Mutual Benefit Health & Accident Ass'n v. Francis

• Decision Date: 11 April 1945
• Docket Number: No. 12976.,12976.
• Citation: 148 F.2d 590
• Parties: MUTUAL BENEFIT HEALTH & ACCIDENT ASS'N v. FRANCIS.
• Court: U.S. Court of Appeals — Eighth Circuit

148 F.2d 590 (1945)

MUTUAL BENEFIT HEALTH & ACCIDENT ASS'N v. FRANCIS.

No. 12976.

Circuit Court of Appeals, Eighth Circuit.

April 11, 1945.

Henry I. Eager, of Kansas City, Mo. (Robert E. Coleberd and Michaels, Blackmar, Newkirk, Eager & Swanson, all of Kansas City, Mo., on the brief), for appellant.

William G. Boatright, of Kansas City, Mo., for appellee.

Before GARDNER, THOMAS, and JOHNSEN, Circuit Judges.

GARDNER, Circuit Judge.

Appellant, Mutual Benefit Health and Accident Association, prosecutes this appeal from a judgment establishing its liability under an accident insurance policy.

By its policy, issued May 3, 1939, it insured appellee's husband John Pritchard Francis, against loss of life, limb, sight or time resulting directly from accidental means and against loss of time resulting from disease contracted during the term of the policy. The policy was in effect at the time of assured's death. Proofs of claim of accidental death were submitted to the company but it denied liability and this action resulted. It will be convenient to refer to the parties as they were designated in the trial court.

On trial of the action, at the close of plaintiff's testimony, and again at the close of all the testimony, defendant moved for a directed verdict, which motion was denied and the case was submitted to the jury on instructions to which certain exceptions were saved by defendant. The jury returned a verdict in favor of plaintiff on all the issues and from the judgment entered thereon defendant prosecutes this appeal. In seeking reversal it urges that: (1) the court erred in denying defendant's motion for a directed verdict; (2) that the court erred in its rulings on the reception of certain evidence designated by it; (3) the court erred in certain portions of its charge to the jury.

In considering the question of the sufficiency of the evidence presented by the denial of defendant's motion for a directed verdict, we must accept as true the evidence favorable to plaintiff, and we must assume that the jury determined all conflicts in the evidence in her favor. She is also entitled to the benefit of all inferences which may reasonably be drawn therefrom. If the evidence so considered was such that reasonable men might reach different conclusions, then the case was one for the jury. Gunning v. Cooley, 281 U.S. 90, 50 S.Ct. 231, 74 L.Ed. 720; Champlin Refining Co. v. Walker, 8 Cir., 113 F.2d 844; Illinois Power & Light Corporation v. Hurley, 8 Cir., 49 F.2d 681.

Assured at the time of his death was 58 years old. He had been married to and lived with the plaintiff for 21 years. During that time he had consulted a physician but once and that was with respect to his teeth. Prior to the accident he was continuously at work and had not missed a single day's work on account of sickness in over twenty years, and he was in apparent good health. On April 2, 1942, at 7:30 p. m., he fell down the back steps of his home. While he was in the house plaintiff turned the water on the back steps of the house and as the assured came out and started down the steps he slipped and fell on the second from the bottom step, falling on his left side. In answer to inquiry whether he was hurt, he exclaimed, "Help me up. My God, I didn't see the steps were wet." He was helped into the house, where he laid down on the davenport, complained of being cold and complained of pain in his side. On examination his side was found to be red. He stayed on the couch one-half hour, when he had a phone call, to which he replied, "I can't go," but being unable to secure anyone else he got up from the couch and left his home for an hour and a half, when he returned, complaining of his side and arm. The following day he did not eat his breakfast. In the evening of that day he refused to eat dinner and laid down on the couch. He looked sick and gray and was cold. The next day, April 4, he did not eat his breakfast but drank a little tomato juice; that afternoon he returned earlier than usual from the office. He was sick and gray and pale in appearance. He spent the afternoon lying down and ate nothing that evening. The following day, Sunday, April 5, he did not eat breakfast but remained in his bed until 11 o'clock a. m., and then went with his wife to church, being gone about one hour. When they returned home he again laid down, his eyes looked very heavy and droopy and his face was pale. He ate no solid food on Sunday but drank a little coffee, and laid down during the afternoon. On Monday, the 6th, he did not eat breakfast but went to his office. He had no dinner that evening. On Tuesday, the 7th, he ate no breakfast, and although the day was warm he put on a winter suit and overcoat before going to the office, although he had theretofore been wearing a spring suit. He did nothing that required physical exertion after his fall. On Tuesday, the 7th, while at his office he was taken suddenly ill and was moved to the hospital where he died. An autopsy was performed, disclosing a fresh thrombotic occlusion approximately one inch from the orifice of the coronary artery. The immediate cause of his death was coronary thrombosis. The autopsy revealed diffuse arteriosclerosis of both the right and left coronary arteries, with ulcerative arteriosclerosis of the left coronary artery. The inside of this artery was almost occluded.

Dr. George C. Lee, a heart specialist, explained that a coronary occlusion means anything that occludes or shuts off the coronary artery which supplies the heart with blood, and that a coronary thrombosis or thrombotic occlusion means that the thing that has shut off the blood supply to the coronary artery is a blood clot. Arteriosclerosis is commonly known as hardening of the arteries. Symptoms of coronary occlusion are pain in the chest or in the arms, a feeling of indigestion, shortness of breath, pain in the abdomen or legs. There may be short attacks during a period of several days and usually where there is a sudden ending of the occlusion there is a terrific pain felt in the chest, radiating to either or both arms and often into the abdominal region. An occlusion may be forming over a considerable period of time previous to the final occlusion. The time consumed between the beginning of a thrombotic occlusion until it reaches the point of progress which discloses its symptoms may extend from a week to ten days of symptoms, and often it takes longer. Coronary thrombosis is infrequently caused by blows on the chest that have shown no penetration or crushing of the chest wall. A patient who has arteriosclerosis is more likely to suffer coronary occlusion through strain, effort or trauma than one who does not. Where coronary sclerosis is present, effort is frequently the cause of thrombosis, while external trauma is fairly infrequent. Effort causes the arteries to contract and dilate and where there is coronary sclerosis present any effort either physical or mental, or mental excitement may cause a spasm of those arteries and thereby increase the likelihood of the thrombosis forming. Fifty per cent. of the cases that have coronary thrombosis have it at a time of either physical or mental over-exertion. Arteriosclerosis is a condition frequently found in people of middle age.

In answer to a hypothetical question embodying the entire history of assured's injury and symptoms up to the time of his death, the doctor answered that the thrombasis of the coronary artery might have had its inception at the time of his fall; that cases of coronary thrombosis frequently have their inception several days before final occlusion in which they have their pain. Often the patients think they are having indigestion and refuse to eat and finally have their complete occlusion and severe pain, and it may be sudden death or they may recover. Many of those who are afflicted with the ailment are not aware of the seriousness of their condition at the time of its incipiency. If assured had the fall described, and if that was the precipitating cause of his acute coronary thrombosis, he was seriously ill from that time and was not able to be up and around and attending to his duties. The heart does not enlarge from sclerosis or degenerative processes — it enlarges from overwork, from some other cause than has caused it to overwork, and in this particular case from hypertension.

Dr. Cecil Kohn, a heart specialist, in answer to a hypothetical question embodying the history of the case, stated that the thrombotic occlusion found on postmortem in assured's heart could have been precipitated by the fall he suffered; that a person with coronary sclerosis may have precipitated in the coronary artery a thrombus as a result of over-exertion, emotional upset, excitement, or anything that might produce a sudden change in circulation. A thrombus is a blood clot. There are two stages of the thrombus — one is the time when it starts to grow and develop, the beginning of the clot, and the other when it reaches the point where it occludes, that is shutting off the blood supply completely. The time interval may be several days. If assured's fall was the precipitating cause of the thrombotic occlusion, then he was a very sick man from that moment and should have been in bed; that while the characteristic symptoms of the coronary occlusion are pain in the chest, radiating out to the arms and frequently down the arms and more frequently down the left arm to the fingers, and occasionally radiating into the abdomen, even simulating an attack of gall bladder or appendicitis, some people have an attack without pain. In cases where final occlusion occurs while the patient is in bed or asleep, the occlusion itself may have started days before when the patient was exerting himself. As to characteristic symptoms at the outset of an occlusion, it might be indigestion, it might be vomiting, might be a feeling of weakness, or "just feeling poorly;" that the time elapsing from the...