Bankers Life & Casualty Company v. Goodall

• Decision Date: 28 December 1966
• Docket Number: No. 22991.,22991.
• Citation: 368 F.2d 918
• Court: U.S. Court of Appeals — Fifth Circuit
• Parties: BANKERS LIFE & CASUALTY COMPANY, Appellant, v. Raldo G. GOODALL, Appellee.

368 F.2d 918 (1966)

BANKERS LIFE & CASUALTY COMPANY, Appellant, v. Raldo G. GOODALL, Appellee.

No. 22991.

United States Court of Appeals Fifth Circuit.

November 30, 1966.

Rehearing Denied December 28, 1966.

Roger A. Hansen, Oliver A. Fountain, Brundidge, Fountain, Elliott & Churchill, Dallas, Tex., for appellant.

J. R. Black, Jr., Scarborough, Black, Tarpley & Scarborough, Abilene, Tex., for appellee.

Before BROWN, COLEMAN and AINSWORTH, Circuit Judges.

AINSWORTH, Circuit Judge:

Raldo G. Goodall, by judgment rendered on a general verdict, recovered $100,000, the stated amount in a group accident insurance policy, for the irrevocable loss of the entire sight of one eye. Bankers Life & Casualty Company appealed from the judgment rendered against it and from the order overruling its motion for a new trial. We affirm.

On February 18, 1964, Goodall slipped and fell, striking his left eye and forehead on a bolt. On the same day he was driven to the nearest available doctor who, after rendering first aid treatment, advised appellee to consult an eye specialist. On the following day an ophthalmologist examined Goodall and found that "he had a fairly red eye, sensitive to light, two minor abrasions, rough areas on the cornea, and he had a mild to moderate iritis, which is eye inflammation of the interior of the eye induced by various types of injections or injuries." On October 1, 1964, appellee's left eye was surgically removed by another ophthalmologist, who had examined the patient for the first time on the preceding day. In the interim between the accident and the surgical operation, Goodall, complaining at times of loss of vision and on other occasions of severe pain, was examined and treated by numerous doctors. Goodall filed a complaint to recover $100,000 under a group policy issued by appellant to Ford Motor Company, in which he was a named insured. The policy provides a benefit of $100,000 for the irrevocable loss of the entire sight of one eye resulting from injury "causing the loss * * * directly and independently of all other causes and effected solely through an accidental bodily injury to the Insured Person * * *. The policy does not cover any loss caused or contributed to by * * medical or surgical treatment (except medical or surgical treatment made necessary solely by injury); * * *"

Appellant lists seven specifications of error of the trial court, the first of which is the denial by the court of a motion for a directed verdict; the remaining specifications of error pertain to the lower court's charge to the jury. Appellant summarized the alleged errors in three points:

1. Plaintiff failed to submit any evidence that the alleged accidental injury was the sole cause of irrevocable loss of sight directly and independently of all other causes, as it was his burden to do.

2. The trial court erred in failing to submit clearly and so as to prevent confusion the requirements of the policy that the cause of the loss be a certain accident and that such accident be the sole cause directly and independently of all other causes.

3. A voluntary surgical removal of an eye, without prior irrevocable total loss of sight, cannot be the basis of recovery under the policy requiring irrevocable loss of sight directly and independently of all other causes and solely caused by accidental injury.

Appellant argues that in order to recover under the policy the assured must plead and prove under the specific provisions contained therein that the accidental injury complained of was the sole cause of his loss, independently of all other causes; that the assured's failure to carry this burden entitled appellant to a directed verdict.¹

The fact of an accident occurring on February 18, 1964, causing injury to appellee's left eye, is not in dispute. The controversy is over the causal connection between the particular injury and the subsequent blindness prior to surgical removal. There is an abundance of medical evidence to the effect that Goodall was not blind; that no blindness was found as late as two days prior to surgery; that Goodall did not complain of blindness on various visits to doctors; and that there was no necessity that his eye be surgically removed. There was evidence of medical treatment for complaints unrelated to the accident in question, and evidence which put at issue the veracity of Goodall, as well as evidence from which the jury could have inferred that he was malingering; that his complaint of blindness was attributable to psychosomatic symptoms; that he deliberately aggravated his condition in an attempt to reap the benefits of the insurance policy because of financial difficulties and even subsequent self-inflicted injury as a result of...