Arabia v. John Hancock Mut. Life Ins. Co.
| Citation | 301 Mass. 397,17 N.E.2d 202 |
| Parties | GREGORIO ARABIA v. JOHN HANCOCK MUTUAL LIFE INSURANCE COMPANY. |
| Decision Date | 28 October 1938 |
| Court | United States State Supreme Judicial Court of Massachusetts |
September 28, 1938.
Present: FIELD, C.
J., DONAHUE, QUA & RONAN, JJ.
Insurance Disability, Construction of policy, Proof of loss. Contract Construction. Law of the Trial. Practice, Civil, Exceptions what questions open. Evidence, Relevancy. Estoppel.
In a supplementary contract attached to a life insurance policy issued by a company authorized under G. L. (Ter. Ed.) c. 175, Section 24, to issue a policy against total and permanent disability, but not against either alone, a provision that total disability continuing for four months should be "deemed to be permanent only for the purpose of determining commencement of liability," in the absence of any further definition of permanent disability and in view of the company's own construction by its conduct, meant that total disability continuing for four mouths was permanent disability.
An instruction to the jury, not excepted to, became the law of the trial and a party had no standing in this court to contend that the instruction was erroneous. "Due proof" of total disability, required by the provisions of a policy of disability insurance, was furnished by the insured's setting forth his claim by filling out in every detail blanks furnished by the insurer.
An opinion, which was set forth by a physician in a statement to an insurer under a policy of disability insurance and which was contrary in some particulars to statements made by the insured in a proof of claim made by him on blanks furnished by the insurer, was not part of the insured's proof nor binding on him.
Having furnished "due proof" of his claim under a policy of disability insurance, the insured, where the insurer did not request further proof of continuance of total and permanent disability after it had discontinued payments, was not required to furnish such proof before bringing an action for further payments.
On the issue, whether total and permanent disability of one insured under a policy of disability insurance continued after the insurer discontinued payments, testimony of attending physicians of the insured as to his condition after the commencement of the action was admissible in the discretion of the trial judge, the jury being instructed to consider such evidence only as bearing upon the insured's condition during the period before the date of the writ.
The mere facts that one, insured under a policy of disability insurance which provided that, upon total and permanent disability, he would be exempt from paying premiums, received and accepted without objection payment of less benefits than he was entitled to, and paid premiums during a time when he contended he continued to be totally and permanently disabled, did not estop him from maintaining an action for further benefits and repayment of such premiums.
CONTRACT. Writ in the Superior Court dated November 15, 1934. The action was tried before Broadhurst, J. There was a verdict for the plaintiff in the sum of $1,455.87. The defendant alleged exceptions.
C. C. Milton, (R.
C. Milton with him,) for the defendant.
Nunziato Fusaro, for the plaintiff.
The plaintiff seeks in the first count of his declaration to recover benefits for total and permanent disability from April 10, 1933, to November 15, 1934, under a supplementary contract attached to a life insurance policy; and, in the second count, to recover the premiums paid during the same period. The jury returned a verdict for the plaintiff on each count of the declaration. The defendant excepted to the denial of its motion for a directed verdict and to the admission of evidence relative to the plaintiff's physical condition subsequent to November 15, 1934, the date of the writ.
The supplementary contract provided that "If . . . due proof shall be presented at the Home Office of the Company that the Insured has . . . become totally disabled as the result of bodily injury or disease so as to be wholly prevented thereby from engaging in any occupation or employment for wage or profit, and that such disability has already continued uninterruptedly for a period of at least four months (such disability of such duration being deemed to be permanent only for the purpose of determining commencement of liability hereunder) the Company, during the continuance of such disability, will" waive payment of premiums due after commencement of such disability and pay monthly benefits in a certain amount beginning with the fourth month from the commencement of disability. A part of the caption of this contract is "Benefit for Total and Permanent Disability," but no mention whatever is made in the body of the contract concerning permanent disability other than in the portion above quoted.
It could have been found upon all the evidence that the plaintiff was so severely injured on September 10, 1932, that he has since been unable to engage in any occupation or employment for compensation. His ailments and incapacity resulting from the accident were set forth in great detail by himself and his physicians. There was evidence that his condition was "permanent and progressive" and that it "will become worse as time goes by." Written proof of his disability was given to the company on January 24, 1933. On May 5, 1933, the plaintiff's physician furnished the defendant a written statement concerning the plaintiff's condition. The plaintiff's proof and the physician's statement were made on forms furnished by the defendant. Thereafter, the defendant paid all benefits due under its contract up to and including April 10, 1933, and refunded the premiums that had then been paid during the plaintiff's disability.
The defendant contends that, in order to recover, the plaintiff must show that his disability was both total and permanent, and that permanence of disability cannot be presumed from total disability under the terms of the contract. It is true that the contract does not in terms define permanent disability. It provides that total disability, continuing for four months, shall be "deemed to be permanent only for the purpose of determining commencement of liability." The company could insure only against total and permanent disability. G. L. (Ter. Ed.) c. 175, Section 24. It could not issue a policy against either total or permanent disability. Mutual Benefit Life Ins. Co. v. Commissioner of Insurance, 271 Mass. 365 . Shea v. Aetna Life Ins Co. 292 Mass. 575 , 584. Liability could not attach until the total disability became permanent, and the provision in the contract fixing liability as commencing upon the continuance of total disability for four months, construed in the light of the statute, must mean that such a disability had then become compensable. Such a construction is supported by the design of the statute, the language of the contract, and the intent of the parties. Rezendes v. Prudential Ins. Co. 285 Mass. 505 . Shea v. Aetna Life Ins. Co. 292 Mass. 575 . Benefit payments were made by the company and received by the insured upon the understanding that total disability continuing for four months became a total permanent disability. "It is a familiar rule that when the...
To continue reading
Request your trial