Trusting in nature: some courts are relying on the laws of nature, not policy time-limit provisions, to determine when an insured's injuries become disabling.

After an injury-producing accident, many policies require that the injury, death or disability for which a claim is being made occur within a specified time period following the accident--usually 90 days--to assure the loss was caused by said accident. Yet some jurisdictions apply the "process-of-nature rule" to lessen the harshness of requiring that disabilities occur immediately, or within a specified number of days, after accidents.

Under the process-of-nature rule for policy provisions requiring disability within a certain time frame ("immediately," "from the date of the accident," or "within 90 days"), the onset of disability relates back to the time of the accident (if the disabling injury arises directly from the accident during the course of nature).That is, when the process of nature eventually brings the injured person to a state of total disability.

In adopting the rule, courts have noted that the human body does not act on a precise timetable in responding to injuries:

"It is a matter of common knowledge that in a large majority of instances in which bodily injuries are received, the real nature and extent of said injuries are not revealed until some time in the future and after the first pains have passed away. The injured part often lies dormant for an indefinite period, with but little or no consciousness of its existence by the person injured, although from the very moment of the accident, perhaps the process of nature may be busily engaged in developing what may have seemed to be but a slight hurt into a most serious and perhaps fatal injury."

In support of the process-of-nature rule, it has been argued that serious internal injuries often do not manifest themselves for a long time and injuries such as blood poisoning, which cannot disable without some lapse of time, would otherwise not be covered at all. As such, a strict and literal interpretation of a policy provision requiring that disability be immediate, or from the date of the accident, or follow the accident within a specified number of days, would lead to an unjust result and would unreasonably restrict the coverage of the policy.

Not all jurisdictions, however, agree.

Some jurisdictions have limited the process-of-nature rule to policies that contain ambiguous provisions such as requiring the insured to be "immediately" disabled, and decline to apply the rule to policies that require the insured to be totally disabled within a specified period of time. These jurisdictions note that the time limitation provision assists an insurance company in setting policy rates based on the risks of recovery and uphold the time limitation as an unambiguous, reasonable provision aimed at minimizing uncertainty as to the cause of the insured's death or disability.

In contrast, other jurisdictions have applied the rule even where the policy contains a clause limiting coverage to injuries which disable the insured within a specific number of days from the accident. For example, in Willden v. Washington National Insurance Co., the California Supreme Court applied the process-of-nature rule to a policy that contained a provision limiting coverage to a disability occurring within 30 days of the accident. The court saw "no distinction" between a provision using the word "immediately" and a provision with a specific time limitation.

Because serious injuries often do not manifest until long after an accident, the California court concluded that the insured's ability to work should not deprive him of coverage when the previously-hidden injury ultimately disabled the insured. The court thus concluded that strictly interpreting the time limitation in the policy under such circumstances would lead to an unjust result and would restrict unreasonably the policy's coverage to a small number of disabilities: "Such a very limited and highly technical construction of an insurance contract cannot be foisted onto a layman nor does it make any sense in terms of the risks insured against."

The process-of-nature rule avoids unjust and unreasonable results contrary to the insured's ordinary expectations. Further, not applying the rule creates perverse incentives by encouraging insureds to stop work immediately after an accident and to overstate the injury for fear that honest efforts to work will destroy eligibility for benefits. The alternative also creates perverse incentives for employers and insurers to encourage an employee to attempt to work until the designated time period in the policy has lapsed.

Frank N. Darras, a Best's Review columnist, is a partner with Shernoff Bidart Darras LLP, Claremont, Calif. He is a plaintiff's lawyer representing disabled insureds. He can be reached at [e-mail].