Irelan v. Standard Mut. Ass'n of Cassville

Decision Date28 May 1964
Docket NumberNo. 8264,8264
PartiesNelda V. IRELAN, Plaintiff-Respondent, v. STANDARD MUTUAL ASSOCIATION OF CASSVILLE, Missouri, a corporation, Defendant-Appellant.
CourtMissouri Court of Appeals

Joe R. Ellis, Royle Ellis, Cassville, for defendant-appellant.

Myers & Birk, Joplin, for plaintiff-respondent.

RUARK, Presiding Judge.

Plaintiff sued on a life insurance certificate which provided a death benefit of five hundred dollars. Trial was by the court. Plaintiff recovered judgment, and defendant has appealed.

The contract provided that 'within Three Months from the date of the receipt of approved Proof of Death of the Certificate Holder herein named, it will pay IN CASH to the Beneficiary herein named, the benefits shown herein except as provided below.

'GRADUATED BENEFITS

'It is understood and agreed that the Benefits provided in this Certificate shall graduate in amount as follows: 10% if death occurs within the first month, 25% if death occurs within the second month, and 50% if death occurs within the third month (after the date of the Certificate).

'In the event of the death of the Member named herein, within two years from the date hereof from TUBERCLOSIS, CANCER, HEART DISEASE, or APOPLEXY, or from any chronic disease with which said Member is afflicted AT THE TIME THIS CERTIFICATE IS ISSUED, either as a direct or contributory cause, then the amount due and payable hereunder shall be limited to One-Half the amount otherwise due and payable, provided however, that if any material representations in the application are untrue then the entire Certificate shall become null and void, except as to the return of assessments paid thereon. * * *'

The certificate was issued on April 8, 1960. The insured died on March 19, 1962, and thus within two years. The death certificate listed 'IMMEDIATE CAUSE * * * Coronary occlusion INTERVAL BETWEEN ONSET AND DEATH 8 hours.' Plaintiff's proof of death listed as 'CAUSE OF DEATH Coronary occlusion.' There is no dispute as to cause of death. The widow beneficiary testified that the insured had no heart trouble or heart disease prior to the day of his death; and the defendant-appellant did not and does not contend that insured suffered from heart disease at the time the policy was issued.

Appellant contended below and here contends that under the limiting clause above set forth it owes only one-half the death benefit, or two hundred fifty dollars, which it tendered. Respondent contends, as the trial court found, that the full benefit of five hundred dollars was payable.

The first question we have is raised by the respondent: Is death caused by a coronary occlusion, death by 'heart disease'? At trial defendant's witness Dr. Newman testified unqualifiedly that a coronary occlusion is a heart disease. Her statement was that heart disease is 'any abnormal pathology affecting the heart.' On cross-examination she testified in elaboration that if an 'artery into the heart was cut in such a manner that the blood supply to the heart was cut off' death would result from 'heart disease.' Further in her examination she qualified her definition to some extent by saying that there is 'some difference between disease and what can happen as an injury.' She concluded by stating that a person with a perfectly healthy heart cannot die of a coronary occlusion; that a coronary occlusion is a stopping of a coronary artery. It was stipulated that another physician, if present, would testify that coronary occlusion is a heart disease.

The general rule is that in construing an insurance policy, if there is a conflict between a technical medical definition and a meaning which would normally be accepted by the average layman, then unless it plainly appears that the technical meaning is intended, the courts will accept and apply the layman's viewpoint. 27 C.J.S. Disease, pp. 302, 303; Robinson v. Commonwealth Casualty Co., 224 Mo.App. 969, 27 S.W.2d 49, 51; Farmer v. Railway Mail Ass'n, 227 Mo.App. 1082, 57 S.W.2d 744, 745. For the test of understanding is that 'revealed in the common speech of men.' State ex rel. Prudential Ins. Co. of America v. Shain, 344 Mo. 623, 127 S.W.2d 675, 678; Feldmann v. Connecticut Mut. Life Ins. Co. of Hartford, Conn., 8th Cir., 142 F.2d 628, 631.

Turning then to the common understanding: We find that the definitions of 'disease' are quite broad. Brinkoetter v. Pyramid Life Ins. Co., Mo.App., 377 S.W.2d 560. Referring to the dictionaries we find many specific definitions but one general throughout, to wit: disease is a condition of the body or some part or organ in which the functions are disturbed or deranged. This is usually followed by a more definitive declaration that the derangement is understood to be of settled duration and one which is due to causes as distinguished from a wound. 1

In Frank v. Atlanta Life Ins. Co., Mo.App., 211 S.W.2d 940, 942, it is said that 'heart failure' or 'cardiac failure' is commonly accepted as describing death by heart trouble or disease. An occlusion is a shutting off, or the closing or obstruction, of a passage. (See dictionary definition.) Anatomically the coronary arteries are a part of the 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 disease'; and we rule against the respondent as to this contention.

The principal argument is over the construction of the limiting and qualifying clauses first above set forth. Appellant says that the meaning is plain that, if the insured died from heart disease within two years after issuance of certificate, then the benefit was to be one-half. Respondent contends that it plainly means and should be read so that 'heart disease' (and the other named causes) is to be taken along with the words 'any chronic disease' and governed by the following words, 'with which said Member is afflicted AT THE TIME THIS CERTIFICATE IS ISSUED.' In other words, the affliction at the time the certificate is issued relates back to all the diseases set forth in capital letters, and the sense of the meaning is as though the word 'other' was inserted before the word 'chronic.' It is the view of the writer (not however concurred in unanimously by the other members of the court) that, by giving effect to the word 'or' in front of the word 'APOPLEXY' and to the comma after such word, the policy is to be construed as the insurer-appellant contends. But that does not solve our problem. An insurance policy is not necessarily to be construed in the manner of a (hopefully) painstaking lawyer, sitting at his desk and attempting to apply all the proper rules of punctuation and grammatical niceties. We must consider the meaning which would reasonably be attached by the ordinary person of average intelligence or common understanding. Crenshaw v. United States Fidelity & Guaranty Co., Mo.App., 193 S.W.2d 343, 344; Liberty Storage Co. v. Kansas City Terminal Warehouse Co., Mo.App., 340 S.W.2d 189. It has been said that punctuation is 'a most fallible guide' and that '[t]he sense of a contract is gathered from its words and their relation to each other, and, after that has been done, punctuation may be used to more readily point out the division in the sentences and parts of sentences. But the words control the punctuation marks, and not the punctuation marks the words.' See discussion in Commonwealth Casualty Co. v. Aichner, 8th Cir., 18 F.2d 879, 881.

We must, of course, read the policy as a whole and consider all of its portions together. Appleman, Insurance Law and Practice, Vol. 13, Secs. 7383, 7425, pp. 10, 125; State ex rel. Mutual Ben. Health & Accident Ass'n v. Shain, 350 Mo. 422, 166 S.W.2d 484, 487. It should be interpreted according to its plain terms, and if the language is plain there is not room for construction. We cannot, under the guise of construction, alter, rewrite, or modify a policy so as to pervert its meaning by adopting a strained construction (Pierce v. Business Men's Assur. Co. of America, Mo., 333 S.W.2d 97, 100; Ward v. Gregory, Mo.App., 305 S.W.2d 499, 503; Winston v. Hartford Fire Ins. Co., Mo.App., 317 S.W.2d 23) or invent an ambiguity. Central Sur. & Ins. Corp. v. New Amsterdam Cas. Co., 359 Mo. 430, 222 S.W.2d 76, 78; Glenn v. Missouri Ins. Co., 238 Mo.App. 236, 179 S.W.2d 644, 646. But if the policy is in fact reasonably susceptible of being understood in two or more senses or is 'dulled by ambiguity,' then it will be construed most strongly against the insurer. In other words, we will take that meaning which favors the insured. Simpson v. American Auto. Ins. Co., Mo.App., 327 S.W.2d 519; Chamberlain v. Mutual Ben. Health & Acc. Ass'n, Mo.App., 260 S.W.2d 790; Walker, to Use of Foristel, v. American Automobile Ins. Co., 229 Mo.App. 1202, 70 S.W.2d 82, 89.

This rule is especially applicable where insurance is first 'granted' and is then followed by provisions limiting or avoiding liability. Such limiting provisions are strictly construed against the insurer. 2 It is said that if the insurer intends to place limitations upon the liability it is required to set these limitations forth clearly, definitely, and explicitly (Appleman, Vol. 13, Sec. 7403, p. 97; Schmohl v. Travelers' Ins. Co., Mo.App., 189 S.W. 597, 600, aff. Mo., 197 S.W. 60; see Chamberlain v. Mutual Ben. Health & Acc. Ass'n, supra), for ambiguous phrases are not to be permitted to serve as traps for policyholders. Davis v. Mutual Life Ins. Co., 234 Mo.App. 748, 119 S.W.2d 488; see Boillot v. Income Guaranty Co., 231 Mo.App. 531, 102 S.W.2d 132, 145. And if the meaning of the limiting language is the least doubtful, it will be taken against the insurer (Souders v. Commonwealth Casualty Co., Mo.App., 246 S.W. 613), even though the insurer actually...

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