Oscar Bernard Wold v. State Mutual Life Assurance Co., of Worcester

• Court: Minnesota Supreme Court
• Writing for the Court: JULIUS J. OLSON, JUSTICE.
• Citation: Oscar Bernard Wold v. State Mutual Life Assurance Co., of Worcester, 270 N.W. 150, 198 Minn. 451 (Minn. 1936)
• Decision Date: 11 December 1936
• Docket Number: 31,052
• Parties: OSCAR BERNARD WOLD v. STATE MUTUAL LIFE ASSURANCE COMPANY OF WORCESTER, MASSACHUSETTS

270 N.W. 150

198 Minn. 451

OSCAR BERNARD WOLD v. STATE MUTUAL LIFE ASSURANCE COMPANY OF WORCESTER, MASSACHUSETTS

No. 31,052

Supreme Court of Minnesota

December 11, 1936

Action in the district court for Hennepin county to recover disability benefits alleged to be due plaintiff under a life policy with disability benefit provision. Plaintiff's motion for judgment on the pleadings was granted, Frank E Reed, Judge, and defendant appealed from an order denying its motion for a new trial. Affirmed.

SYLLABUS

Insurance -- proof of loss -- purpose.

1. The purpose of furnishing proof of loss under a policy of insurance is to provide insurer with information from which it may determine its liability.

Insurance -- proof of loss -- waiver -- conduct of insurer's officers or agents.

2. The general rule is that there may be an express or an implied waiver of proofs of loss and that a waiver may be inferred from any words or conduct of the insurer's authorized officers or agents evincing an intention on the part of the insurer not to insist on compliance with the requirements of the policy in respect to proofs of loss and calculated to lead the insured to believe that they will not be insisted on.

Insurance -- proof of loss -- waiver -- payments to insured.

3. Under policy provision stated in opinion, plaintiff was only required, as condition precedent to his right of recovery, to furnish due proof that he had become totally and permanently disabled subsequent to date of policy. He having furnished such proof, which was duly received by and acted upon by defendant and was recognized by it as efficient and sufficient over a period of nine years, during all of which time it made the stipulated payments, defendant may not now put in issue the validity or sufficiency of such proofs there being no claim of error, omission, fraud, or concealment by plaintiff or anyone else acting for him.

Insurance -- life -- disability benefits -- termination of liability.

4.Defendant's liability under policy disability provision here involved can be terminated only as authorized thereby.

Pleading -- answer insufficient.

5. Court rightly held that defendant's answer presented no fact issue.

Snyder, Gale & Richards, for appellant.

Oscar G. Haugland, for respondent.

OPINION

JULIUS J. OLSON, JUSTICE.

Plaintiff's motion for judgment on the pleadings was granted. Defendant's motion for a new trial was denied, and it appeals.

The following facts are concededly established: On September 20, 1921, defendant, in consideration of $45.06 and a like sum to be paid annually thereafter, issued and delivered to plaintiff its policy of insurance upon his life in the amount of $2,000, payable at his death. The policy also contained the following provision:

"Total and Permanent Disability Benefit Provision.

"If the insured hereunder, after the payment of one full year's premium on this policy, and while no premium hereunder is in default, shall furnish due proof that * * * because of accident or disease he has become wholly, continuously and permanently unable to pursue any gainful occupation and presumably for life will be unable to perform any work, mental or manual, or engage in any business for compensation or profit, and that such disability, or the cause there, was sustained or contracted after the date hereof, the Company will * * * waive the payment of all premiums becoming due under this policy after the expiration of the then current policy year, and pay the insured one percent of the face amount of this policy * * * and a like amount each month thereafter during the continuance of said total disability of the insured prior to the maturity of this policy.

"The first of said payments shall be made six months after the receipt of such proof of said disability, and then only if it shall appear that the insured is still totally, permanently and incurably disabled as defined above. During said period of six months, any medical examiner, or other accredited representative of the Company, shall be permitted to examine the person of the insured in respect of the alleged disability, at such time and in such manner as the Company may desire.

"By the acceptance of this contract the insured agrees that, after the said payments become payable as above described, any medical examiner appointed by the Company shall be allowed from time to time to satisfy himself of the continuance of such disability by the examination of the person of the insured, and if it is established that the insured has recovered so as to be able to again engage in some gainful occupation, or has so engaged, or if the insured refuses to permit such examination by a medical examiner, no further premiums will be waived, and no further payments under this provision will be made by the Company.

"The disability payments made and the premiums waived under this provision will not reduce the amount payable under this policy at maturity, either as an endowment or as a death claim, or affect the distribution of surplus as provided in this policy. The values provided under 'Non-Forfeiture Provisions' shall continue with the same force and effect as if the premiums hereunder were duly paid."

And the further provision:

"This policy shall be incontestable after one year from the date of its issue except for nonpayment of premiums."

Shortly prior to April 30, 1925, plaintiff then having reached the age of 31 years and having paid four full annual premiums, there being no default whatever, furnished to defendant proof that he had become wholly, continuously, and permanently unable to pursue any occupation because he had become afflicted with tuberculosis; that by reason of such affliction, presumably for life, he would be unable to perform any work, mental or manual, or engage in any business for compensation or profit, "and that such disability or the cause thereof was sustained or contracted after said September 20, 1921."

Ever since April 30, 1925, and until and including March 30, 1934, defendant duly paid to plaintiff $20 per month in accordance with the quoted language of the permanent disability provision. On April 14, 1934, defendant informed plaintiff that it would no longer pay this or any other sum per month. Since the last mentioned payment defendant has refused to pay the monthly installment. Plaintiff sought recovery for such installments as had matured as and when the case was to be heard.

The only issue of fact, if such there be, arises by virtue of the following allegations of defendant's amended answer:

"II. Admits the allegations contained in paragraph V of said complaint, excepting that defendant expressly denies that plaintiff has at any time furnished to defendant proof that the cause of his disability was sustained or contracted after September 20, 1921; that copies of the proofs furnished defendant by plaintiff in support of plaintiff's claim for disability benefits under said policy are hereunto attached and identified as Exhibits A, B and C, and hereby made part of this amended answer. * * *

"IV. Admits that for the period commencing April 30, 1925, and ending April 30, 1934, defendant has paid plaintiff the sum of twenty dollars ($20.00) on the 30th day of each month as and for total and permanent disability benefits under its policy described in said complaint.

"V. Admits that on April 14, 1934, defendant notified plaintiff that it had terminated plaintiff's claim for disability benefits under said policy, and that it then had in its possession evidence that the cause of plaintiff's disability was sustained or contracted prior to September 20, 1921, and that such being the case no further disability benefits on account of said disability were payable to plaintiff; that in fact no further disability benefits have been paid plaintiff since April 30, 1934.

"VI. Alleges that the cause of said disability was sustained or contracted by plaintiff before September 20, 1921, which is the date of said policy; that defendant had no knowledge or notice of such last mentioned fact until no or about April 14, 1934; that defendant in making disability payments to plaintiff as hereinbefore admitted, believed that the cause of said disability was first sustained and contracted by plaintiff after said date of said policy."

The exhibits to which defendant refers in the first quoted paragraph of its answer are these: Exhibit A is the claimant's statement, duly verified, showing his name, date of birth, and residence; that his illness began the first part of October, 1924; that his application for disability benefits was based upon pulmonary tuberculosis and tuberculosis laryngitis; that his disability became total December 22, 1924, and that he has...