Robinson v. Bhd. Op Raid Rd. Trainmen

• Citation: 92 S.E. 730
• Decision Date: 15 May 1917
• Docket Number: (No. 3223.)
• Court: West Virginia Supreme Court
• Parties: ROBINSON. v. BROTHERHOOD OP RAID ROAD TRAINMEN.

(80 W.Va. 567)

92 S.E. 730

ROBINSON.

v.BROTHERHOOD OP RAID ROAD TRAINMEN.

(No. 3223.)

Supreme Court of Appeals of West Virginia.

May 15, 1917.

(Syllabus by the Court.)

Error to Circuit Court, Mineral County.

Assumpsit by Salem L Robinson against the Brotherhood of Railroad Trainmen. Judgment for plaintiff on defendant's demurrer to evidence, and defendant brings error. Demurrer sustained, and judgment entered for defendant.

Wm. MacDonald, of Keyser, for plaintiff in error.

Chas. Ritchie, of Charleston, for defendant in error.

LYNCH, P. Upon a demurrer to the evidence introduced by him on a trial in assumpsit, plaintiff, a railroad brakeman, recovered a judgment for the sum of $1,500 against the Brotherhood of Railroad Trainmen, which it seeks to reverse upon this writ of error. Plaintiff bases his alleged right of recovery upon a beneficiary certificate issued to him by the grand lodge of the brotherhood April 24, 1912, and upon sections 68 and 70 of the constitution of that order. The injury averred consisted of the loss of three fingers from the right hand. In addition to the general issue entered, defendant asked but was denied leave to file a special plea setting up the decision of its beneficiary board under section 70, disallowing plaintiffs claim, as conclusive upon his right to a recovery in this action. The nature and existence of such liability, if any, is the sole question requiring consideration on this review. The certificate sued on provides that plain-tiff, a member of H. G. Buxton Lodge, No. 758, "is entitled to all the rights, privileges and benefits of membership and to participate in the beneficiary department, class C, of said brotherhood to the amount set forth in the constitution thereof, which amount in the event of his total and permanent disability, as defined in section 68 of the constitution, shall be paid to him, " or at his death to his wife if living, or if not to his personal representative. The certificate contains the express condition that the member receiving it."shall comply with the constitution, general rules and regulations now in force or that may hereafter be adopted by the within named brotherhood, which, as printed and published by the grand lodge of the said brotherhood, with the application for this certificate as signed by him and his medical examination, copies of which application and medical examination are attached hereto, all are made a part hereof, and together with this certificate constitute the contract between him and said brotherhood."

By the constitution of the grand lodge, in addition to various other funds, there is created a beneficiary fund, "to be disbursed exclusively in paying death, total and permanent disability and benevolent claims, as defined in sections 68, 69 and 70." In the maintenance of this fund all beneficiary members are required to participate by payment of monthly assessments levied upon them. For this purpose plaintiff was required to pay, and regularly did pay, an assessment of $2.50 per month. By virtue of section 60, "each certificate shall show in what class it is issued, and provide for the payment, in accordance with this constitution, of the full amount of such claims upon the death of the member insured therein, or upon his becoming totally and permanently disabled within the meaning of section 68." Sections 64 and 67 provide that the required proofs of death or disability shall be forwarded to the general secretary and treasurer within six months after the accident. Upon receipt of proof of death, "if the same shall be regular and satisfactory to said general secretary and treasurer, and the claim be by him deemed valid, the same shall be adjusted in its regular order" and the beneficiary "shall be entitled to receive from the beneficiary fund the full amount of the class in which the certificate was issued." But "if the general secretary and treasurer shall for any reason disapprove or reject such claim it shall he referred to the beneficiary board, who may approve or disapprove the claim; if approved it shall be assessed for and paid in its regular order. If disapproved by the beneficiary board, the claimant may appeal to the board of insurance, who may allow or disallow the claim, and its action shall be final."

Section 68 is entitled "total and permanent disability claims." It provides that "any beneficiary member in good standing who shall suffer the amputation or severance of an entire hand at or above the wrist joint, or who shall suffer the amputation or severance of an entire foot at or above the ankle joint, or who shall suffer the complete and permanent loss of sight of both eyes, shall be considered totally and permanently disabled, and shall thereby be entitled to receive, upon furnishing sufficient and satisfactory proofs of such total and permanent disability, the full amount of his beneficiary certificate, but not otherwise." Formal written proofs of such disability, signed by the insured member, his attending physician and certain officers of the subordinate lodge, containing "a statement setting forth the nature and extent of the injury and all proofs, including the beneficiary certificate of the member and his receipt for all dues and assessments for the month in which he was injured, shall be forwarded to the general secretary and treasurer, and if the same are found to be regular and satisfactory by him the claim shall be assessed for and paid in its regular order. But if the general secretary and treasurer shall for any reason disallow or reject said claim, it shall be referred to the beneficiary board, who may allow or disallow the claim. If allowed it shall be assessed for and paid in its regular order. If disallowed by the beneficiary board the claimant may appeal to the hoard of insurance, which may allow or disallow the claim, and its action shall be final."

Section 70, upon which the declaration supporting the judgment is based, is entitled "Benevolent Claims." It is quoted in its entirety:

"All claims for disability not coming within the provisions of section 68 shall be held to be addressed to the systematic benevolence of the brotherhood, and shall in no case be made the basis of any legal liability on the part of the brotherhood. Every such claim shall be referred to the beneficiary board, composed of the president, assistant president and general secretary and treasurer, who shall prescribe the character and decide as to the sufficiency of the proofs to be furnished by the claimant, and, if approved by said board, the claimant shall bo paid an amount equal to the full amount of the certificate held by him, and such payment shall be considered a surrender and cancellation of such certificate, provided that the approval of said board shall be required as a condition precedent to the right of any such claimant to benefits hereunder; and it is agreed that this section may be pleaded in bar of any suit or action at law, or in equity, which may be commenced in any court to enforce the payment of any such claims. No appeal shall be allowed from the action of said board in any case; but the general secretary and treasurer shall report all disapproved claims made under this section to the board of insurance at its next annual meeting, for such disposition as such board of insurance shall deem just and proper."

A brother desiring to present a claim under this section is required by section 71 to "petition his lodge in writing upon the form provided by the general secretary and treasurer; said form must be properly executed by the claimant, and a regular practicingphysician or surgeon, showing the condition of the brother and the basis of his claim. If approved by the lodge, the secretary shall forthwith forward them with notice of such approval to the general secretary and treasurer, who will at once forward to the lodge necessary blanks and instructions for presenting a claim." By another section it is made the "duty of the board of insurance to meet annually on the second Monday in January, at grand lodge headquarters, to consider and determine all death, and all total and permanent disability claims under section 68 which have been appealed to the said board, and all claims addressed to the systematic benevolence of the brotherhood which have been disapproved by the beneficiary board." The decision of the board of insurance "upon each claim appealed or referred to it shall be in writing, and shall be the final adjudication of any and all rights of such claimants or parties claiming any interest in or to the beneficiary certificate or the proceeds thereof. The board shall have the power to approve or disapprove, or refer back to the beneficiary board for further consideration, any claim appealed to it. It shall also have the power to make allowances in disapproved or rejected claims, if such action is deemed by them advisable, provided that no such allowance shall exceed the amount of the beneficiary certificate of the member." Under section 75, "no suit or action at law or in equity shall ever be commenced upon any beneficiary certificate by any claimant until after he by appeal has exhausted all remedies provided for in this constitution."

The declaration alleges, and the proof sufficiently shows, that at the time of his injury in March, 1911, plaintiff was in good standing in the brotherhood. He has also complied with all the conditions of his contract of insurance, and all the laws and regulations of the order. He has exhausted all the remedies provided in its constitution. Upon presentation to it of proofs of injury, in the manner and form prescribed by sections 70 and 71, the beneficiary board disallowed his claim for benefits; and this decision, on a reference had thereto, was sustained by the board of insurance, and payment of the claim refused "as not proven."

As disclosed by the foregoing and other provisions of its organic law, defendant is an unincorporated fraternal and mutual...