Mitchell v. Equitable Life Assur. Soc. of U.S., 46126

• Decision Date: 03 September 1976
• Docket Number: No. 46126,46126
• Parties: Constance Grace MITCHELL, Appellant, v. EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Respondent.
• Court: Minnesota Supreme Court

Page 618

245 N.W.2d 618

310 Minn. 219

Constance Grace MITCHELL, Appellant, v. EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Respondent.

No. 46126.

Supreme Court of Minnesota.

Sept. 3, 1976.

Syllabus by the Court

1. The notice required of a disability insurance policy may be satisfied by a report of claim filed by the employer which is timely within the terms of the policy.

2. A claimant under a disability insurance policy who fails to timely submit an employee's statement and a physician's certificate, which are conditions precedent to recovery under the terms of the policy, may not commence an action to recover benefits under the policy 2 1/2 years after such reports were due. Such delay is akin to laches and precludes the action where, as the facts here disclose, the other party is actually prejudiced.

William Starr, Minneapolis for appellant; Daniel Zeddies, Minneapolis, of counsel.

Briggs & Morgan and Samuel L. Hanson, St. Paul, for respondent.

Heard before SHERAN, C.J., and ROGOSHESKE and TODD, JJ., and considered and decided by the court en banc.

TODD, Justice.

Constance Grace Mitchell (Mitchell), an employee of Twin City Federal Savings and Loan Association (TCF), sought to recover disability benefits from The Equitable Life Assurance Society of the United States (Equitable) under a group long term disability income policy furnished by Equitable to TCF to cover TCF employees. The lower court denied recovery, finding that Mitchell failed to prove total disability and that she had failed to conform to the policy requirements as to medical treatment, notice of injury, and proof of disability. Mitchell appeals from the judgment. We affirm on the ground that Mitchell did not comply with the policy requirements as to proof of disability, and therefore principles similar to those underlying the doctrine of laches dictate that she should be barred from asserting this claim.

Mitchell was employed by TCF in its cafeteria. In May 1970, she was hospitalized and treated for phlebitis of the left leg, varicose veins, and obesity. A claim based on the expenses of this hospitalization was timely submitted to Equitable on Mitchell's behalf by TCF, and such claim was duly paid. On June 2, 1970, Mitchell's treating physician reported that she had recovered and was capable of returning to work, although a subsequent report by this same physician in November 1970 stated that Mitchell should avoid prolonged sitting or standing in one place. Mitchell sought to return to work at TCF on a part-time basis in June 1970, but was informed there was no part-time work available, and her employment was terminated by TCF.

In August 1970, Mitchell inquired of TCF regarding possible disability claims. Equitable's notice-of-claim form under the disability policy was comprised of three parts: An employer's statement, an employee's statement, and a physician's certificate. By letter dated August 13, 1970, TCF transmitted the employee's statement and the physician's certificate to Mitchell's attorney, who delivered them to Mitchell. In addition, TCF at that time mailed to Equitable the employer's statement relating to Mitchell's potential disability claim. That statement notified Equitable that Mitchell claimed disability, but also contained TCF's recommendation that no benefits be paid because Mitchell could obtain full-time employment at the time and had requested part-time employment with TCF. Mitchell never furnished TCF or Equitable with the employee's statement or the physician's certificate. Equitable made several requests of TCF for the employee and physician statements and was finally advised by TCF in early 1971 that Mitchell had abandoned her claim, a fact which is not disputed in the record by Mitchell. Accordingly Equitable closed its file on Mitchell's claim.

In March 1973, Mitchell commenced this action against Equitable, seeking recovery for long term disability benefits as provided in the policy. ¹ The policy provides that an employee is totally disabled and thus entitled to receive benefits under the following circumstances:

'* * * (I)f he is wholly and continuously unable (i) during the first two years of any one period of disability, to perform any and every duty pertaining to his employment, and (ii) during the remainder of such period of disability, to engage in any occupation or perform any work for compensation or profit for which he is or may become reasonably fitted by education, training or experience.'

The trial court found that Mitchell was 'totally disabled' under the policy definition for the first 2 years, but that she did not qualify thereafter since she was suitable for other employment. The trial court also found that Mitchell was not 'under the regular care and attendance of a legally qualified physician' as required by the policy. Further, the trial court found that she had not complied with policy provisions requiring that the claimant submit notice of injury was proof of disability to Equitable. Mitchell appeals from the judgment entered for defendant pursuant to these findings, challenging principally the findings as to notice of injury and proof of disability.

1. With...