Prince v. U.S. Life Ins. Co. in City of New York

• Decision Date: 01 April 1965
• Citation: 23 A.D.2d 723,257 N.Y.S.2d 891
• Parties: Aaron PRINCE, Plaintiff-Respondent, v. The UNITED STATES LIFE INSURANCE COMPANY IN The CITY OF NEW YORK, Defendant- Appellant.
• Court: New York Supreme Court — Appellate Division

Page 891

257 N.Y.S.2d 891

23 A.D.2d 723

Aaron PRINCE, Plaintiff-Respondent, v. The UNITED STATES LIFE INSURANCE COMPANY IN The CITY OF NEW YORK, Defendant- Appellant.

Supreme Court, Appellate Division, First Department.

April 1, 1965.

Robert M. McCormick, Jr., New York City, of counsel (McCormick, McCormick & Dunne, New York City, attorneys) for defendant-appellant.

Ivan M. Dochter, of counsel (Harry H. Lipsig, New York City, attorney) for plaintiff-respondent.

Before VALENTE, J. P., and McNALLY, STEVENS, EAGER and STEUER, JJ.

MEMORANDUM BY THE COURT.

Judgment affirmed with $50 costs to respondent. The defendant's policy is written to cover loss 'resulting from injury or sickness', with 'injury' defined as meaning an 'accidental bodily injury' and with 'sickness' defined as 'sickness or disease'. The medical expense for which plaintiff has recovered judgment was a 'covered expense' arising from an 'accidental bodily injury' and not arising from 'sickness or disease'. The undisputed medical testimony was that the expense for physician's services was incurred in treating a psychoneurotic reaction resulting from 'a traumatic injury'. The defendant's claimed exemption from liability under the policy rests solely upon the effect of an exception clause excluding coverage for 'mental disease or deficiencies, psychotic or psychoneurotic disorders or reactions'. But the plaintiff's expert testified that the psychoneurotic reaction arising from the injury was not a 'mental disease or deficiency'. For the reasons more fully developed in the opinion at Special Term, we conclude that the 'average man' (see McGrail v. Equitable Life Assurance Society, 292 N.Y. 419, 424, 55 N.E.2d 483, 486), in reading the policy as a whole, would believe that the exclusion of coverage for loss occasioned by 'psychotic or psychoneurotic disorders or reactions' was intended to apply only where the disorders or reactions resulted from 'sickness or disease'--'mental disease and deficiencies', disassociated with bodily injury; that he would be entitled to assume that he was covered for all disorders or reactions, psychoneurotic or otherwise, directly resulting from an accidental bodily injury.

All concur except STEVENS and STEUER, JJ., who dissent.

STEUER, Justice (dissenting).

Plaintiff sues on a major medical insurance policy for the costs of certain medical treatment. There is no dispute but that the sum sued for was in fact paid to a doctor for treatment of the plaintiff's son and that the latter was a person covered by the policy. It appears that the son, as the result of an accident, had to undergo an operation which resulted in the loss of an eye. Following the operation the young...