What is an unintended and unforeseen event that results in bodily harm?

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Simply put, an accident is an unintended or unexpected occurrence. Accidental means is a provision under an insurance policy that covers losses incurred by an insured. This is an insurance policy that provides coverage for losses, body injuries, damage of property, or death cause by an unforeseen event or accident. This policy has no provision for losses from non-accident events, insurers are only liable for losses resulting from events that were out of the control of the insured.

How Does Accidental Means Work?

Coverage for unintended acts that cause bodily injury, harm or death to an insured are provided under an insurance policy (accidental means). Not all claims for losses are covered under this policy but losses that are proven to have been caused by accidents. For instance, an insured construction worker that is injured or suffer losses as a result of an accident that happened on the construction site can have access to this coverage. Losses, Bodily injuries, damages or death that occur as a result of carelessness or failure to take precautions are not covered by accidental means. Accidental means takes into account the cause and effect of the accidental event and not just the result of the event. While some insurance companies use 'accidental means', some use 'accidental injury'. Both terms have different meanings in different contexts and as used in different states. There is a specific way that the language of an insurance policy refers to accidental means. Take the following clause as an example; "Due proof that the death of the insured occurred as a result, directly and independently of all other causes, of bodily injuries effected solely through external, violent and accidental means..." this implies that the insurance policy caters for accidental means. However, in some cases, the court determines whether losses resulting from an event is covered or not. Events that include the occurrence of "Violent" and "external" commonly qualify as accidental means.

Related Topics

The Distinction Between Accidental Means and Accidental Results in Accidental Death Insurance, Ingram, J. D., & Ostfeld, L. R. (1984). The Distinction Between Accidental Means and Accidental Results in Accidental Death Insurance. Fla. St. UL Rev., 12, 1.
Accidental Death Insurance Coverage of Drunk Drivers, Gardner, M. E. (2004). Accidental Death Insurance Coverage of Drunk Drivers. Mo. L. Rev., 69, 235.
The Meaning of the Accidental Means Clause in Accident Insurance Policies, Rothman, B. (1981). The Meaning of the Accidental Means Clause in Accident Insurance Policies. INs. CouNsEL J., 48, 231.
Modern Environmental Insurance Law: Sudden and Accidental, Ribner, S. A. (1988). Modern Environmental Insurance Law: Sudden and Accidental. . John's L. Rev., 63, 755.
The Distinction Between Accidental Means and Accidental Results in Accidental Death Insurance, Ingram, J. D., & Ostfeld, L. R. (1984). The Distinction Between Accidental Means and Accidental Results in Accidental Death Insurance. Fla. St. UL Rev., 12, 1.

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Accidental means is a condition for losses covered under an insurance policy that requires the loss to have been the result of an accident, rather than the result of a non-accident. As a condition, accidental means is designed to protect insurers from having to pay claims on events that were not accidents.

"Accidental means" is a term used by insurance companies in their policies to decline paying out claims that result from non-accidents.
Both the injury and the event have to be considered accidents in order for a claim to be covered under the definition of "accidental means."
Insurance policies for bodily harm or death often include a provision that requires the death or injury to be caused by external, violent, and accidental means.
Some states consider bodily injury policies that use the words “accidental means” to be different from those that mention “accidental injury."

Insurers use the word “accident” to describe an event that happens unintentionally, and which is unexpected or unforeseen. Accidental means may involve acts that caused damage or harm, but which were themselves accidental. Both the injury and the event have to be considered accidents in order for a claim to be covered. Accidental means is a precise definition of “accident”, and is stricter than merely defining an accident as an unforeseen event.

Insurance policies for bodily harm or death often include a provision that requires the death or injury to be caused by external, violent, and accidental means. Accidental means takes into account both the cause and effect of the event, rather than just the result of the event.

For example, a construction worker with an accidental death and dismemberment policy who is injured would have to (1) not know that the risk of an activity would result in a loss, and (2) not know that any events leading up to that activity could result in a loss. If that worker were to use a machine that they knew had faulty wiring and was electrocuted, then they would not receive a benefit because they should have known that they could be injured because of the wiring problem.

A typical clause in an insurance policy that provides coverage for accidental death means might read, "Due proof that the death of the insured occurred as a result, directly and independently of all other causes, of bodily injuries effected solely through external, violent, and accidental means..."

Whether a given event is covered depends on how the relevant jurisdiction construes "external, violent, and accidental means." "Violent" and "external" commonly qualify the concept of "accidental means," and the courts are in widespread agreement on that definition.

Some states consider bodily injury policies that use the words “accidental means” to be different from those that mention “accidental injury." Court cases may hinge on whether the wording of the policy implies that the insurer has liability for the cause of the accident (death or injury from accidental means), or if the liability is dependent on the effect (injury or death).

R.C. Heating & Gasfitting Ltd. v. The Sovereign General Insurance Company,
2017 BCSC 1916

Most liability policies may be classified as either occurrence or claims-made policies. An occurrence policy responds where an event occurs during the policy period that gives rise to a covered loss. A claims-made policy responds where a claim is made against the insured party during the policy period. Recently, the British Columbia Supreme Court concluded that, when determining whether a loss is covered under an occurrence policy, the proximity in time between the occurrence and the actual loss may be relevant, depending on the policy wording.

The insured, R.C Heating & Gasfitting Ltd. (“R.C. Heating”) was in the business of installing gas systems between August 2001 and September 2007. In February and March, 2005, R.C. Heating installed a gas system at a property on Whitetail Lake in British Columbia. During this time, R.C. Heating held a third party liability policy issued by Sovereign General Insurance Company (“Sovereign”). In 2007, R.C. Heating ceased operations and its Sovereign policy was not renewed.

On August 13, 2014, an explosion occurred at the property on Whitetail Lake, resulting in serious bodily injuries to members of a family who were renting the property at the time. An action was commenced and R.C. Heating was added as a party to that action.

R.C. Heating tendered the claim to Sovereign who refused to defend it on the basis that there had not been an “occurrence” during the policy period. R.C. Heating took the position that, because the policy was in place at the time of its alleged negligent acts, there had been an “occurrence” during the policy period. The matter turned on whether R.C. Heating’s alleged negligent work in 2005 constituted an “occurrence” under the policy.

The policy provided coverage for “Bodily Injury or Property Damage caused by an occurrence” and defined “occurrence” as “an accident, including continuous or repeated exposure to substantially the same general harmful conditions”. The policy, in turn, defined “Accident” as “an unintended or unforeseen event which causes an injury or damage.”

Justice A. Saunders found in favour of Sovereign, determining there was no duty to defend for lack of there being an “occurrence”, reasoning:

The focus must be on the immediate circumstances of a loss, not its originating cause.

…

…in the present case the natural and ordinary meaning of “accident” is reinforced by the Policy’s definition of that term, which explicitly limits the unintended or unforeseen events insured against to those which cause an injury or damage. If the interpretation contended for by the petitioners were what was intended, the phrase “which causes an injury or damage” in the definition of “accident” would be redundant; it would be sufficient for the definition simply to be “an unintended or unforeseen event”, with the necessary causal connection between the insured’s negligence and the resulting bodily injury then being provided by the Insuring Agreement’s stipulation that the bodily injury or property damage be “caused by an occurrence”. The inclusion in the definition of “accident” of a causal linkage between the unforeseen event and its consequences strongly implies, therefore, that an “accident” — and, by extension, an “occurrence” — is the discrete event that immediately results in the loss, not the originating cause of the insured’s negligent act.

[emphasis in original]

Ultimately, R.C. Heating’s alleged negligence pre-dated the loss by almost a decade and was determined to lack sufficient proximity to the loss to be considered an “occurrence” under the policy.

Justice Saunders’ reasons reinforce the principle that every insurance policy should be interpreted according to the particular wording utilized by the insurer. Some may consider that the decision fails to give life to the interpretive principle of interpreting coverage provisions broadly. However, unless wording in the definition of “accident” was deemed superfluous, the definitions of “accident” and “occurrence” support the end result.