McKillips v. Railway Mail Ass'n

• Decision Date: 18 August 1941
• Docket Number: 28411.
• Citation: McKillips v. Railway Mail Ass'n, 116 P.2d 330, 10 Wn.2d 122 (Wash. 1941)
• Court: Washington Supreme Court
• Parties: McKILLIPS v. RAILWAY MAIL ASS'N.

116 P.2d 330

10 Wn.2d 122

McKILLIPS v. RAILWAY MAIL ASS'N.

No. 28411.

Supreme Court of Washington

August 18, 1941

Department 2.

Action by Henry A. McKillips against the Railway Mail Association upon a beneficiary department certificate. From judgment for plaintiff, defendant appeals.

Reversed with instructions to grant new trial.

MILLARD J., dissenting.

Appeal from Superior Court, Spokane County; Charles W. Greenough judge.

Graves, Kizer & Graves, J. W. Greenough, and R. L. Greene, all of Spokane, for appellant.

H. Earl Davis, of Spokane, for respondent.

BEALS Justice.

Plaintiff, Henry A. McKillips, who for many years had been in the employ of the postoffice department as a railway mail clerk, was injured September 9, 1938, while engaged in lifting a mail sack from the floor of a mail car.

May 18, 1923, Railway Mail Association, a mutual benefit corporation, organized under the laws of the state of New Hampshire, and authorized to engage in business in the state of Washington, issued to plaintiff its 'beneficiary department certificate,' whereby, in consideration of payments to be made by plaintiff and plaintiff's agreement to comply with the by-laws and rules of the association, the latter agreed to pay plaintiff certain sums in case his employment should be interrupted by accidental injury. The certificate covers both temporary and permanent disability.

October 10, 1938, plaintiff filed with the local representative of the association a 'notification of disability,' advising the association of the fact that he had been injured, and that he would claim benefits under his certificate above referred to. During the month of January following, plaintiff filed with the association a formal application for benefits. Paul D. Vincent, the president of the Spokane division of the association, signed two endorsements on the claim, to the effect that the claim was correct and payment thereof recommended. One of the endorsements bears date December 14, 1938, the other January 13, 1939.

The association having refused to pay the claim, plaintiff instituted this action, based upon his certificate above referred to. The action was tried upon plaintiff's first amended complaint and the defendant's answer thereto. After denying certain allegations of the complaint, defendant, by way of affirmative defenses, pleaded certain of its by-laws, contending that plaintiff's disability, if any, did not result only from violent and accidental means, but was contributed to by a pre-existing arthritic condition; that plaintiff was neither permanently disabled nor wholly incapacitated from performing any labor or following any occupation, within the terms of his beneficiary certificate; and that plaintiff had not complied with the rules of the association in connection with the giving of notice of his injury and making due proof thereof. The issues having been made up, the action was tried to the court sitting with a jury, and resulted in a verdict in plaintiff's favor. From a judgment for $2,254 entered upon this verdict, defendant has appealed.

Appellant assigns error upon the denial of its motion for a nonsuit interposed at the close of respondent's case, and upon the denial of its motions for a directed verdict and later for the entry of judgment in appellant's favor, or in the alternative for a new trial. Error is also assigned upon the rejection of evidence offered by appellant, and upon certain instructions given to the jury.

Appellant's constitution and by-laws provide for the filing of claims for payments under certificates similar to that issued to respondent. The notification of disability and proof of claim must be accomplished upon blanks furnished by appellant. The report by a physician must be included, and the president of the local branch must attach his certificate. Failure on the part of the claimant to comply with the provisions of the constitution and by-laws shall invalidate a claim.

The notification of disability and claim which respondent filed were prepared upon blanks furnished by appellant. In the notification respondent stated that he was piling a sack of magazines in the mail car, and 'pulled muscles or ligaments in left side of back just above the hip. Did not appear that it would bother much at first, but it has turned out quite serious.' In the physician's statement attached to the notification, the injury is described as 'severe sacro-iliac sprain with complicating sciatica.' The symptoms are also particularly described. The notification contains a statement by another physician, corresponding to the statement already referred to.

In his claim respondent stated that his disability might continue for six months or a year. In appellant's main office at Portsmouth, New Hanpshire, the claim was amended by appellant's officers so as to read as a claim for eighty-nine days' disability, from September 16th to December 13th. Respondent was advised by the secretary, under date December 19, 1938, 'When you file for additional benefits, the next claim should begin December 14th.' The claim was re-referred for further statement by the attending physician, and was formally approved as correct by the local president. Later, the secretary of the association wrote the local president as follows:

'Railway Mail Association

'Office of the Secretary

'Portsmouth, New Hampshire,

'February 2, 1939.

'Mr. Paul D. Vincent, President,

'Spokane Branch, R. M. A.,

'Spokane, Wash.

'My dear Mr. Vincent:

'Please refer to the claim submitted by Henry A. McKillips, Certificate 17898.

'The committee on claims has given very careful consideration to this claim and cannot approve it in its present form and for the amount claimed by Mr. McKillips.

'In returning the papers to this office the committee advises that the medical evidence submitted seems reasonably clear that disease is the cause of and for the prolongation of the injury sustained by the claimant.

'It is my personal belief that the committee might and probably would approve a claim for a short period of time for sacroiliac sprain, but a sacro-iliac sprain without complications would not cover a period of more than two or three weeks at the very most.

'Will you get in touch with Mr. McKillips and see if he would agree to change the number of days claimed and, if so, I will send the papers back to the committee on claims for their further consideration.

'Fraternally yours,

R. E. Ross

'Secretary.'

Appellant complains because upon the trial respondent testified that while lifting the sack of mail his foot slipped, throwing him against a stanchion, severely bruising his back. Appellant contends that the claim as originally filed was so vague and indefinite as to suggest a doubt that any reason for compensation was stated, and that appellant was never given an opportunity to investigate the situation, as stated by respondent on the trial. Appellant's local president twice approved the claim as filed. Appellant, after respondent's injury had been drawn to its attention by a notification and claim, both seasonably filed, through its own officers amended the claim as to the period for which compensation was asked, and made such investigation of the situation as was deemed proper and adequate.

Appellant's rules and regulations governing the filing of claims under its beneficiary certificates are rather vague and indefinite as to the statements to be made in such claims. Our attention is called to no requirement that every circumstance in connection with the injury must be particularly stated, the rules being more concerned with the making of the claim upon blank forms furnished by the association and with the filing of the claims within a certain specified time. Apparently the matter of chief importance is the requirement that notice of the fact that a claim might be presented by a certificate holder should be promptly called to the attention of appellant's officers.

The matter of the sufficiency of a claim against an indemnity company was considered by this court in the case of Moran Bros. Co. v. Pacific Coast Casualty Co., 48 Wash. 592, 94 P. 106. The facts in the case cited are entirely different from those here present, but this court clearly expressed the view that a claim upon which might be based liability against a policy need not state in detail, or with absolute accuracy, all relevant facts.

In the case at bar, we are convinced that respondent in good faith prepared and seasonably filed his claim, and that it cannot be held that the claim as filed did not comply with appellant's rules and regulations.

Appellant knew that respondent claimed to be suffering from a severe sacro-iliac sprain. Respondent's claim was rejected because it was deemed excessive. It would not be reasonable to hold that the claim should now be held insufficient because respondent did not claim a still larger amount.

We are convinced that appellant's contention that respondent's claim was insufficient to afford an adequate basis for some recovery by respondent is not well founded. The trial court did not err in holding that the claim was in law sufficient.

By the certificate issued to respondent, it is provided that respondent should receive from the benefit fund

'1. A sum of $21.00 per week for such period as he may not be able to perform service as a railway postal clerk, or follow any other employment, not exceeding fifty-two weeks from day of injury resulting through causes as aforesaid. The same to be paid as provided by the laws of this association after the required proofs have been filed with the secretary.

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'3. If said member during the continuance of this certificate shall sustain through causes as aforesaid injuries...