Prudential Ins. Co. of America v. South

• Decision Date: 14 November 1934
• Docket Number: 10010.
• Citation: 177 S.E. 499,179 Ga. 653
• Parties: PRUDENTIAL INS. CO. OF AMERICA v. SOUTH.
• Court: Georgia Supreme Court

177 S.E. 499

179 Ga. 653

PRUDENTIAL INS. CO. OF AMERICA v. SOUTH.

No. 10010.

Supreme Court of Georgia

November 14, 1934

Syllabus by the Court.

1. This was a suit to recover alleged total and permanent disability benefits under a policy of insurance. Under the evidence adduced, it was a question for the jury whether the plaintiff, who was employed as a switchman and lost his right arm, became, as a result of such injury and the particular circumstances applicable to him, totally and permanently disabled within the purview of the policy defining such disability as one which would render any person insured thereunder "wholly, continuously, and permanently unable to engage in any occupation, or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime."

2. The trial court erred in awarding a nonsuit, and this judgment was properly reversed by the Court of Appeals.

Certiorari to Court of Appeals.

Suit by W. T. South against the Prudential Insurance Company of America. Judgment of nonsuit was reversed by the Court of Appeals (47 Ga.App. 590, 171 S.E. 215), and defendant brings certiorari.

Affirmed.

GILBERT J., dissenting.

Spalding MacDougald & Sibley, Estes Doremus, and P. F. Brock, all of Atlanta, for plaintiff in error.

T. J Lewis and Jno. T. Dennis, both of Atlanta, for defendant in error.

BELL Justice.

Certiorari was granted in this case, to review the following decision and judgment of the Court of Appeals: "Plaintiff was employed by a railroad terminal company as a switchman. It took an able-bodied man with two feet and two hands to perform this work. Plaintiff was insured by the defendant insurance company against death and accident. He met with an accident which necessitated the amputation of his arm just below his shoulder. The policy provided that total disability, within the meaning of the policy, existed whenever the insured was 'rendered wholly, continuously, and permanently unable to engage in any occupation or perform any work for any kind of compensation of financial value during the remainder of his life.' Plaintiff was unable to continue as a switchman on account of such injury; railroad and terminal companies not employing one-armed men in such capacity. He filed a claim with the insurance company, and it refused to pay the same, and denied liability on the ground that the insured was not totally disabled within the meaning of the above clause in the policy. Plaintiff filed suit against the insurance company. On the trial the above facts appeared. There was also evidence to the effect that the plaintiff had not earned any money since his injury, and was unable to perform any substantial work, and that, while he lived on the farm with his father, he was not able to do any farm work on account of such injury. Upon the conclusion of plaintiff's evidence, the court granted a nonsuit, and to this judgment plaintiff excepts. Held, that this case is controlled by the rulings of the Supreme Court in Cato v. Ætna Life Ins. Co., 164 Ga. 392, 138 S.E. 787, and of this court in Marchant v. New York Life Ins. Co., 42 Ga.App. 11, 155 S.E. 221, and New York Life Ins. Co. v. Thompson, 45 Ga.App. 638, 165 S.E. 847. The plaintiff made out a case showing that he was totally disabled, within the meaning of that term, as construed by the above decisions, and his case should have been submitted to the jury." South v. Prudential Ins. Co., 47 Ga.App. 590, 171 S.E. 215.

It is contended, among other things, that the Court of Appeals ignored that portion of the disability clause to the effect that the insured must be unable to "perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime." All contentions made, except one, relate to the meaning and effect of this clause. In cases of this character, the policy should be construed liberally to effectuate the general purpose of the contract, which is to indemnify the insured for the loss of time by reason of incapacity to perform his usual work or carry on his usual business by reason of a happening covered by the policy. Cole v. Metropolitan Life Ins. Co. (R. I.) 170 A. 74. The policy here contained language different from that involved in Cato v. Aetna Life Ins. Co., 164 Ga. 392, 138 S.E. 787, and the other cases cited by the Court of Appeals; but the purpose of the contract was substantially the same, and the case should be governed by like principles. There are two lines of authority relating to cases of this kind, one tending to literalism, and the other applying the principle of liberal construction. The authorities which incline to strict interpretation are seemingly in the minority, and this court is committed to the more liberal doctrine. Cato v. Aetna Life Ins. Co., supra; New York Life Ins. Co. v. Thompson, 177 Ga. 898, 172 S.E. 3. The two lines of authority were recognized in Hurley v. Bankers' Life Co., 198 Iowa 1129, 199 N.W. 343, 37 A.L.R. 146, a case in which the court did not apply the more liberal doctrine, but intimated that except for its own prior decision in Lyon v. Railway Passenger Co., 46 Iowa 631, it might be persuaded to do so. See reference to these cases in Marchant v. N.Y. Life Ins. Co., 42 Ga.App. 11, 155 S.E. 221, supra. The Hurley Case was distinguished and apparently relaxed in the later decision of Kurth v. Continental Life Ins. Co., 211 Iowa 736, 234 N.W. 201, 206.

The words "occupation" and "work" must each be construed according to the facts and circumstances of the execution of the contract, including the objects to be effectuated thereby. The insured was at the time employed as a switchman, and the company must have known of this fact. It received a valuable consideration for which it agreed to confer a benefit, and it is presumed that a substantial benefit was intended. If a literal construction is applied in this case, the insured would be required to show a condition of practical helplessness in order to recover. Few people ever arrive absolutely at that condition from a nonfatal accident. The term "work" is itself ambiguous, having numerous definitions, including (1) mental or physical effort directed to an end; (2) toil or labor; and (3) employment or occupation. Where a provision in a policy is susceptible of two or more constructions, the courts will adopt that construction which is most favorable to the insured. Massachusetts Benefit Life Ass'n v. Robinson, 104 Ga. 256 (2), 30 S.E. 918, 42 L.R.A. 261. Under this policy, any reasonable person would have expected substantial protection, and would never have thought of the disability as one which must incapacitate him to earn the smallest sum in any possible manner. We do not think it material in this case that the wording of the contract may be somewhat different from the language dealt with in the several cases cited by the Court of Appeals. "Total disability," irrespective of the technical variations in the language employed, should be given a rational and practical construction. The phrase is a relative term, depending upon the circumstances and peculiar facts of each particular case, and is usually a question of fact to be determined by the court or jury trying the case. American Liability Co. v. Bowman, 65 Ind.App. 109, 114 N.E. 992. The policy in the present case further provided that, "without prejudice to any other cause of disability, the company will recognize the entire and irrecoverable loss of the sight of both eyes, or of the use of both hands, or of both feet, or of one hand and one foot, as total and permanent disability under this policy." Some of these specific conditions might not render the insured literally unable to "perform any work for any kind of compensation of financial value during the remainder of his life time." Thus, the company did not go so far in its own particular definition of "total disability" as it would ask the courts to go in applying the general definition as contained in the same contract. Cf. Kurth v. Continental Life Ins. Co., supra.

"Occupation" and "work" may not mean the same thing, and it appears from the context that they were not intended to be used interchangeably in the instant policy. But it does not follow that the latter term shall be accepted in the sense of any sort of labor, however insignificant or irregular. The word ""occupation" is a more elevated term, signifying a trade or calling; but each may include the idea of continuity and imply regularity in a specific line of endeavor. The term "work" being ambiguous and susceptible of various meanings, it should, on a proper construction of this contract, be defined as an employment having some degree of permanency, though not amounting to an occupation. This is true even if we look to the contract alone, without reference to the extraneous circumstances, which should also be considered. In Foglesong v. Modern Brotherhood, 121 Mo.App. 548, 97 S.W. 240, 241, Marchant v. New York Life Ins. Co.,

42 Ga.App. 11 (2), 155 S.E. 221, supra, the Court of Appeals saw fit to distinguish its earlier decisions in Whitton v. American Ins. Co., 17 Ga.App. 525, 87 S.E. 827, and Parten v. Jefferson Standard Ins. Co., 30 Ga.App. 245, 117 S.E. 772. The earlier cases were in some degree different; but, in any view, these cases do not persuade us to a different conclusion in the present case.

This being a group policy covering employees of a railroad company, the insurer necessarily knew that the plaintiff was a railroad employee; and, as indicated above, it presumably knew that his own particular work was that of a switchman. From common knowledge it may also be inferred that the premium rates were based upon the risk assumed. The language of the disability clause shows that it was an...