Muse v. Metropolitan Life Ins. Co.

• Citation: 192 So. 72,193 La. 605
• Decision Date: 30 October 1939
• Docket Number: 35448.
• Court: Supreme Court of Louisiana
• Parties: MUSE v. METROPOLITAN LIFE INS. CO.

192 So. 72

193 La. 605

MUSE v. METROPOLITAN LIFE INS. CO.

No. 35448.

Supreme Court of Louisiana.

October 30, 1939

Action on a group accidental death and dismemberment insurance policy by Ben A. Muse against the Metropolitan Life Insurance Company. To review a judgment of the Court of Appeal, 191 So 586, affirming a judgment of dismissal, plaintiff brings certiorari.

Judgment of the Court of Appeal affirmed.

An accidental injury by which third and little fingers were completely torn from hand, and thumb and remaining fingers were severed from hand but for a narrow connection of skin was not within group accidental death and dismemberment policy insuring against " Loss of one hand by severance at or above wrist-joint," notwithstanding that use of hand was lost.

James T. Shell, Jr., of Bastrop, for applicant.

Harry Cole Bates, of New York City, and Madison, Madison & Files of Bastrop, for respondents.

ODOM Justice.

Plaintiff was employed by the Southern Kraft Corporation as a laborer at its Basstrop, La., mill, and, while at work, his right hand was accidentally caught in running machinery and severely injured. The Kraft Corporation, his employer, carried group life insurance, group accidental death and dismemberment insurance, and group health insurance in favor of its employees. The policies were written by the Metropolitan Life Insurance Company, the defendant in this case. One of the policies provided that an employee should be paid a certain sum for ‘ Loss of one hand by severance at or above wrist-joint; or loss of one foot by severance at or above ankle joint; or total and irrevocable loss of sight of one eye.’

Plaintiff brought suit to recover the amount specified for ‘ Loss of one hand by severance at or above wrist-joint’ . In his petition he described in detail and at great length the nature of the accidental injury to his right hand.

He attached the policy sued on to his petition and made it a part thereof.

Defendant excepted to the petition on the ground that it set out no cause of action. The exception was sustained by the trial court, and plaintiff's suit was dismissed. He appealed to the Court of Appeal, Second Circuit. The judgment was affirmed. La.App., 191 So. 586. Plaintiff applied to this court for writs, which were granted, and the case is before us for review.

Plaintiff grounds his right to recover on the policy issued by the defendant company. The company's defense is that, according to plaintiff's allegations relating to the nature of the injuries to his hand, he is entitled to nothing under the policy because its provisions do not relate to such injuries as plaintiff sustained by the accident.

Plaintiff did not allege that, as a result of the accident, he lost his right hand by severance. According to his petition, all the bones in his hand were ‘ fractured, broken and crushed’ and his hand ‘ virtually torn into pieces'. The third and little fingers were ‘ torn completely off’, and the thumb and first and second fingers were ‘ left hanging by a small amount of skin attached to the palm’ . The thumb and first and second fingers ‘ were sewed back to the hand’ . His hand was left in such condition that he ‘ has no control over or use thereof’ .

Plaintiff attached to, and made a part of, his petition a photograph of his right hand, bearing this legend: ‘ Plaintiff's Exhibit ‘ A’ . Photograph of Right Hand Taken 11/8/38'. The suit was filed on November 28, 1938.

This photograph shows the entire metacarpus, or hand proper, and the entire thumb and first and second fingers attached in place. The third and little fingers are completely severed from the hand; so that plaintiff still has his hand, less two fingers. But it is alleged and the X-ray shows, that the bones of the hand proper are fractured and dislocated. The hand as it is is useless. Plaintiff, therefore, has lost the use of his hand, as he alleges. But his hand was not severed.

The policy provides in plain terms that its beneficiaries are entitled to a certain sum for ‘ Loss of one hand by severance at or above wrist-joint’ . The policy, as written, clearly shows that liability for the loss of a member of the body is limited to the loss of that member ‘ by severance’ . It grants full coverage for ‘ Loss of life; or total and irrevocable loss of sight of both eyes', and full coverage for the ‘ loss of both hands by severance at or above wrist-joints; or loss of both feet by severance at or above ankle-joints; or loss of one hand and one foot by severance at or above wrist-or ankle-joints respectively’ . And it grants one-half the amount for ‘ Loss of one hand by severance at or above wrist-joint; or loss of one foot by severance at or above ankle-joint’ . Wherever the loss of a member of the body is mentioned in the policy, it speaks of a ‘ loss by severance’ at or above the wrist or ankle-joints.

The policy nowhere speaks of disability caused by the loss of a hand, nor does it mention the loss of the use of a member. It is, according to its precise terms, an ‘ Accidental Death and Dismemberment’ insurance policy.

The risk assumed by the insurer is stated in the policy in clear and unambiguous language. The language of the policy so clearly speaks the intent of the parties that there is no room left for speculation as to its meaning. As relates to the two members of the body, the hand and the foot, it is a ‘ Dismemberment Insurance’ policy. It says so. On its face, it speaks of ‘ Accidental Death and Dismemberment Insurance’, and specifies the sum to be paid for ‘ loss of one hand by severance at or above wrist-joint’ . The indemnity specified is for the loss of a hand or a foot ‘ by severance’ . The word ‘ severance’, according to Webster's Dictionary, means the ‘ Act of severing, or state of being severed; partition; separation’ . According to the same authority, the word ‘ sever’ means: ‘ 1. To separate, as one from another; to cut off from something; to divide; to part in any way, esp. by violence, as by cutting, rending, etc.; as, to sever the head from the body. 2. To cut or break open or apart; to divide into parts; to cut through; to disjoin; as, to sever the arm or leg’ .

Admittedly plaintiff's right hand was not severed from the arm. The third and little fingers were severed from the metacarpus, or hand proper. But there was no severance of the hand.

The theory upon which plaintiff relies for recovery is ‘ that it was the loss of the use of the hand, as such, that was covered by the insurance’, that ‘ the true intent and purpose of the insurance was for indemnity against the loss of the use of the member, as such; and that, where by actual severance, either in whole or in part, the entire use of the member is wholly and totally lost, a liberal construction in line with the logical intention should be applied and recovery allowed’ .

The ‘ severance’ mentioned by counsel was not the severance of the hand, but the severance of the third and little fingers from the hand. And it is pertinent to state that, according to plaintiff's allegations and his brief, it was not the severance of these two fingers from the hand which caused the loss of the use of the hand. He alleged, and his counsel says in brief, that he sustained certain injuries to his hand, ‘ as a result of which all the bones thereof were crushed and fractured * * *, leaving his hand as nothing more than a mass of flesh and crushed bones, over which he has no control whatever and which he cannot use for any purpose’ .

Counsel's contention, as set out in his brief, is that the policy should not be given a ‘ strict and literal’ construction, but that its ‘ true intent and purpose’ should guide in its construction.

If there were ambiguities in the terms of the policy, there would be merit in counsel's argument. But there are no ambiguities in this policy. An insurance policy is the contract between the parties, and, like all other contracts, it is the law between them. Dorsett v. Thomas, 152 La. 60, 92 So. 734; Laporte v. North American Accident Ins. Co., 161 La. 933, 109 So. 767, 48 A.L.R. 1086.

‘ Agreements legally entered into have the effect of laws on those who have formed them.’ C.C. Art. 1901.

The rule for the interpretation of contracts is laid down in Article 1945 of the Civil Code, which provides ‘ That courts are bound to give legal effect to all such contracts according to the true intent of all the parties', and ‘ That the intent is to be determined by the words of the contract, when these are clear and explicit and lead to no absurd consequences'.

The words of this contract are ‘ clear and explicit’ and lead to no ‘ absurd consequences'. It specifies indemnity for the loss of a hand ‘ by severance’, but none for the loss of the use of a hand. Apt and precise language was chosen to indicate that the insurer did not intend to indemnify an insured for the loss of the sue of a hand, or for the loss of a hand unless such loss consisted in the actual physical severance of that member at or above the wrist-joint. The policy placed restrictive limitations upon the insured's right to recover the indemnity for the loss of a hand, and, because the language used is plain and without ambiguity, we can find the intention of the parties only from the language employed in the contract, keeping in mind the rules of interprestation laid down in the Code, which have been repeatedly followed by this court. The language used in the policy is not confusing. It does not constitute a snare and a delusion to the unwary, and we can think of no ground upon which plaintiff may be relieved from its effect.

The general rule is that, in case of doubt as to its meaning, a contract will be construed against the party who framed it. And, keeping...