denied the additional $15,000 accidental-death benefits based on the 90-day limitation and the disability/premium-waiver exclusion.
- Jo Ann C. Burne, the named beneficiary, sued in assumpsit for the accidental-death benefits.

## Issues

1. Whether the insurer could deny accidental-death benefits under a 90-day death-from-accident condition when the accident was the undisputed sole cause of death but death occurred after prolonged medical life support.
2. Whether an exclusion barring accidental-death benefits when death occurs during a disability premium-waiver period could defeat coverage under these facts.

## Decision

- The Supreme Court of Pennsylvania reversed summary judgment for the insurer.
- The court held the insurer could not rely on the 90-day limitation to deny accidental-death benefits where causation was conceded and strict application would produce an arbitrary forfeiture unrelated to the risk assumed.
- The court also held the disability/premium-waiver exclusion could not be used to defeat accidental-death coverage in this context.
- The beneficiary was entitled to recover the double-indemnity accidental-death benefits.

## Legal Principles

- Insurance conditions may be refused enforcement when, as applied to the proven facts, they cannot reasonably operate as intended and would create an arbitrary forfeiture.
- Time-from-accident limitations in accidental-death riders are commonly aimed at reducing disputes about causation; when causation is undisputed, literal enforcement may be unreasonable if it defeats the bargain’s protective function.
- Courts may reject policy constructions that would incentivize premature withdrawal of medical care to obtain benefits.
- Exclusions that would nullify accidental-death protection precisely when the insured is totally disabled from the covered accident may be treated as inapplicable or unenforceable when they produce arbitrary results inconsistent with the coverage purchased.

## Conclusion

Because the accident was the conceded sole cause of death and the insured’s survival beyond 90 days resulted from extended medical support, the court declined to enforce the rider’s 90-day limitation and the disability premium-waiver exclusion as applied, and required payment of the accidental-death benefits.


Burne v. Franklin Life Ins. Co., 301 A.2d 799 (Pa. 1973)