ACCIDENT INSURANCE. Written by DR. J. B. Lewis, Medical Director and Adjuster of the Historical. That form of underwriting which is now generally known as accident insurance is of comparatively recent origin. It is evident, however, that there was an early conception of the idea, for we find in the ancient sea laws, under date 1514, there existed a custom of insuring masters of ships "against the perils of the seas," the success of the commercial enterprises of that period being largely dependent upon the personal safety of the captains in command. Subsequently, there were other and more definite notions of that, which, later on, evolved accident insurance. We perceive this in the proclamations issued by warring nations, awarding a stated recompense to soldiers who should be mutilated in battle, the compensation being fixed by a published schedule which was to govern the amount of indemnity. In the municipal mining laws of the old town of Goslar, Prussia, may be found distinct stipulations, some of them dating back to 1524, requiring payment of indemnity to miners in the Harz region who should suffer accidental injury. One of these reads as follows: He who breaks any member of the body so as seriously to interfere with his capacity to work, shall receive from the common fund an amount equal to eight weeks' wages, besides free care of the physician." Other and clearer indications appear from time to time, yet it was not until about fifty years ago that the system of accident insurance as now in use was formed. The first practical attempt was by an English company, in London, in 1848. Its operations were restricted to insurance against injuries sustained while traveling by railway, and undoubtedly the introduction of steam railway travel suggested the gen 66 eral features of our present-day accident insurance. Fifteen years later-in 1863-the first accident-insurance company in this country was chartered, and it at once entered upon a successful career which has continued uninterruptedly to the present time. To write the history of that company would be, substantially, to write the history of the growth of accident insurance, the modifications it has undergone, the obstacles it has encountered, and the firm basis upon which its various forms of insurance now rest. Misuse of terms. Accident vs. injury.. DISCUSSION OF TERMS AND EXPRESSIONS Common usage has restricted the term accident insurance to an indemnity for loss by injury, notwithstanding the fact that every other branch of underwriting also intends to cover only such losses as may unexpectedly or accidentally happen. This is notably evident in fire, marine, and all other property insurance. Even in life insurance, when a policy-holder dies of "natural causes," it will almost invariably be found that the fatal disease was accidentally contracted, or brought on by circumstances which give it the character of accident. Just why one particular form of underwriting is designated accident insurance par excellence is not easily explained, but possibly it has grown out of the fact that the word "accident" and the word "injury " are frequently spoken, and sometimes written, as though they were synonyms. This fact is of common observation by those who are accustomed to handle correspondence giving notice of accidental injuries, or making informal claim for indemnity based thereon. In verification of this the writer has just taken, at random, one hundred such notices and claims, which have been received from as many localities, and finds that the words designated are used therein synonymously, and sometimes interchangeably, in sixty-one instances. This usage is unfortunate, because it introduces an element of confusion in the consideration of claims arising under accident policies, and medical men should be careful, when writing a surgical history of such cases, to see that they do not help perpetuate the erroneous habit or custom indicated. THE INSURANCE CONTRACT. Bodily Injury.-The insurance contract is usually explicit, and distinctly states that it is a stipulation against "loss resulting from bodily injuries effected through external, violent, and accidental means." It is the bodily injury, therefore, and the means through which it was effected or produced that call for our first consideration. Simple as this may appear to the novice, it nevertheless has given occasion for the most profound research, study, and critical judgment of the ablest jurists in the land. Take the word "injury" and note the unlike significations which longcontinued usage has attached to it. Webster defines an injury to be" that which injures or brings harm," and all recent lexicographers give substantially the same definition. A meaning is thereby given to the term injury similar to that which we commonly apply to the word tort—that is to say, an injury becomes a harmful or wrongful act. Such a definition of the word is wholly at variance with its use in either its medical or its medicolegal sense. The surgeon's meaning has reference only to the harm which has been done; and likewise in its medicolegal use it means the effect produced, and not the cause whereby it was accomplished. With these preliminary remarks we venture to define the term "injury".as a local alteration from its normal condition of any part of the body as an immediate effect of violence or force. This, too, we understand to be the underwriter's Underwriters' meaning of the word, in its unqualified sense, when standing alone. An injury, therefore, may be external, visible, and its character clearly manifest, as in outward wounds of various kinds; or the lesion may be internal, obscure, and of an occult nature, as in shock of the nervous system. The Means Through which an Injury is Effected. These must be threefold in their nature-external, violent, and accidental. Of the first two it may be said that the term external violence is self-explanatory, and sufficiently comprehensive to indicate to an examining surgeon what is required in surgical questions arising under this feature of an insurance contract. In an inquiry into an alleged injury the surgeon should fully note all evidences which lead him to conclude that certain appearances were produced by outward or external means, and that definition. Threefold. Scope of sur they have resulted from force or violence applied to the person. The degree of violence is not material. On the other hand, he geon's inquiry. should also take the same precaution to observe the indications which may have brought him to an opposite conclusion. This course is essential in a case where the insurance policy requires that there shall be a visible sign or mark of the alleged violence upon the person or body of the insured. Direct violent contact with blunt objects, as by blows or falls, produces a bruise of greater or less severity. There may result no apparent alteration of the parts sustaining the blow other than a slight discoloration due to the effusion of blood-stained fluids just beneath the unbroken skin,-in popular language, "a black-and-blue," —or there may be a crushing of the parts involved to mere pulp. Between these two extremes there is every manner of contusion, according to the degree of violence encountered. To unmistakably distinguish such traumatic contusions and resulting ecchymoses from postmortem bruises and cadaveric lividity will sometimes require the most critical inspection, and is at times impossible. Postmortem bruises. What constitute visible signs. External indications of internal injury. Visible Signs of Injury.-In actions at law to recover under accident-insurance policies, where there has been conflicting evidence upon facts relating to external and visible signs of violence, the question usually has been submitted to a jury under instructions by the court. A few instances of such instructions may be cited, as follows: "It becomes material, in the first place, to inquire whether the injury received in this case was such that it left visible external marks. Visible signs of an injury would not be confined to scratches, or bruises, or broken limbs; there might be other indications-as, for instance, if the nosebleed he had at times was the direct result of an injury, then that would be a visible sign. So if, even after two or three weeks, the bloody discharges from the bowels were the direct result of the injury, that would be a visible sign." * "An injury that is internal may afford external indications or evidences, which are visible signs of the injury within the meaning of such term as is used in an accident policy. If the injury * Whitehouse z's. Ins. Co., U. S. C. C., New Hamp., 7 Ins. L. Jour. 23. produces, for example, a pale face and sickly look, if it causes retching or bloody or unnatural discharges from the bowels; if, in short, it sends forth, to the observation of the eye, in the struggle of nature any signs of the injury, then those are external and visible signs provided they are the direct results of the injury."* In an appealed case it was held that it was not error to refuse to instruct that if there were no visible and external signs of injury but froth on the mouth and red spots on the body these did not constitute such signs. Whether they were external signs of injury was a question of fact for the jury. External signs invisible to the eye. In the case of Gale vs. Insurance Company the Supreme Court of New York (in an opinion filed January 18, 1893) held that when the diaphragm and recti muscles had been injured through a strain, it was sufficient to constitute an injury of which there were external and visible signs, if it could be ascertained by laying the hand on the body, though not visible to the eye. Probably because of rulings such as the preceding one the Amended clause relating to visible signs of violence has been amended in some recent accident-insurance policies so as to require a visible mark of violence impinging on the body. No legal interpretation of this phrase has yet been made.‡ Accident. Of the causative agencies through which bodily injuries may be effected, it remains for us to consider the third. one mentioned in the insurance policy, and which is therein designated "accidental means." This term, as used in the policy, * Barry vs. Ins. Co., U. S. C. C., Wis., 14 Ins. L. Jour. 603. Newman vs. Ins. Co., S. C., Va., 17 Ins. L. Jour. 97. The following citations may be consulted for further information upon the manner in which the clause relating to visible sign or mark of injury has been construed by the courts: Clidero vs. Scottish L. A. Co., 29 Scott. L. R. 303; Newman vs. Ins. Co., 84 Va. 52; Gale vs. Accident Assn., 66 Hun. 600; McCarthy vs. Trav. Ins. Co., 8 Biss. 362; Barry vs. Accident Assn., 23 Fed. Rep. 712, 131 U. S. 100; Pennington vs. Pacific Mutual, 52 N. W. Rep. 432; Whitehouse vs. Trav. Ins. Co., 17 Fed. cases, 7 I. L. J. 23; Eggenburger vs. Accident Assn., 41 Fed. Rep. 172; McGlinchey vs. F. and C. Ins. Co., So Maine 251; Paul vs. Trav. Ins. Co., 112 N. Y. R. 472 and note; Bernays vs. Accident Assn., 41 Fed. R. 455; Mallory vs. Trav. Ins. Co., 47 N. Y. R. 52; Owens vs. Trav. Ins. Co., 12 I. L. J. 75; Meneilly vs. Ins. Co., 148 N. Y. 596; Cronkite vs. Trav. Ins. Co., 75 Wis. 116; Tennant vs. Trav. Ins. Co., 31 Fed. Rep. 322. policies. |