Ramsey v. General Accident, Fire & Life Ins. Co.

• Decision Date: 09 January 1912
• Citation: 160 Mo. App. 236,142 S.W. 763
• Parties: RAMSEY v. GENERAL ACCIDENT, FIRE & LIFE INS. CO.
• Court: Missouri Court of Appeals

142 S.W. 763

160 Mo. App. 236

RAMSEY v. GENERAL ACCIDENT, FIRE & LIFE INS. CO.

Kansas City Court of Appeals. Missouri.

January 9, 1912.

1. INSURANCE (§ 525) — SICK INDEMNITY — POLICY—CONSTRUCTION—"NECESSARILY AND CONTINUOUSLY CONFINED."

A health indemnity policy provided for payment for the number of consecutive days after the first week that insured was necessarily and continuously confined within the house and regularly visited by a physician by reason of illness contracted after the policy had been in force for 30 days. Plaintiff was taken ill in a hotel while in Florida, where he was treated by a physician, and, after getting somewhat better, was transported in a Pullman car to his home, where it was determined that it was necessary for him to undergo an operation by surgeons in a nearby city. He was operated upon, attended by them daily by being taken to them in a carriage from his hotel near by and occasionally walking to them when able, and on being returned to his home was yet under the treatment of physicians and confined to his house, except occasionally when he sat on the porch, and was once driven to his place of business without taking any part in business matters. At another time he was taken to the physicians' office, and with these exceptions he was in the house and much of the time in bed. Held, that the policy did not require that plaintiff should be literally confined within the walls of his house all the time, and that he was necessarily and continuously confined within the house within the terms of the policy.

2. INSURANCE (§ 560)—HEALTH POLICY—NOTICE OF ILLNESS—WAIVER.

A health policy provided for written notice of any illness within 10 days after the commencement thereof, and that failure to give such notice should limit the insurer's liability to one-fifth of the amount otherwise payable. Notice was given more than 10 days after the beginning of plaintiff's sickness on preliminary proofs sent, which were returned for correction by plaintiff's physician, and, this requirement having been complied with without any objection to the notice not having been given in time, plaintiff was furnished blanks for final proof and was referred to insurer's agent for adjustment of the claim, after which defendant wrote to plaintiff's attorney that it was ready to make settlement provided evidence was produced that the disability was within the terms of the contract. Held, that defendant waived a strict compliance with the requirement that proof of loss should be rendered within the time specified.

Appeal from Circuit Court, Pettis County; H. B. Shain, Judge.

Action by W. H. Ramsey against the General Accident, Fire & Life Insurance Company. Judgment for plaintiff, and defendant appeals. Affirmed.

Harvey D. Dow, for appellant. G. W. Barnett, for respondent.

ELLISON, J.

Plaintiff is a merchant living in Sedalia, Mo., and there took out a policy of health insurance. He afterwards was taken sick, on the 19th of March, 1910, in the state of Florida, came home, and continued to be sick for several weeks. Defendant refused to pay his claim, whereupon he brought this action and recovered judgment in the trial court.

The policy contained the following provisions: "Illness indemnity, at the rate of one hundred dollars per month for the number of consecutive days, after the first week, that the insured is necessarily and continuously confined within the house, and therein regularly visited by a legally qualified physician by reason of illness that is contracted and begins after this policy has been maintained in continuous force for thirty days. * * * Written notice * * * of any illness for which claim can be made, must be given to the company at Philadelphia, Pa., within ten days of date of accident or beginning of illness. Failure on the part of the assured of the beneficiary to comply strictly with said notice requirement shall limit the liability of the company to one-fifth the amount which would be otherwise payable under this policy."

When plaintiff's sickness came upon him in Florida, he went to his hotel, had fever, was sick at the stomach, and suffering severe pains in his bowels. He went to bed at the hotel and sent for a doctor and was so sick through the night that he had to make arrangements for the porter to stay in his room. He was unable to get a doctor at first. The doctor came to his room and prescribed for him, and the porter sent out for medicine. The doctor administered certain remedies and soon called again. He took sick on Sunday, and on Tuesday morning, the treatment having relieved him temporarily, he was able to be up and walk to the office of the doctor. The doctor, after giving him further treatment and prescription, recommended him to go home, telling him to keep out of the sun and to do no walking or exercise. Plaintiff was taken to the depot in a carriage that was summoned to the hotel for him, and was taken to Sedalia, his home, in a Pullman car, where he was driven in a carriage to his home. He remained at his home and within his house a few days under the treatment of a doctor. He was at home during all this time, except he...