## Facts

- Donald D. Martin was insured under a group accidental death and dismemberment policy issued through an American Legion program.
- On October 5, 1995, Martin suffered a severe fracture dislocation of his lower left leg in a motor vehicle collision.
- Physicians pursued extended treatment and rehabilitation with ongoing uncertainty about limb salvage.
- On April 18, 1996—196 days after the accident—Martin’s lower left leg was surgically amputated.
- The policy conditioned payment on a “Covered Loss” occurring within 90 days after the accidental injury.
- Allianz denied Martin’s dismemberment claim because the amputation occurred after the 90-day period.
- The district court granted summary judgment to Allianz, and Martin appealed.

## Issues

1. Whether “loss” or “severance” of a limb occurred within 90 days when the leg allegedly became medically unsalvageable or functionally useless within that period, despite amputation occurring later.
2. Whether a policy provision requiring a covered loss to occur within 90 days of injury is unenforceable as unreasonable or contrary to North Dakota public policy.

## Decision

- The North Dakota Supreme Court affirmed summary judgment for Allianz.
- The court held that no covered loss occurred within 90 days because severance occurred only upon actual surgical amputation.
- The court held the 90-day limitation was enforceable and not void as against public policy.

## Legal Principles

- Insurance policies are interpreted as contracts; unambiguous coverage conditions are enforced as written.
- In an AD&D dismemberment policy, “loss” of a limb refers to actual physical severance (amputation), not functional loss or medical futility of salvage.
- Temporal conditions requiring a covered loss to occur within a specified period after injury are valid absent statutory prohibition or a clearly articulated public policy against them.
- Courts do not rewrite insurance contracts to create coverage beyond the risk the insurer assumed and for which premiums were set.
- The rule construing ambiguities against the insurer does not apply where the policy language, read in context, is not materially ambiguous.

## Conclusion

Because Martin’s amputation occurred 196 days after the accident, the policy’s requirement that the covered loss occur within 90 days was not met; the court enforced the limitation as a valid contractual condition and upheld the denial of benefits.


Martin v. Allianz Life Ins. Co. of N. Am., 573 N.W.2d 823 (N.D. 1998)