Goodwin v. Nationwide Ins. Co.

• Citation: 104 Idaho 74,656 P.2d 135
• Decision Date: 28 December 1982
• Docket Number: No. 13782,13782
• Parties: Irvin GOODWIN and Rose Goodwin, husband and wife, Plaintiffs-Respondents, v. NATIONWIDE INSURANCE COMPANY, Defendant-Appellant.
• Court: Idaho Court of Appeals

Page 135

656 P.2d 135

104 Idaho 74

Irvin GOODWIN and Rose Goodwin, husband and wife, Plaintiffs-Respondents, v. NATIONWIDE INSURANCE COMPANY, Defendant-Appellant.

No. 13782.

Court of Appeals of Idaho.

Dec. 28, 1982.

Petition for Review Denied Feb. 17, 1983.

Dave R. Gallafent of Merrill & Merrill, Pocatello, for defendant-appellant.

Dean Williams of Kerr & Williams, Blackfoot, for plaintiffs-respondents.

SWANSTROM, Judge.

On August 16, 1973, Irvin Goodwin, then sixty-four years old, was injured in an accident in which his pickup was struck from the rear and rolled three times. At the time, he was insured by Nationwide Insurance Co. under a group policy providing for medical coverage and disability benefits in case of accidental injury. Nationwide promptly paid claims submitted for his medical expenses. Twenty-five months after the accident, Goodwin filed a claim with Nationwide asserting he was entitled to receive accident disability benefits for life because the accident had resulted in headaches that totally disabled him. When Nationwide refused to honor his claim, Goodwin sued and recovered a judgment in district court.

Nationwide filed this appeal, raising several issues. First, Nationwide contends that the trial court erred in relying upon lay testimony to determine the nature and extent of the alleged disability. Nationwide asserts that a disability claim must be supported by competent medical evidence. Second, Nationwide argues that there is inadequate evidence in the record to support the trial court's finding that Goodwin was totally disabled within thirty days of the accident as required by the policy. Specifically, Nationwide contends that there was no medical proof that bodily injuries suffered in the accident caused Goodwin's headaches, and that the record does not establish that the headaches were caused by the accident, independently of all other causes. Finally, Nationwide claims that the district judge was wrong in concluding--as a matter of law--that Goodwin had satisfied the notice and proof of loss requirements of the insurance policy.

Because the trial court's findings of fact were supported by competent and substantial evidence, we will not disturb them on appeal. The court's conclusions of law are supported by these findings. Therefore, we affirm the judgment.

I.

Before addressing the substantive issues, we will survey the contentions and evidence presented by the parties. Nationwide concedes that Goodwin is totally disabled; but Nationwide denies that Goodwin is entitled to accident disability benefits. For several months prior to the accident in August, 1973, Goodwin had been receiving sickness disability benefits from Nationwide, under a provision of his group policy providing for payment of $400 a month (for a maximum of twenty-four months) for total disability due to sickness. Goodwin, a heavy smoker, was suffering from a severe case of emphysema, which made it impossible for him to carry on his work as a dairy farmer. Nationwide paid Goodwin monthly sickness disability benefits until they expired in December, 1974. Goodwin testified that his emphysema condition improved greatly after he quit smoking in 1974. The district judge found that the headaches suffered by Goodwin after the accident in 1973 had become a second, concurrent cause of his disability; and the judge concluded that Goodwin was entitled to accident disability benefits after the sickness disability benefits expired. Nationwide contends that Goodwin was never disabled by his headaches, and that the causes of his present disability are emphysema, arthritis, and age.

The evidence at trial showed that after his pickup rolled on August 16, 1973, Goodwin remained unconscious, slumped over the steering wheel, for nearly an hour. Despite the force of the impact, it appeared, however, that he sustained only minor injuries, a cut over his left eye, and contusions and bruises to the head and body. He was hospitalized for one day, treated and released.

Goodwin relied primarily upon his own testimony, and that of his wife and son, to establish that headaches had disabled him ever since the accident. Goodwin testified that he has had a headache everyday since the accident and that his head aches constantly, preventing him from performing his farm work. He said that after each attempt to work he has "ended up in bed for a couple of days." Where before the accident he suffered only rarely from headaches, now he must take three types of drugs daily to cope with headache pain. Goodwin also testified that he believes he is "pretty much cured" from emphysema and would be able to work were it not for his headaches.

Goodwin's wife, Rose, and son, Dean, offered similar testimony concerning Goodwin's condition. Mrs. Goodwin testified, without objection, that her husband's head hurts all the time and that he takes aspirin and valium every day. She stated that he has not been able to work since the accident and that when he tries, his head begins "pounding and beating," and he must lie down. She also said that he never had headaches before the accident. Dean Goodwin testified that his father had not been able to return to his regular duties after the accident and that he could no longer run a dairy business. Dean also stated that whenever his father has tried to work he has had to go to bed because of the headache pain. Dean said that his father's emphysema improved after he quit smoking and that only the headaches have kept him from working.

Several doctors also testified. Although none of the doctors was able to pinpoint the source of Goodwin's headaches, and each had a different theory about their origin, none doubted that Goodwin actually experienced headache pain.

Dr. Merrill Packer, Goodwin's personal physician for a number of years, testified that he had treated Goodwin for emphysema prior to the accident, but that he believed the emphysema, though still present, was no longer bothering Goodwin. Dr. Packer stated that he had never treated Goodwin for headaches prior to August 16, 1973. He admitted, however, that the first indication in his record that Goodwin was suffering headaches is a note he made on February 23, 1974, more than six months after the accident. Thereafter he recorded numerous complaints by Goodwin concerning his headaches. Dr. Packer said that on April 25, 1975, Goodwin told him that he had been having persistent headaches since the accident, and the doctor noted that the headaches seemed to be getting worse. He prescribed several drugs, valium, fiorinal, and codeine, in the course of his treatment of Goodwin's condition. In conclusion, Dr. Packer testified that there was no doubt that Goodwin was in fact suffering from headaches, even though there appeared to be no objective reason for them. In Dr. Packer's opinion, the headaches became Goodwin's prominent problem and the prominent cause of his disability. Dr. Packer stated that though it is difficult to discern the cause of headaches, the pain is real to the sufferer and can be disabling. Dr. Packer also indicated that the existence of several gaps in his records, concerning Goodwin's headaches, did not necessarily mean that Goodwin was not being treated for headaches during those periods. Finally, Dr. Packer admitted it was not until September, 1975, approximately two years after the accident, that he first sent a physician's "statement of disability" form to Nationwide indicating that Goodwin was suffering from head and neck pains related to the accident in 1973.

Two physicians offered testimony in Nationwide's behalf. Dr. James Lansche treated Goodwin for his headaches from April 28, to May 4, 1975. Dr. Lansche took x-rays of Goodwin's skull and neck, but detected no abnormalities, other than an arthritis problem in the neck. Dr. Lanchse treated Goodwin with several types of physical therapy, but Goodwin complained that the pain increased after each treatment. This lead Dr. Lansche to conclude that Goodwin's headaches were due to a psychological disorder rather than organic causes. Dr. Lansche stated that he could find nothing objective, other than Goodwin's story, to connect the headaches with the 1973 accident. Moreover, Dr. Lansche stated that in his opinion the headaches produced only a small disability. In conclusion, he testified that though it was possible that Goodwin's headaches were caused by his cervical arthritis, which may have been aggravated by the accident, he did not believe that this was their origin. He concluded that Goodwin's headaches were of a psychosomatic kind, "related to a muscle contraction headache." In his opinion, the headaches were caused by a "muscle contraction problem related to some inner psychic turmoil."

Dr. Harvey Hatch also testified for Nationwide. Dr. Hatch examined Goodwin only on one occasion, April 27, 1976. He stated that Goodwin still had emphysema at the time. Dr. Hatch testified that Goodwin's emphysema condition was permanent, although it may have improved somewhat after he quit smoking. He found no objective evidence concerning Goodwin's headaches. He admitted, however, that all headaches are subjective, and cannot be diagnosed objectively.

From this evidence, the district judge made several findings of fact. The court determined that Goodwin had suffered a severe impact in the accident of August, 1973, resulting in bodily injuries to the head and neck areas. Prior to the accident, Goodwin did not suffer from any unusual headaches, but commencing immediately after the accident and until the time of trial, Goodwin suffered from severe chronic headaches which were totally disabling. These headaches were a concurrent cause of Goodwin's total disability from the time of the accident until mid-1975, when the emphysema condition improved, and they then became the sole cause of his disability. The court concluded that it had no cause to disbelieve Goodwin's description of his headaches; and it...