Metropolitan Life Ins. Co. v. Williams

• Citation: 180 Miss. 894,178 So. 477
• Decision Date: 31 January 1938
• Docket Number: 32944
• Court: United States State Supreme Court of Mississippi
• Parties: METROPOLITAN LIFE INS. Co. v. WILLIAMS

178 So. 477

180 Miss. 894

METROPOLITAN LIFE INS. Co. v. WILLIAMS

No. 32944

Supreme Court of Mississippi

January 31, 1938

Division A

1 INSURANCE.

In action on certificate issued under group accidental death policy, direct evidence that fatal injury was caused by accidental means was not required, where the fact of the injury was clearly shown, but cause of injury could be proved by circumstances, including nature and appearance of injury the same as any other fact in civil or criminal cases.

2 INSURANCE.

Under accidental death policies, where injury appears to have been sustained through external and violent means, it is presumed to have been sustained through accidental means.

3 INSURANCE.

In action on certificate issued under group accidental death policy which was applied for and delivered in Texas, under evidence that insured, a railroad blacksmith, had small hand abrasion at end of day's work, that hand became wrinkled at place of abrasion and was bleeding, swelling, and turning blue, that injury continued to grow worse although continuously treated, that red streaks appeared on insured's arm, necessitating amputation, and that insured died a few days later, whether injury was caused by "accidental means" was for jury.

4. INSURANCE.

In action on certificate issued under group accidental death policy, jury, to allow recovery, was not required to know that injury was caused by accidental means, but was only required to believe from preponderance of all facts and circumstances in evidence that it was so caused.

5. INSURANCE.

Under Texas law, where insured is injured while performing act which he intended to do and in manner intended, but where ultimate result is infection, blood poison, and death, such death is caused by "accidental means" within meaning of policy insuring against accidental death.

6. INSURANCE.

In action on accident policy containing the usual insuring clause, plaintiff makes prima facie case sufficient for jury where it is shown that insured had bodily injury, that such injury was sole cause of death, and that injury must necessarily have been brought about by being intentionally self-inflicted, intentionally inflicted by another, or by accidental means not in the nature of a criminal assault.

7. INSURANCE.

In action on certificate issued under group accidental death policy which was applied for and delivered in Texas, under evidence, including medical testimony that septicemia arising from accidental hand abrasion caused insured's death, and not diabetes, which did not require taking of insulin for one year prior to insured's death, and certificate of insured's attending physician stating that diabetes was a secondary cause of death, whether death resulted from abrasion directly and independently of all other causes, as required by policy, was for jury.

8. INSURANCE.

Under policy insuring against death resulting directly and exclusively of all other causes from bodily injuries sustained wholly through accidental means, where accident is proximate cause of death and sets in motion or starts latent or dormant disease, and such disease merely contributes to death after being so precipitated by accident, disease is not a proximate cause or a contributing cause of death barring recovery on policy.

9. INSURANCE.

In action on certificate issued under group accidental death policy requiring that death result from bodily injury caused, directly and independently of all other causes, by violent and accidental means, beneficiary had burden of proving that injury was caused by accidental means, and that death resulted from injury directly and independently of all other causes.

HON. ARTHUR G. BUSBY, Judge.

APPEAL from the circuit court of Lauderdale county HON. ARTHUR G. BUSBY, Judge.

Action by Mrs. Mary E. Williams against the Metropolitan Life Insurance Company on a certificate issued under a group accidental death policy. From a judgment for plaintiff, defendant appeals. Affirmed.

Affirmed.

Wells, Wells & Lipsomb and W. R. Newman, Jr., all of Jackson, for appellant.

It is the well recognized universal rule that in cases of this kind the burden of proof is on the appellee not only to prove the death of the insured but also to prove that the cause of the insured's death was insured against in the policy.

U. S. Cas. Co. v. Malone, 126 Miss. 73, 87 So. 896; Ryan v. Continental Cas. Co., 47 F.2d 472; National Masonic Acc. Assn. of Des Moines v. Shyrock, 73 F. 774; Order of the United Commercial Travelers of America v. Nicholson, 9 F.2d 7; Isoard v. National Life Ins. Co. of New York, 22 F.2d 956; Travelers Ins. Co. v. Wilkes, 76 F.2d 701; Harrison v. New York Life Ins. Co., 78 F.2d 421; New York Life Ins. Co. v. Ollich, 42 F.2d 399; Love v. New York Life Ins. Co., 64 F.2d 829; Strumberg v. Travelers Protective Assn. of America, 80 F.2d 997; New York Life Ins. Co. v. Doerkson, 75 F.2d 96; Anderson v. Travelers Protective Assn. of America, 74 F.2d 170; Connecticut General Life Ins. Co. v. Maher, 70 F.2d 441; Burkett v. New York Life Ins. Co., 56 F.2d 105; Lincoln National Ins. Co. v. Erickson, 42 F.2d 997; Svenson v. Mutual Life Ins. Co. of New York, 84 F.2d 441.

Other states have placed the burden of proof on the plaintiff to prove that the insured died as a result of accidental means.

Christianson v. Metropolitan Life Ins. Co., 102 S.W. 682.

If in one state of case, the plaintiff may recover, and on another, he cannot recover and the evidence for the plaintiff tends no more strongly to prove the first state of case than the second, no recovery can be had.

Bingham v. Continental Cas. Co., 293 S.W. 968; Aetna Life Ins. Co. v. Bethel, 131 S.W. 523; Rathman v. New Amsterdam Cas. Co., 152 N.W. 983; Inter, Ocean Cas. Co. v. Jordan, 150 So. 147; National Life & Acc. Ins. Co. v. Hampton, 72 S.W.2d 543; Robinson v. Aetna Life Ins. Co., 276 S.W. 900.

In the case of Westchester Fire Ins. Co. v. Maddox, 60 S.W.2d 1074, the Texas Court held as follows: "However, the rule as recognized by our Supreme Court and enforced in this state is that where the general liability of the insurer is thus limited by the terms of the policy, the burden is on the insured to both allege and prove that the loss sustained by him comes within the general liability thus assumed by the insurer, and in addition that it does not come within any of the excepted causes."

Washington Fidelity Nat. Ins. Co. v. Williams, 49 S.W.2d 1093; Georgia Home Ins. Co. v. Trice, 70 S.W.2d 356; Travelers Ins. Co. v. Barker, 96 S.W.2d 559; City of New York Ins. Co. v. Middleton, 62 S.W.2d 681; Amicable Life Ins. Co. v. O'Reilly, 97 S.W.2d 249.

It is apparent that the burden of proof is on the appellee in this case to prove thai; the insured's death was caused in a manner and under such circumstances as it would be covered by the policy and upon failure to do so cannot recover. We submit that the appellee wholly failed to meet this burden of proof. There is not one single solitary circumstance in the entire record which tends to show that the insured received an injury under the circumstances insured against or that an injury caused his death, directly and independently of all other causes.

Verdicts of juries cannot be based upon conjecture or possibilities.

New Orleans & N. E. Ry. v. Holsomback, 151 So. 720, 168 Miss. 493; Williams v. Lumpkin, 152 So. 842, 169 Miss. 146; Tyson v. Utterback, 122 So. 496, 154 Miss. 381; Hercules Powder Co. v. Calcote, 138 So. 583, 161 Miss. 860; Yazoo & M. V. R. Co. v. Green, 147 So. 333, 167 Miss. 137; Burnside v. Gulf Refining Co., 148 So. 219, 166 Miss. 460; Columbus & G. R. Co. v. Coleman, 160 So. 277; Love v. New York Life Ins. Co., 64 F.2d 829; Deadrich v. U.S. 74 F.2d 619.

If we should go off into the realm of speculation and assume that the insured received-the injury to his hand when in a personal difficulty with another person, in order for the appellee to recover, it would be necessary that the further presumption be indulged in to the effect that he did not provoke the difficulty and was not the aggressor, because if he provoked rite difficulty and was the aggressor, then the injury was not by accidental means.

Interstate Business Men's Acc. Assn. v. Lester, 257 F. 225; Smith v. New York Life Ins. Co., 31 F.2d 281; Occidental Life Ins. Co. v. Holcomb, 10 F.2d 125; Mutual Life Ins. Co. v. Sargent, 51 F.2d 4; Taliaferro v. Travelers' Protective Assn., 80 F. 368.

There is no proof in the record that the insured received an injury by accidental means and there is no presumption that the injury received in the case at bar was accidental.

New York Life Ins. Co. v. Ollich, 42 F.2d 399; Svenson v. Mutual Life Ins. Co. of N. Y., 87 F.2d 441; Ewing v. Goode, 78 F. 442; Gunning v. Cooley, 281 U.S. 90, 74 L.Ed. 720; Stevenson v. The White City, 285 If. S. 195, 52 S.Ct. 347, 76 L.Ed. 699; Eggsen v. U.S. 59 F.2d 616; Deadrich v. U.S. 74 F.2d 619; Claywell v. Inter-Southern Life Ins. Co., 70 F.2d 569; New York Life Ins. Co. v. Doerksen, 75 F.2d 96; New York Life Ins. Co. v. Anderson, 66 F.2d 705.

It is a well established rule that a presumption can be legally indulged only when the facts from which the presumption arises are proven by direct evidence, and that one presumption cannot be deduced from another. To hold that a fact inferred or presumed at once becomes an established fact, for the purpose of serving as a base for a further inference or presumption, would be to spin out the chain of presumptions into the regions of the barest conjecture.

10 R. C. L. 870; New York Life Ins. Co. v. Ollich, 42 F.2d 399.

Proofs of death constitute prima facie evidence of facts stated and are conclusive against the beneficiary when unexplained.

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