Hayes v. Prudential Ins. Co. Of Am.

• Decision Date: 21 November 1933
• Docket Number: No. 7632.,7632.
• Citation: 171 S.E. 824
• Court: West Virginia Supreme Court
• Parties: HAYES. v. PRUDENTIAL INS. CO. OF AMERICA.

171 S.E. 824

HAYES.

v.PRUDENTIAL INS. CO. OF AMERICA.

No. 7632.

Supreme Court of Appeals of West Virginia.

Nov. 21, 1933.

Syllabus by the Court.

1. A disability clause in a life insurance policy entitling the insured to benefits if he "shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such an extent that he (or she) is rendered wholly, continuously and permanently unable to engage in any occupation, or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime, " does not mean a state of absolute helplessness, but means the inability of the insured to engage in practical manner in useful work, whether in his accustomed vocation or another. Total disability is a relative term. Each case must be considered on its own facts.

2. Where a disability clause of a life insurance policy provides that "the first monthly payment shall be made immediately upon receipt by the company of due proof of such disability, " the furnishing of such proof is a condition precedent to the company's liability to pay disability benefits, and the insured may not recover monthly payments prior to the time of furnishing such proof.

Error to Circuit Court, Fayette County.

Action by W. R. Hayes against the Prudential Insurance Company of America. To review an adverse judgment, defendant brings error.

Judgment reversed, verdict set aside, and cause remanded for a new trial.

Charles Ritchie, of Charleston, for plaintiff in error.

Hubard & Bacon, of Fayetteville, for defendant in error.

MAXWELL, President.

This action is based on the disability clause of a life insurance policy. The case is here on writ of error awarded the defendant to a judgment against it, on verdict, in favor of the plaintiff for $3,073.61.

The policy, issued February 3, 1926, for $5,000.00, provided that upon total disability of the insured, the insurer would waive the premiums on the policy during the disability and pay $50.00 per month. The prefatory portion of the disability clause reads: "If the insured shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such an extent that he (or she) is rendered wholly, continuously and permanently unable to engage in any occupation, or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime, and if such disability shall occur at any time after the payment of the first premium on this policy, while this policy is in full force and effect and the insured is less than sixty years of age, and before any non-forfeiture provision shall become operative, the Company, upon receipt of due proof of such disability, will grant the following benefits: (1) Waiver of premiums * * *. (2) Monthly income to insured * * *." Under the second provision there is this undertaking on the part of the insurer: "The first monthly payment shall be made immediately upon receipt by the company of due proof of such disability and subsequent payments shall be made on the first day of each month thereafter."

Plaintiff, a bank cashier, became ill from heart disease in July, 1927. He has been under the advice and care of physicians since that time. Following his initial attack, he spent several weeks in a hospital, then tooka trip; tried to return to work at the bank but was unable to render service and had to abandon the effort. His indisposition has been diagnosed as coronary thrombosis. Three physicians who have examined and treated plaintiff sustain his position that he has been and is unable to do any work of consequence, either clerical or physical. They say his condition is permanent. The thought of the physicians seems to be that though the plaintiff might for certain periods be able to engage in some gainful activity, he would thereby subject himself to the constant danger of breakdown and collapse, possibly fatal. Perhaps the strongest statement made by any of the physicians in respect of the plaintiff's ability to work was made by Dr. R. P. Woods on cross-examination as follows: "Mr. Hayes would be able to do work which required no considerable physical exertion or mental exertion at such times as he might not be feeling ill from the heart's bothering him on that day." This statement of the physician is pointed out and relied on by the defendant as showing that the plaintiff is not totally disabled, but we are unable to attach that meaning.

Total disability clauses of life insurance policies have been prolific sources of litigation. Shall they be strictly or liberally construed? The courts are not in accord, but the weight of opinion sustains a practical and liberal construction, for, it is said, if such provisions are strictly and literally construed, it would be almost impossible for any person to sustain a recovery thereunder; that few persons short of serious mental breakdown are totally disabled from doing some sort of work, or rendering some sort of service. "Total disability" clauses appear sometimes in life insurance policies and sometimes in accident policies. Some of the cases deal with one and some with the other, but the basis for determination of the meaning of the phrase is the same in either Instance.

Absolute helplessness is not deemed by the courts to be a condition precedent to the right of an insured to recover under a total and permanent disability clause. According to many cases, recovery may be had by an insured where, because of injury or illness, he has become unable to do substantially all the material acts necessary to the conduct or prosecution of his business or occupation in substantially his usual and customary manner. McCutcheu v. Life Ins. CO., 153 S. C. 401, 151 S. E. 67; Berry v. United Life & Accident Ins. Co., 120 S. C. 328, 113 S. E. 141; Industrial Mut. Indemnity Co. v....