Ballam v. Metropolitan Life Ins. Co.
| Decision Date | 24 September 1936 |
| Citation | 295 Mass. 411,3 N.E.2d 1012 |
| Parties | BALLAM v. METROPOLITAN LIFE INS. CO. |
| Court | United States State Supreme Judicial Court of Massachusetts Supreme Court |
Report from Superior Court, Suffolk County; Swift, Judge.
Action of contract by Evelyn R. Ballam, administratrix of the estate of her husband William H. Ballam, deceased, against the Metropolitan Life Insurance Company, wherein the Superior Court ordered a verdict for the defendant, and reported the case.
Judgment for plaintiff.
J. A. Herbert and D. C. Sachs, both of Boston for plaintiff.
B. J Killion, of Boston, for defendant.
This is an action of contract brought by the plaintiff as administratrix of the estate of her husband William R Ballam, deceased, upon two policies of life insurance issued by the defendant to recover benefits arising under provisions therein for double indemnity in the event of the accidental death of the insured. The declaration contains a count on each of these policies. Such provisions of the policy declared on under the first count covered the death of the insured ‘ suffered as a result, directly or independently of all other causes, of bodily injuries sustained solely through violent external and accidental means.’ In this respect the language of the policy declared on in the second count is not materially different. Exceptions to the coverage by such provisions of the policy declared on in the first count include the following: ‘ * * * nor shall such insurance cover accident, injury, death or other loss caused wholly or partly by disease, or bodily or mental infirmity or by medical or surgical treatment thereof, or by hernia, ptomaine, or by bacterial infection (except only septic infection of and through a visible wound accidentally sustained).’ Exceptions to the coverage by such provisions of the policy declared on in the second count include the following: ‘ No Accidental Death Benefit will be paid * * * if death is caused or contributed to, directly or indirectly, or wholly or partially, by disease, or by bodily or mental infirmity.’ The trial judge ‘ directed a verdict for the defendant on the ground that the clauses of exception contained in the policies relieved the defendant of liability,’ and reported his ruling to this court for determination on the stipulation of the parties that if the ruling was correct ‘ judgment is to be entered on the verdict; otherwise judgment is to be entered for the plaintiff in the amount prayed for in her declaration, with interest and costs.’
The only matter for our determination is the question reported, that is, whether as matter of law on the evidence the ‘ clauses of exception contained in the policies'-material portions of which are quoted above-‘ relieved the defendant of liability.’ Holbrook v. Young, 108 Mass. 83, 85, 87.Crowe v. Boston & Maine Railroad, 242 Mass. 389, 392, 393, 136 N.E. 189.Weiner v. D. A. Schulte, Inc., 275 Mass. 379, 384, 385, 176 N.E. 114. The case, therefore, must be considered on the ground that the plaintiff is entitled to recover on each count of the declaration unless such recovery is precluded by the clause of exception in the policy referred to is such count. We do not stop to consider whether the clauses of exception in question merely explain the language of the policies limiting the double indemnity coverage of such policies to death resulting ‘ directly or independently of all other causes' from ‘ bodily injuries' sustained ‘ solely through violent external and accidental means,’ and, consequently, leave on the plaintiff the burden of bringing the case within the terms of these policies as so explained, or, on the other hand, exclude from the general provisions for coverage cases which otherwise would be included within them, so that the burden of bringing the case within the clauses of exception rested on the defendant. See Nichols v. Commercial Travelers' Eastern Accident Association, 221 Mass. 540, 546, 109 N.E. 449, and cases cited; Leland v. United Commercial Travelers of America, 233 Mass. 558, 565, 124 N.E. 517. For we are of opinion that, even if the burden of bringing the case within the terms of the policies as so explained was on the plaintiff, the verdict for the defendant was not rightly directed.
There was evidence that on May 3, 1934, the insured, who, except for a strain in 1931 and another in 1932, had always been in excellent physical health, while working in the warehouse of his employer carrying two five gallon cans of oil, weighing approximately fifty pounds each, slipped and fell on an oily floor and suffered great pain in his right groin; that he continued to suffer such pain; that an ice bag was used and a truss, but the insured did not obtain relief therefrom; and that on July 12, 1934, the insured was operated on for hernia and on July 22, 1934, died of pulmonary embolism. According to testimony of medical witnesses the operation ‘ caused the embolism’ which was ‘ an accident of surgery’ and ‘ apt to set in after any operation,’ the ‘ operation was a reasonable cure from a medical standpoint’ of the insured's condition at the time the operation was performed, and ‘ an operation was the proper cure for his trouble.’ Indeed the surgeon who performed the operation testified that ‘ in his opinion an operation was the only thing that would cure Ballam's trouble,’ and that ‘ he thought it was necessary to operate.’ There was no evidence tending to negative the existence of the hernia, the operation therefor, and the death of the insured as a result of the embolism.
The provisions in the so called clause of exception in the policy declared on in the first count of the declaration requiring consideration are those applicable to death ‘ caused wholly or partly’ by ‘ bodily * * * infirmity,’ by ‘ surgical treatment therefor’ or by ‘ hernia.’ Neither the provision applicable to ‘ bodily * * * infirmity’ nor that applicable to ‘ hernia’ applies to a hernia sustained ‘ solely through violent external and accidental...
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