Metropolitan Life Ins. Co. v. Lindsey

• Decision Date: 16 January 1939
• Docket Number: 33457
• Citation: 184 Miss. 359,185 So. 573
• Court: Mississippi Supreme Court
• Parties: METROPOLITAN LIFE INS. Co. v. LINDSEY

185 So. 573

184 Miss. 359

METROPOLITAN LIFE INS. Co. v. LINDSEY

No. 33457

Supreme Court of Mississippi, Division B

January 16, 1939

APPEAL from the circuit court of Jones county HON.W. L. PACK, Judge.

Action by Mack Lindsey against the Metropolitan Life Insurance Company for disability benefits under an employees' group insurance policy. Judgment for plaintiff, and defendant appeals. Reversed and remanded.

Reversed and remanded.

Wells Wells & Lipscomb of Jackson and Welch & Cooper, of Laurel for appellant.

It is our contention that the words "due proof" mean "timely proof, " and that in the absence of any specific time for making proofs the plaintiff is entitled only to a reasonable time and what constitutes a reasonable time must be determined by the facts in each case. It is further our contention that if proof is not made within a reasonable time, all of the facts and circumstances being taken into consideration, and the defendant is thereby prejudiced or injured, the plaintiff cannot recover.

We respectfully submit that Section 2294, Mississippi Code of 1930, being the uniform Statute of Limitations, has no application whatever to this situation.

It is to be noted that this provision does not attempt to limit the time within which a suit may be filed, but simply requires that reasonable notice be given to the defendant in order that it may take necessary steps to investigate the plaintiff's claim and to protect itself if the claim is without merit, or fraudulent; or to pay the claim if it is a meritorious one.

Metropolitan Life Ins. Co. v. Peoples Trust Co., 98 N.E. 513, 177 Ind. 578, 41 L.R.A. (N.S) 285; Metropolitan Life Ins. Co. v Frankel, 103 N.E. 501, 58 Ind.App. 115.

If no time is fixed by the policy for the giving of the notice and proofs, they must be given within a reasonable time. What constitutes a reasonable time for giving notice depends on the circumstances of the particular case.

Burton v. Metropolitan Life Ins. Co., 173 S.E. 922, 177 Ga. 899; Prudential Ins. Co. of America v. Falls, 87 S.W.2d 567; Metropolitan Life Ins. Co. v. Walton, 83 S.W.2d 274.

The purpose of the provision of the policy requiring "due proof" is obvious. Certainly in a case of this kind, the insured knows better than any one else in the world whether or not he is totally and permanently disabled. Can it be said that he will be allowed to sit back for five years, with full knowledge of his own condition, and then after the witnesses have gone, and after it has become impossible for the insurance company to make a proper investigation of the merits of his claim, charge that he has been totally disabled for lo, these many years? We respectfully, and with deference, submit that such a holding is repugnant to the sense of justice of any fair and impartial man.

Berry v. Lamar Life Ins. Co., 142 So. 445, 165 Miss. 405.

In the face of the undisputed facts as set forth by the plaintiff and his witnesses, the motion to exclude his evidence and direct a verdict for the defendant should, in our opinion, and with deference, have most certainly been sustained. And after all the evidence was in certainly the defendant was entitled to the peremptory instruction requested.

Brotherhood of Railway Trainmen v. Nelson, 147 So. 661, 166 Miss. 671.

Surely this case must be reversed and remanded on the instructions granted by the court for the plaintiff.

Interstate Life & Accident Co. v. Cooly, 150 Miss. 502, 117 So. 267; Southern Ry. Co. v. Ganong, 99, Miss. 540, 55 So. 355.

Leonard B. Melvin, of Laurel, for appellee.

In appellant's second point, they rely for a reversal of this case and make the point that appellee did not furnish them due proof as provided for in the terms and conditions of said policy sued on, and in the trial court they filed what they designated as a first special plea in bar, which plea was demurred to by the appellee, and which demurrer was sustained by the trial court. The plea as set out by the record charges that on account of long delay of giving notice and making proof, the defendant was unable at that late date to make a proper investigation of the case. It is the contention of appellee that Section 2294 of the Code of 1930 is controlling in this point, and that there are ample decisions of this court which have interpreted Section 2294 in favor of appellee.

Aetna Life Ins. Co. v. Roberts, 164 So. 311; Kimel v. Missouri State Life Ins. Co., 71 F.2d 921; Aetna Life Ins. Co. v. Davis, 60 S.W.2d 912; Horn v. Prudential Life Ins. Co., 65 S.W.2d 1017; U.S. v. Meyer, 75 F.2d 355; 33 C. J. page 14, sec. 661, and page 7, sec. 649; 37 C. J., page 556, sec. 311, page 597; par. 378, and page 598, par. 379; National Casualty Co. v. Mitchell, 138 So. 809; Standard Accident Ins. Co. v. Broom, 71 So. 653; Sovereign Camp, W. O. W. v. Miller, 87 So. 893; Stuyvesant Ins. Co. v. A. C. Smith Motor Sales Co., 99 So. 577.

It will be seen that by the numerous decisions of this court, this court has repeatedly held that Section 2294 is applicable and controlling in suit on policies like the one before the court at this time.

Horn v. Prudential Life Ins. Co., 65 S.W.2d 101; Metropolitan Ins. Co. v. Carroll, 299 Ky. 522, 273 S.W. 54; U.S. v. Meyer, 76 F.2d 355.

Corpus Juris recognizes that there are two classes of policies, one where notice of disability is required as a condition precedent and the essence of the contract, and another where notice is not required as a condition precedent and where notice is not of the essence of the contract.

33 C. J., page 14, sec. 661; Kimel v. Missouri State Life Ins. Co., 71 F.2d 921; Missouri State Life Ins. Co. v. Case, 71 S.W.2d 203; Aetna Life Ins. Co. v. Davis, 60 S.W.2d 912; Aetna Life Ins. Co. v. Roberts, 164 So. 311; Aetna Life Ins. Co. v. Davis, 187 Ark. 398, 60 S.W.2d 912.

If this court should hold in this case that the contentions of appellant are correct, it would only mean that this court would practically abrogate Section 576 of the Mississippi Code. To hold that the insured must give notice in a shorter time than the six year Statute of Limitation requires would in all respects do away with the six year Statute of Limitations in insurance policies. If the insured had died at the time of his alleged disability, while he was in the employment of Gilchrist Fordney Company and before he was sixty years old, would the insurance company now be contending that the six year statute of limitation did not apply and because they had not received proof of insured's death would this, and this alone, defeat an action on this policy?

The opinion of the Alabama court in the case of Protective Life Ins. Co. v. Wallace, 161 So. 256, is authority for what is total and permanent disability in policies like the one here sued on. It will be noticed that the Alabama Court quotes the case of Metropolitan Life Insurance Company v. Lambert, 157 Miss. 759, 128 So. 750, as an authority for its decision.

New York Life Ins. Co. v. Bain, 152 So. 845.

Taking all of the instructions together, appellee respectfully contends that they all give the jury a fair analysis of the law and the facts of this case.

Instructions similar to the ones here complained of were approved by the Mississippi Supreme Court in the case of Metropolitan Life Ins. Co. v. Lambert, 128 So. 750.

Protective Life Ins. Co. v. Wallace, 161 So. 256.

Argued orally by W. Calvin Wells, Jr., for appellant, and Leonard B. Melvin, for appellee.

OPINION

Anderson, J.

Appellee brought this action in the circuit court of Jones County against appellant to recover disability benefits alleged to be due him under a group policy of insurance issued by appellant to Gilchrist-Fordney Company for the benefit of the latter's employees, one of whom was appellee. The amount sued for was the first instalment of $ 321, for which there was a verdict and judgment, from which judgment appellant prosecutes this appeal.

The particular provisions of the policy for consideration follow:

"Total and Permanent Disability Benefits.--On receipt by the Company at its Home Office of due proof that any Employee insured hereunder has become wholly and permanently disabled by accidental injury or disease, before attaining the age of sixty years, so that he is and' will be permanently, continuously and wholly prevented thereby from performing any work for compensation or profit, the Company will waive the payment of each premium applicable to the insurance on the life of such disabled Employee that may become payable thereafter under this Policy during such disability, and, in addition to such waiver, will pay to such Employee, " etc.

"Six months after the receipt of due proof of such disablement, the Insurance Company will begin making payments of the amount of insurance under any one of the following plans at the option of the person insured:"

The following facts were established without conflict: Appellee was a servant of Gilchrist-Fordney Company working in its plant from 1906 to July, 1937, when the company closed down and went out of business. It paid the premiums on the group insurance from the issuance of the, policy up to that time. In 1925 appellee, in trying to extinguish a fire, had his hands badly burned. The fire had no connection with the business of the master. The appellee claims to have become totally and permanently disabled from the burn on November 15, 1932; nevertheless he continued in the service of the company up to July, 1937, when it went out of business. Appellee was sixty years of age on February 5, 1933. He did not make proof of his disability until October 4, 1937, and brought suit in May, 1938.

Appellant filed a special plea to the declaration, appellee's demurrer to which was sustained. That action...