Rezendes v. Prudential Ins. Co. of America

• Citation: 285 Mass. 505,189 N.E. 826
• Parties: REZENDES v. PRUDENTIAL INS. CO. OF AMERICA.
• Decision Date: 31 March 1934
• Court: United States State Supreme Judicial Court of Massachusetts

285 Mass. 505

189 N.E. 826

REZENDES

v.PRUDENTIAL INS. CO. OF AMERICA.

Supreme Judicial Court of Massachusetts, Bristol.

March 31, 1934.

Appeal from Third District Court, Bristol County; F. A. Milliken, Judge.

Action of contract by Manuel F. Rezendes against the Prudential Insurance Company of America. From an order of the appellate division for the Southern district dismissing a report from the district court after findings in favor of the plaintiff, the defendant appeals.

Order dismissing the report affirmed.

W. S. Downey, of New Bedford, for appellant.

J. Ferreira and W. R. Freitas, both of New Bedford, for appellee.

DONAHUE, Justice.

The plaintiff has brought suit to recover disability benefits of $100 per month from November, 1930, alleged to be due under a policy of insurance issued to the plaintiff by the defendant company on April 1, 1927.

The policy recites that the company ‘hereby insures the person herein designated as the Insured, for the series of monthly instalments hereinafter provided.’ It contains a provision for the payment of sixth monthly instalments of $100 each ‘upon receipt of due proof of the death of the Insured during the continuance of this Policy’ and a further provision for the payment of the same number of additional monthly instalments of the same amount in the event of the death of the insured by accident. Under the caption ‘Total and Permanent Disability Benefits' it provides for the payment to the insured of a ‘monthly income’ of $100 ‘in event of total and permanent disability before age 60, subject to the provisions as to Total and Permanent Disability contained in the Policy.’ Under the heading ‘Provisions as to Total and Permanent Disability’ the policy states: ‘If the Insured shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such an extent that he * * * is 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 * * * lifetime, and if such disability shall occur at any time after the payment of the first premium on this Policy, while this Policy is in full force and effect and the Insured is less than sixty years of age, and before any non-forfeiture provision shall become operative, the Company, upon receipt of due proof of such disability’ will waive payment of any premium falling due after he receipt of proof of such disability and will pay to the insured the monthly income above specified. Under the same heading the policy further provides that ‘Notwithstanding the acceptance by the Company of proof of total and permanent disability, the Insured, upon demand by the Company from time to time * * * for the purpose of verifying that such disability is actually permanent and not temporary, shall furnish due proof that he * * * actually continues in the state of disability defined above. * * *’ In consideration of the payment by the insured of an additional premium, a rider was attached to the policy which states that: ‘The following provisions are hereby made part of the clause headed ‘Provisions as to Total and Permanent Disability,’ contained in this Policy: If due proof of total and permanent diability has not been previously furnished, and if the Insured shall furnish due proof that he has been totally disabled, either physically or mentally, from any cause whatsoever, to such an extent that he was rendered wholly and continuously unable to engage in any occupation or perform any work for any kind of compensation of financial value during a period of ninety consecutive days, and if such disability shall occur after the payment of the first premium on this Policy, while this Policy was in full force and effect and the Insured was less than sixty years of age and before any non-forfeiture provision became operative, such disability shall be presumed to be permanent and the Company will upon receipt of such proof grant the disability benefits provided, subject to all other provisions of said clause including those relating to proof of continuance of disability.'

The case was tried in the Third district court of Bristol. The judge found for the plaintiff. He stated in his finding among other things that no question of pleading was raised and that ‘the only issue involved at the trial was whether or not the plaintiff was totally and permanently disabled as provided in the policy. * * * I find as a fact that the plaintiff is not in a physical and mental condition to do any work to such an extent as to enable him to engage in any occupation for any kind of compensation of financial value, without unreasonable, excessive and harmful effort or exertion detrimental to his condition; in his present heart and nervous condition any continuous exertion, either physical or mental may shorten his life.’ At the request of the defendant the trial judge reported to the appellate division his refusal to grant certain requested rulings of law and ‘the findings and order of the Court in favor of the plaintiff.’ The appellate division ordered the report dismissed and the defendant has appealed.

The plaintiff became disabled after the payment of the first premium while the policy was in full force and effect and the plaintiff was under the age of sixty and before any non-forfeiture provisions of the policy became operative. It does not seem to have been in dispute that his disability began about December 1, 1930, and continued for more than ninety days prior to the bringing of the suit. The question mainly in controversy is whether or not he was disabled to the extent required by the policy in order to entitle him to monthly payments.

The policy in referring to disability of the insured repeatedly employs the absolute words ‘total’ and ‘permanent’ and their derivatives and synonyms but from a reading of the policy as a whole it is manifest that it was not intended that those words should be taken in a literal sense or given an absolute effect. So far as concerns totality of disability complete physical or mental incapacity is not necessary; that policy in terms makes the obligation of the insurer rest upon a lesser disability than ‘total.’ He is entitled to the stated monthly income if he is ‘totally disabled * * * to such an extent that he was rendered wholly and continuously unable’ to do any remunerative work. Something less than absolute permanency of disability is contemplated. An obligation of the insurer to pay the stated monthly income arises if disability of the character described in the policy exists for a period of ninety consecutive days. In such case the ‘disability shall be presumed to be permanent.’ Another clause in the policy requires the insured, even after payment of the benefits has begun, on demand by the insurer from time to time to furnish proof that his condition is ‘actually permanent.’ The words with which we are here particularly concerned are those which provide that the company will pay disability benefits ‘if the Insured shall furnish due proof that he has been totally disabled, either physically or mentally, from any cause whatsoever, to such an extent that he was rendered wholly and continuously unable to engage in any occupation or perform any work for any kind of compensation of financial value during a period of ninety consecutive days.’ The question of the construction of this language is presented.

As in the case of any other contract (Oakes v. Manufacturers' Fire & Marine Ins. Co., 131 Mass. 164, 165) if there is no ambiguity in the words of an insurance policy they must be given their natural and ordinary meaning (Farber v. Mutual Life Ins. Co. of New York, 250 Mass. 250, 253, 145 N. E. 535, 36 A. L. R. 806). If for any reason there is ambiguity in the language employed consideration must be given to the document as a whole (Perry v. Provident Life Ins. & Investment Co., 103 Mass. 242), and to its principal apparent purpose (Cutting v. Atlas Mutual Ins. Co., 199 Mass. 380, 382, 85 N. E. 174). Where the language permits two rational interpretations that more favorable to the interests of the insured is to be...