Mutual Ben. Health & Accident Ass'n v. Mathis

• Citation: 169 Miss. 187,142 So. 494
• Decision Date: 13 June 1932
• Docket Number: 30079
• Parties: MUTUAL BEN. HEALTH & ACCIDENT ASS'N v. MATHIS
• Court: United States State Supreme Court of Mississippi

142 So. 494

169 Miss. 187

MUTUAL BEN. HEALTH & ACCIDENT ASS'N v. MATHIS

No. 30079

Supreme Court of Mississippi

June 13, 1932

1 INSURANCE. "Total disability," within health insurance policy, is not necessarily incapacity to perform any duty incident to usual employment or business.

Insured under health policy is "totally disabled," if his illness prevents him from doing the substantial acts required of him in his business, or if his physical condition is such that, in order to effect a cure or prolongation of life common care and prudence require that he cease all work.

2 INSURANCE.

In determining meaning and effect of phrase "total loss of time" within health policy, same rules of construction apply as those applicable to determine meaning and effect of phrase "total disability."

3 INSURANCE.

Disease which causes "total disability," within health policy, likewise necessitates "total loss of time;" there being no "total disability" without consequent "total loss of time."

4. INSURANCE. Evidence held to establish, as matter of law, that insured suffering from acute diabetes was "totally disabled," necessitating "total loss of time" within health policy, notwithstanding performance of light and incidental duties of business.

Accident and health policy provided for benefit to insured, in part, at the rate of fifty dollars per month for one day or more, but not exceeding one month, "for disability resulting from disease,... which does not confine the insured continuously indoors, but requires regular medical attention; provided said disease necessitates total disability and total loss of time."

Division A

APPEAL from circuit court of Alcorn county.

HON. THOS. H. JOHNSON, Judge.

Suit by C. H. Mathis against the Mutual Benefit Health & Accident Association. Judgment for the plaintiff, and the defendant appeals. Affirmed.

Affirmed.

Orma R. Smith, of Corinth, for appellant.

W. C. Sweat, of Corinth, for appellee.

Briefs of counsel not found.

OPINION

Cook, J.

The appellee, C. H. Mathis, instituted this suit in the circuit court of Alcorn county against the appellant, the Mutual Benefit Health & Accident Association, on an insurance policy issued by the appellant, which provided for certain disability benefits to the appellee. At the conclusion of the testimony, the court directed a verdict for the appellee for one hundred seventy dollars and eighty-three cents for disability and hospital expenses, while he was continuously confined within doors, and five hundred ninety dollars and sixty-seven cents for the time that he was totally disabled and suffered total loss of time, but was not confined within doors; and, from the judgment entered for the aggregate amount of seven hundred sixty-one dollars and fifty-one cents, this appeal was prosecuted.

The clauses of the policy upon which the judgment was based, are parts I and J thereof, which read as follows:

"Illness Indemnities.

"Part I. Confining illness one hundred dollars per month for life.

"The association will pay, for one day or more, at the rate of one hundred (100.00) dollars per month for disability resulting from disease, the cause of which originated more than thirty days after the date of this policy, and which confines the insured continuously within doors and requires regular visits therein by legally qualified physician; provided said disease necessitates total disability and total loss of time."

"Part J. Non-confining illness fifty dollars per month.

"The association will pay, for one day or more at the rate of fifty dollars per month, but not exceeding one month, for disability resulting from disease, the cause of which originates more than thirty days after the date of this policy, and which does not confine the insured continuously within doors but requires regular medical attention; provided said disease necessitates total disability and total loss of time."

Part J of the policy, above quoted, was extended to cover the entire life of the insured by a rider indorsed on the policy, which is as follows: "In consideration of an additional premium of four dollars annually or one dollar quarterly, the association will pay to the insured, the monthly indemnity as specified in this policy, in part J, so long as the insured shall live and suffer the disability therein described."

The appellee had been engaged in the laundry business for fifteen years, and for eight years prior to the beginning of his disability was the owner of a steam laundry in Corinth, Mississippi, and had been engaged in the active discharge of the duties of manager of said laundry. This laundry contains about twenty-five machines, which are operated by different employees, and which are located in a building with a floor space of seventy-five by one hundred seventy-five feet, with the business office of the laundry located at the front of this floor space. In the operation of the laundry it is necessary for the manager to be on his feet almost continuously from eight to ten hours per day while engaged in the supervision of the machines and the employees in order to see that the machines are properly operated and the work properly performed.

In October, 1930, the appellee was stricken with a disease which his family physician and another Corinth physician diagnosed as acute diabetes. These physicians advised him to consult a specialist in Birmingham who operated a clinic and hospital for the treatment of such diseases. He then went to Birmingham for examination by this specialist, who confirmed the diagnosis of the local physicians, and prescribed a very strict diet. He made several trips to Birmingham, and each time remained in the hospital several days. Later he was confined to his bed at home for eighteen days; and it is conceded by the appellant that he is entitled to recover one hundred seventy dollars and eighty-three cents, under part I of the policy, for hospital expenses and disability while confined within doors. The appellee's several physicians testified that common care and prudence and due regard for the preservation of his health and prolongation of his life, required that he give up all work, avoid all exertion and worry, and take a complete rest, and that they advised and urged him to do so; but, over the protest of these physicians, he continued to go to his place of business early in the morning and to remain there throughout the working hours. He turned the active management of the business over to another, but remained in the office. During the hours before noon, in a limited way, he attended to some duties in his office such as answering the telephone, writing an occasional letter, checking receipts from his drivers once a week, checking the pay roll once a month, buying supplies and paying bill...