Probative Value of an Attending Physician's Reply to a Court Fact Inquiry

The Supreme Court has consistently held, in substance, that “even where an insurance contract covering death as the insured event provides that suicide is a ground on which the insurer is exempt from liability, a suicide committed while the insured was unable to make a free decision because of a mental illness or similar condition is covered by the insurance.”

However, because the insured has already died, it is not easy to prove or determine whether the insured took their own life because of a mental illness. In litigation, making a fact inquiry to the attending physician who treated the insured, in order to establish the insured’s condition, is almost the only available means.

There was a case in which the court of first instance and the appellate court, relying on statements by people around the insured and similar evidence, reached a conclusion different from the attending physician’s reply to the fact inquiry. The Supreme Court held, in substance, that a court must not reject an attending physician’s reply to a fact inquiry without relying on medical and expert material, and it reversed the appellate judgment.

Supreme Court Decision 2017Da281367, 4 February 2021

Facts

The deceased, the plaintiff’s daughter (year of birth omitted), had worked as a primary school teacher since around 2004. Around October 2006, she suffered severe stress as a result of verbal abuse and similar conduct by a pupil’s parent. Around October 2008, she was diagnosed with depression and received treatment for about two months. From then on, she complained of depression around autumn every year and received psychiatric counselling and treatment for it about once a month until the following spring.

From around the end of September 2011, the deceased continued to receive inpatient and outpatient treatment for a skin disease, including erythematous papules that had developed over her whole body, and for worsening liver function test results. On 12 October 2011, after returning home from work, she was found hanged in her home. She was taken to hospital but died.

Before the present lawsuit, the plaintiff had claimed a survivor’s compensation payment, asserting that “the deceased was driven to suicide by depression, an illness arising from her official duties.” When the claim was refused, the plaintiff brought an action against the Government Employees Pension Service around that time, seeking the cancellation of the decision refusing payment. In the course of that litigation, it came to light that, around the time of her suicide, the deceased had visited her attending psychiatrist several times. In those consultations she explained that her school duties prevented her from receiving proper inpatient treatment, and said, in substance, that “she wanted to die” and that “she was not much concerned about her liver function results or skin disease; what came first was that she felt anxious and was struggling.”

In that litigation, the deceased’s attending psychiatrist replied to the fact inquiry of the court of first instance to the following effect: “The deceased is said to have suffered severe stress from the 2006 incident and to have struggled for about two months; a period of that length can be regarded as her first depressive episode. Thereafter her depressive symptoms recurred in the same season, so that she can be diagnosed with recurrent major depressive disorder with a seasonal pattern. At the consultation on 4 October 2011, the deceased appears to have been severely anxious that her earlier depressive symptoms might recur, because the period in which she could not receive proper treatment happened to fall in October, and this is presumed to be related to cognitive distortion, a typical symptom of depression. On 10 October 2011, I wrote the deceased a medical opinion for submission to her school and strongly recommended readmission. One of my reasons was to reassure her: to reduce time-related and environmental stress as far as possible so that her treatment could somehow be maintained, and, in the face of her cognitive distortion, in which she believed her situation was hopeless and that no help was available, to show her that there was at least one attending physician who could help her.”

In the present case, the appellate court relied solely on the facts that the insured had commuted to and from work as usual on the day before her death, had shown no unusual behaviour or appearance on the day of her death, and had hanged herself at her residence late in the afternoon. On that basis, it held that “it is difficult to find that the deceased’s mental state had become suddenly unstable, or that she committed suicide in a state of extreme agitation or mental panic,” and concluded that the case fell within the insurer’s exemption under the policy terms.

Holdings

(The following is our English translation of the Court’s holdings; it is not an official text.)

Even where an insurance contract covering death as the insured event provides that suicide is a ground on which the insurer is exempt from liability, that exemption does not extend to a case in which the insured, being unable to make a free decision because of a mental illness or similar condition, brought about their own death. Accordingly, where the direct act that caused the death, committed while the insured was unable to make a free decision, was attributable to an external factor, the death may constitute an accidental event not caused intentionally by the insured, and thus fall within death as the insured event. Whether the death occurred while the insured was unable to make a free decision because of a mental illness or similar condition must be determined by considering, as a whole, the deceased’s age and character; the deceased’s physical and mental condition; the time of onset, course and severity of the mental illness and the deceased’s specific condition around the time of the suicide; the surrounding circumstances and the deceased’s behaviour around the time of the suicide; the time and place of the suicide; and other matters such as the motive for the suicide and its circumstances, method and manner.

Medical criteria for assessing the relationship between major depressive disorder and suicide are well established. Accordingly, where medical opinion has been submitted in evidence to the effect that the deceased committed suicide after reaching a state in which she could not make a free decision because of major depressive disorder, a court may not lightly reject it. If a court is to infer causation differently from such a medical opinion, it must decide carefully on the basis of other medical and expert material. The court below, without considering the opinion of the psychiatrist who had treated the deceased or the medical criteria underlying that opinion, relied merely on circumstances such as that the deceased showed no outwardly unusual signs to the people around her around the time of her suicide, and that she took her life by a method that did not appear impulsive, and held that it was difficult to find that she had committed suicide while unable to make a free decision because of depression. That judgment contained errors, including a misapprehension of the relevant legal principles.