Augusta v. John Hancock Mut. Life Ins. Co.
| Decision Date | 27 February 1958 |
| Citation | 170 N.Y.S.2d 908,11 Misc.2d 111 |
| Parties | Elizabeth AUGUSTA, Plaintiff, v. JOHN HANCOCK MUTUAL LIFE INSURANCE COMPANY, Defendant. |
| Court | New York City Municipal Court |
Goldstein & Goldstein, New York City, Eli B. Levy, Alex Davis and Lawrence Kovalsky, New York City, of counsel, for plaintiff.
Tanner, Friend, Kinnan & Post, New York City, Edward T. Post, New York City, of counsel, for defendant.
This controversy calls for the construction of a policy of group life insurance. There appears to be no authority in this jurisdiction directly in point.
The plaintiff, as widow and named beneficiary, seeks to recover the sum of $2,500, representing increased insurance benefits to which she claims she is entitled by virtue of an amendment to a policy of group life insurance covering her late husband.
Under an effective date of December 28, 1953, the defendant issued its master group life insurance policy to Henry Spen & Co., Inc., of Brooklyn, N. Y., engaged in the business of manufacturing trailers and truck bodies, for civilian and Navy and Air Force use. Under the terms of the policy, one Samuel Augusta, an employee of Henry Spen & Co., Inc., since March, 1946, became insured under such policy on its effective date and received a certificate evidencing his coverage. The certificate named Elizabeth Augusta, described as wife, the plaintiff herein, as beneficiary.
The master policy, in so far as pertinent to the question to be decided, provided:
'Insuring Clause. Subject to the terms and conditions of this policy applicable to this coverage, upon receipt of due proof at the Home Office of the Company of the death of an employee insured for Life Insurance under this Policy, the Company shall pay to the beneficiary the amount of Life Insurance in force under this Policy on the life of such employee at the date of death, in accordance with the provision entitled 'Amounts of Insurance' contained herein.
* * *
* * *
'Amounts of Insurance. The amounts of insurance on any employee and any change in such amounts shall be based upon the following Schedule:
"Schedule of Insurance for Employee Coverage
-----------------------------------------------------------------------
Classification of Employees Class
-------------------------------------------- -----
All Employees under age 65 A
All Employees age 65 and over B
Coverage Amount of Insurance
-------- -------------------
Class A Class B
-------- --------
Life Insurance $2500.00 $1000.00
Accidental Death and Dismemberment Insurance
(Full Amount) $2500.00 $1000.00
* * *
* * *
* * *
* * *
* * *
* * *
On June 12, 1954, Samuel Augusta was taken to the Long Island College Hospital for what proved to be his terminal illness, where he remained until he died on June 30, 1954. He was admitted to the hospital suffering from, and complaining of, shortness of breath. The hospital records, received in evidence, indicate that the direct cause of death was heart failure due to rheumatic heart disease.
In the meantime, and on or about June 25, 1954, Henry Spen & Co., Inc., and the defendant, amended the master policy. The employer's application for this amendment, bearing date June 7, 1954, indicated that the purpose of the amendment was to change the 'Schedule of Insurance' so as to take into account the length of service of various employees, and the pertinent provision of such application reads as follows:
'It is agreed that no change requested herein shall become effective until this request shall have been approved by the Company at its Home Office; and it is further agreed that, subject to such approval, if any employee to whom such reguested change is to be applicable is not actively at work on the effective date, such change shall not be applicable to such employee until the date of his return to active work.' (Emphasis supplied.)
The actual amendment, as approved by the Compnay, was dated June 25, 1954, and reads, in part, as follows:
'It is understood and agreed that effective as of June 28, 1954, said Policy is hereby amended as follows:
'Schedule of Insurance
'The Schedule of Insurance for Employee Coverages contained on Page T-2 of said Policy is cancelled and annulled. The amount of insurance as to each employee remaining insured and each employee becoming insured under said Policy on and after June 28, 1954, shall be determined in accordance with the following Schedule of Insurance for Employee Coverages, except that the amount of insurance for any employee who is not actively at work on said date shall not be increased until the date he returns to active work. (Emphasis supplied.)
"Schedule of Insurance for Employee Coverages
---------------------------------------------------------------------
Classification of Employees Class
-------------------------------------------- -----
All Employees
Length of Service
-----------------
Less than 8 years A
8 years and over B
Coverage Amount of Insurance
-------- -------------------
Class A Class B
------- -------
Life Insurance $2500. $5000
Accidental Death and Dismemberment Insurance
(Full Amount) 2500 5000
'The amount of insurance of an employee shall be reduced to $1000 by reason of attainment of age 65.
'If the classification of an employee shall change his amounts of insurance shall change accordingly on the date of such change in classification provided the employee is then actively at work, otherwise on the date he returns to active work.' (Emphasis supplied.)
To summarize the foregoing provisions, the master policy provided that all employees under age 65 were deemed to be in Class A, and such Class A employees were entitled to life insurance in the amount of $2,500. The amendment to the master policy reclassified the employees, so that those with length of service of eight years or over, who had not attained age 65 at date of death, were deemed Class B employees entitled to life insurance in the sum of $5,000, provided such Class B employees were 'actively at work' on June 28, 1954, the effective date of the amendment, or if not then actively at work, on the date of 'return to active work.' It is conceded that on June 28, 1954, the deceased had been employed for more than eight years and at date of death had not attained age 65.
As indicated, Samuel Augusta died on June 30, 1954. In due course, a death benefit of $2,500, provided in the original terms of the group policy for employees under age 65 was paid to the named beneficiary, the plaintiff herein, and no part of this amount is in question.
The present claim is made on the assertion that Mr. Augusta was entitled to a total coverage of five thousand dollars by virtue of such amendment to the master policy. The payment of $2,500 heretofore received by the plaintiff was made without prejudice to her right to sue for the balance of $2,500, the amount presently in suit.
The foregoing facts are not in dispute.
At the trial, one Arthur Halpern, the office manager of Henry Spen & Co., Inc., testified in behalf of the plaintiff. By his testimony, it was developed that Mr. Augusta's usual duties were those of traffic manager sales manager, and contract administrator for Henry Spen & Co., Inc.
While the decedent was at the hospital, between June 12, 1954, and June 30, 1954, Mr. Halpern stated that he visited him every day with the possible exception of one or two days. During this period, the average length of such visits was an hour to an hour and a half, and included visits on June 28, 29, and 30, 1954. Such visits were made during and after working hours, and were for the purpose of discussing current business problems that had arisen with respect to the deceased's duties as traffic manager, sales manager and contract administrator. Mr. Halpern asked for and received answers, instructions and directions in respect of such problems, which were relayed to his employer. He went to the hospital at the specific direction of Mr. Monroe Spen, the treasurer of Henry Spen & Co., Inc.
Throughout the entire month of June, 1954, the deceased was continued on his employer's payroll, receiving his full salary each week up to and including the week ending July 1, 1954.
The plaintiff, in her own behalf, testified that her husband had originally entered the hospital for rest, and that later she was at his bedside daily between June 25 and June 30,...
To continue reading
Request your trial
-
Bingham's Estate v. Nationwide Life Ins. Co. of Columbus, Ohio, 52480
...a claim arising when a tenured and full-time compensated teacher was on vacation. To like effect is Augusta v. John Hancock Ins. Co., 11 Misc.2d 111, 170 N.Y.S.2d 908 (1958), which held that an employee, though in a hospital, was actively at work if he actively made decisions and gave direc......
-
Roby v. Connecticut General Life Ins. Co.
...This test was reiterated in Great-West Life Assurance Co. v. Levy, 382 F.2d 357, 360 (10th Cir.). In Augusta v. John Hancock Mutual Life Ins. Co., 11 Misc.2d 111, 170 N.Y.S.2d 908, a supervisory employee, in the hospital and in critical condition, was held to be actively at work because he ......
-
Williams v. Metropolitan Life Ins. Co., 33461
...held he was not actually at work. Another case which is pertinent but not referred to in Marshall is Augusta v. John Hancock Mutual Life Insurance Company, 11 Misc.2d 111, 170 N.Y.S.2d 908. Augusta was traffic manager, sales manager and contract administrator. While in the hospital the offi......
-
Morris v. Mutual Benefit Life Insurance Company
...excluded during any week in which he did not work 30 hours because of illness, vacation, etc. The case of Augusta v. John Hancock Mutual Life Ins. Co., 11 Misc.2d 111, 170 N.Y.S.2d 908, is informative. The policy in that case contained no requirement that the employee be at his "usual place......