Lucas v. John Hancock Mutual Life Insurance Co.

• Decision Date: 01 February 1935
• Docket Number: 256-1934
• Citation: 176 A. 514,116 Pa.Super. 298
• Parties: Lucas, Appellant, v. John Hancock Mutual Life Insurance Company
• Court: Pennsylvania Superior Court

176 A. 514

116 Pa.Super. 298

Lucas, Appellant, v. John Hancock Mutual Life Insurance Company

No. 256-1934

Superior Court of Pennsylvania

February 1, 1935

Argued September 26, 1934

Appeal by plaintiff from judgment of M. C., Philadelphia County January T., 1934, No. 158, in the case of Jacob Lucas v. John Hancock Mutual Life Insurance Company.

Assumpsit on policy of insurance. Before Bonniwell, J.

The facts are stated in the opinion of the Superior Court.

Affidavit of defense raising questions of law sustained and judgment entered for defendant. Plaintiff appealed.

Error assigned was judgment.

Affirmed.

Albert L. Moise, and with him Alexander G. Stiefel, for appellant.

Ira Jewell Williams, Jr., with him Richard H. Hollenberg, and Charles M. Willits of Brown & Williams, for appellee.

Before Keller, Cunningham, Baldrige, Stadtfeld, Parker and James JJ.

OPINION

James, J.

Plaintiff filed his statement of claim upon an insurance policy to which defendant filed an affidavit of defense raising questions of law which were sustained and judgment was entered for the defendant, from which order this appeal was taken.

Plaintiff's statement of claim, served January 4, 1934, alleged that on April 3, 1922, the defendant issued a life, health and accident policy containing a disability clause (hereinafter set forth); that since August 11, 1929, plaintiff was permanently and totally disabled within the terms of the policy; that because of a mistake of fact, plaintiff continued to pay the premiums due upon the policy until October 20, 1933, on which date he furnished to defendant proof of his total disability. On November 9, 1933, plaintiff received a check in the sum of $ 51.22, which represented a monthly installment due October 20, 1933, and a refund of the premium for $ 26.22, and that on November 20, 1933, he received a check in the sum of $ 25 for monthly payment due November 20, 1933, neither of which checks were deposited or cashed by the plaintiff.

Plaintiff claims a refund of all premiums paid since August 11, 1929, and the sum of $ 25 per month from August 11, 1929, to date of filing statement. Defendant raised the questions that both as to the premiums paid and the monthly payments due under the policy, plaintiff having failed to present due proof of disability, was barred. The relevant portions of the policy are as follows:

"TOTAL AND PERMANENT DISABILITY BENEFIT PROVISION

1. If after the first premium or regular installment thereof shall have been paid . . . ., the Insured shall become wholly and permanently disabled by bodily injury or disease . . . ., so that thereby he will be wholly, continuously and permanently prevented from the pursuit of any form of mental or manual labor for compensation, gain or profit whatsoever, then if there is no premium in default, . . . ., the Company will upon receipt of due proof of such disability, grant the following benefits subject to the terms and conditions herein set forth and to the payment of any unpaid balance of premiums for the first year hereunder and under the policy.

"2. Disability Occurring Before Age 60. -- If such disability occurs before the Insured reaches the age of 60 years, the Company will waive the payment of further premiums, during the continuance of the disability, and will pay to the Insured, subject to the conditions and limitations of this provision, . . . ., a sum equal to one per centum of the face amount of the policy, . . . ., and a like sum monthly thereafter during the continuance of the disability, until the maturity of the policy."

Appellant's main contention is that the terms of the policy are ambiguous, and if any doubt exists as to the meaning of the policy, it should be resolved in favor of the interests of the assured. Undoubtedly, this is the rule which ordinarily governs, but when the terms of a policy are clear and unambiguous, we should not hesitate to say so: Urian v. Scranton Life Insurance Co., 310 Pa. 144, 165 A. 21.

Under the first provision, when the insured shall become wholly and permanently disabled, so that he will be wholly, continuously and permanently prevented from the pursuit of mental or manual labor for compensation, gain or profit, the company will upon receipt of due proof of such disability grant the benefits as provided in the second provision, which further provides that it will be paid during the continuance of the disability, until the maturity of the policy. It appears that under these provisions due proof of the disability then existing is a condition precedent to the payment, not for the disability that has existed but for the disability then existing and which shall continue from the time that the company has due proof of the existence of the disability. The language clearly looks toward the future, and the word "grant" imports a future liability. The very purpose of the due proof clause is that prompt notice may be given, in order that the company may have an opportunity to make a fair investigation of the claim. The unfairness of plaintiff's position is best established by the present claim, in asserting a disability that had existed for more than four years prior to his filing proofs of his disability.

True it is that proof is not required at any definite time after the disability occurs, but the failure to furnish the proofs should not result in placing the burden for...