Frank v. United Ben. Life Ins. Co.
| Decision Date | 20 June 1950 |
| Docket Number | No. 27780,27780 |
| Citation | 231 S.W.2d 234 |
| Parties | FRANK v. UNITED BENEFIT LIFE INS. CO. |
| Court | Missouri Court of Appeals |
G. W. Marsalek, St. Louis, Moser, Marsalek, Carpenter, Cleary & Carter, St. Louis, for appellant.
Herman Willer, St. Louis, Susman, Mayer & Willer, St. Louis, for respondent.
This is a suit on a policy of accident and health insurance brought by Dr. Adolph M. Frank, as plaintiff, against the United Benefit Life Insurance Company, as defendant. The case was originally filed in the Magistrate Court. A trial in the Magistrate Court resulted in a judgment for plaintiff. Thereafter, an appeal was perfected to the Circuit Court where the cause was tried by the court without a jury. The trial in the Circuit Court resulted in a finding and judgment for plaintiff for $510 benefits under the policy, $38.64 interest, $51 for vexatious refusal to pay, and $200 as attorneys' fees, an aggregate sum of $799.64. From this judgment, defendant has appealed.
The only formal pleading in the case is plaintiff's petition. It is alleged, in substance, that on or about February 3, 1947, in consideration for the payment of a stated premium, the defendant issued to plaintiff a policy of accident and health insurance; that, among other provisions, said policy provided for payments in the event of confining illness at the rate of $100 per month, plus additional benefits if the assured were hospitalized; that on April 29, 1947, plaintiff contracted a disease or illness and was hospitalized from that date until June 1, 1947, and thereafter was confined at home until September 15, 1947; that plaintiff had performed all conditions precedent to recovery, had made necessary demand, but defendant had refused to pay, and that said refusal to pay was vexatious.
The policy sued on provides for specific benefits in event of disability caused by accident or sickness, except that disability originating before six months from the inception of the contract and caused by tuberculosis or 'heart trouble' is not covered. Disability beginning more than six months after the policy date is covered, regardless of the cause.
The policy was issued to plaintiff on February 3, 1947. Plaintiff is a physician of thirty-five years' experience.
On April 29, 1947, plaintiff awoke about 4:00 a. m. suffering from severe pain in his chest. At about 7:00 o'clock that same morning plaintiff called Dr. Robert Nussbaum and later was taken to the Lutheran Hospital. Upon arrival at the hospital he sustained a severe sweat and continued pain in the chest. Dr. Frank and Dr. Nussbaum both testified that plaintiff's illness was caused by a coronary occlusion. Plaintiff remained in the hospital until about the first day of June, 1947. He received sedatives on his first day or two in the hospital and after that only bed rest, without further medication. The bed rest was to allow the blood clot to become fixed and thus prevent it from breaking off; also to allow the heart damage if any, to heal, and to permit establishment of collateral circulation.
After leaving the hospital on June 1, 1947, plaintiff remained at home until June 29, and then went to a resort at Coronada, California, where he remained for five weeks. While at the Coronada resort plaintiff was continuously confined to his hotel and the beach, except for rides in the evening. From California he went to Livingston, Montana, and visited his brother and sister from August 5th to September 1st. He was not confined during that period, but transacted no business. On September 15, 1947, plainfiff returned to his practice, but did not make house calls.
Dr. Frank was given morphine to relieve his pain, but was not given digitalis or quinidine, drugs often administered in instances of heart failure; nor was he given drugs to cause copious urination, a practice employed when the heart is failing. Plaintiff testified that he had no sign of heart failure. He was placed under an oxygen tent for forty-eight hours, the purpose being to get an increased supply of oxygen through the arteries that were still open and thus preserve as much of the heart muscle as possible. There was a lowering of the blood pressure which Dr. Nussbaum stated may or may not be significant in such cases, and which might have been due to the administration of morphine and bed rest.
A medical report signed by Dr. Nussbaum and furnished by insured to another health insurer was introduced in evidence. In said report Dr. Nussbaum stated: 'My physical findings were cardiac shock; weak, rapid pulse; distant heart sounds; electrocardiogram revealed acute coronary occlusion.' Dr. Nussbaum testified, however, that he had not made such findings, and did not dictate those words in the report before he signed it; that someone else put those words in the report; that he did not know who put them in the report, but that his secretary sometimes uses inapplicable words.
Dr. Frank testified:
Dr. Frank further testified that when he arrived at the hospital he had a very profuse sweat, which was not a symptom of a heart condition, but a symptom of coronary occlusion, or shock.
In the medical report signed by Dr. Nussbaum, above referred to, appears the following:
Dr. Nussbaum testified that a peripheral vascular collapse, as occurred in Dr. Frank's case, is nature's way of removing blood pressure and circulation from the involved area of the heart by causing a dilation of the blood vessels of the skin so that blood may be drained away from the heart. He stated that when this happens a sweating occurs, the same as happens in any type of shock. He further stated that when a coronary occlusion causes a sudden collapse of the peripheral vessels, like Dr. Frank had, they usually originate in one of the main stems of the coronary artery, before it reaches the terminal branch. He further testified that if one of the main stems is closed off, a good protion of the heart is deprived of blood and the heart loses its tone and part of its function.
Dr. Frank testified that there are two coronary arteries, an anterior branch and a posterior branch; that they do not arise out of the heart; that the blood that enters the coronary artery comes from the lung, then goes into the coronary vessels and then into circulation; that the coronary artery does not feed any other organ of the body; that the artery divides into small branches, and each of these branches feed part of the heart. He further testified:
* * *
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'The coronary vessel, as I understand, is imbedded in the heart muscle * * * you will have to open up the heart to see the vessels.
Dr. Robert Nussbaum testified: 'the heart has four structures, of which the coronary circulation is one.
Dr. Martin Davis, a witness for the defendant, testified:
The physiology of a coronary occlusion was described by the three physicians...
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Irelan v. Standard Mut. Ass'n of Cassville
...heart, and any pathology within the coronary arteries is an injury to the heart and, therefore, 'heart trouble.' Frank v. United Ben. Life Ins. Co., Mo.App., 231 S.W.2d 234, 239. It is our conclusion that, by the understanding of average man, a death by coronary occlusion is death by 'heart......
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Green v. Mutual Ben. Health & Acc. Ass'n
...Greenberg v. Mutual Ben. Health & Accident Ass'n, Omaha, Neb., 267 App.Div. 186, 45 N.Y.S.2d 193, and Frank v. United Benefit Life Insurance Co., Mo.App., 231 S.W.2d 234, 239. In the latter case, the court 'Appellant contends that coronary occlusion is heart trouble within the meaning of th......