Schoeman v. Loyal Protective Life Ins. Co. of Mass.
| Decision Date | 04 May 1948 |
| Docket Number | 47176. |
| Citation | 32 N.W.2d 212,239 Iowa 664 |
| Parties | SCHOEMAN v. LOYAL PROTECTIVE LIFE INS. CO. OF MASSACHUSETTS. |
| Court | Iowa Supreme Court |
Kepford Heath & Kepford, of Waterloo, for appellant.
Reed & Beers, of Waterloo, for appellee.
In 1943 defendant issued plaintiff its insurance policy providing for payment at $110 per month, for such time, not exceeding twelve months, as he should be totally disabled by sickness. Alleging a heart attack suffered about July 6, 1944, had caused such disability for more than twelve months, plaintiff brought suit upon the policy. Trial to a jury resulted in judgment for plaintiff for $1320.44, with interest, and this appeal. All the errors assigned are based upon the overruling of defendant's motion for directed verdict. No error is assigned to the instructions. Nor are they set out in the record.
I. Defendant contends there was no substantial evidence plaintiff's sickness resulted in his continuous disability.
Plaintiff was thirty-nine years of age. Aside from some heavy labor in a machine shop, farming had been his only occupation. He had helped in the operation of the farm upon which he had been raised and had attended college for one year. About 1927 he took a course in a business college but never did any work along that line except keeping records on the farm. He testified he was not trained nor qualified to do any work other than farming. For nine years he had grown produce and raised live stock and poultry on a small farm. Thereafter he operated a 280 acre dairy and stock farm near Cedar Falls for some years. He employed one farm laborer. He kept 179 acres in crop, about 300 hogs, 125 cattle of which 30 or 35 were milch cows, some sheep and poultry. This required regular manual labor by the two men. On account of the war he was unable to hire a farm hand in June, 1944. He became sick. 'I think I just overdone and by the end of June * * * I couldn't hardly walk.' From July 6, 1944, he was confined to his bed about two weeks and in the house about six weeks. He had a 'mitral lesion in his heart, and a damaged myocardium, a damaged muscle of the heart.' By September he was able to walk about the yard with the aid of two canes. Throughout the ensuing year his condition gradually improved but he was unable to work. His wife managed and operated the farm and supervised the farm laborers with some suggestions and assistance from him. A doctor reported he would never again be able to do farm work.
Defendant concedes plaintiff was unable to do any appreciable amount of physical labor in connection with his farm work but contends there was no evidence that plaintiff was unable to enter into some other business. However, there was substantial evidence tending to show that, aside from other types of work involving heavy physical labor, farming was the only occupation for which plaintiff was fitted.
We conclude the evidence of plaintiff's total disability for the twelve months period following July 6, 1944, was sufficient to require submission to the jury of that question.
He Hoover v Mutual Trust Life Ins. Co., 225 Iowa 1034, 1040, 282 N.W 781, 784, the insured was unable to perform labor on his farm but was still able to direct the farming operations of his hired men. The practical effect of the disability in that case was substantially the same as in the case at bar. The decision points out that a jury could well find a person in such physical condition could not secure a position as a farm operator for others, and holds whether he was totally disabled was a jury question. It states:
'* * * The liberal rule is that the 'total disability' contemplated by a life insurance policy of this character does not mean as its literal construction would require--a state of absolute helplessness; on the contrary, the disability contemplated means, under the liberal rule, inability to do all the substantial and material acts necessary to the prosecution of the business or occupation of the assured or some other business or occupation which he might enter in a customary and usual manner.'
The decision cites, among others, Prusiner v. Massachusetts Bonding & Ins. Co., 221 Iowa 572, 265 N.W. 919; Wood v. Federal Life Ins. Co., 224 Iowa 179, 277 N.W. 241; Kurth v. Continental Life Ins. Co., 211 Iowa 736, 234 N.W. 201. In turn the rule of the Hoover case was approved in Eller v. Preferred Accident Ins. Co., 226 Iowa 474, 477, 284 N.W. 406 and Smith v. Penn. Mut. Life Ins. Co., 233 Iowa 340, 7 N.W.2d 41. The definition of total disability recited in the policy is substantially the same as that enunciated in the Hoover case. We reaffirm the rule of that decision.
II. Defendant asserts the evidence conclusively establishes plaintiff's failure to furnish proofs of loss and that the court should have sustained that ground of the motion for directed verdict. Defendant concedes it received written notice of plaintiff's disability within the 60 days provided by the policy. Hence failure to give notice is not here in question.
August 31, 1944, defendant received proofs of disability executed by plaintiff on one of defendant's printed forms, with a report by his attending physician, who stated he was a chiropractor. Defendant did not make the payment called for by the proofs.
In December, 1944, defendant was again furnished formal proofs of loss showing continued total disability. Therein plaintiff applied for payment on account.
December 29 defendant sent plaintiff its check for $123.33, in full payment of his claim, stating the policy did not cover partial loss of time, that the proofs of loss showed plaintiff was totally disabled from July 6, to the middle of August and that the disability rate was $100 per month (instead of the $110 provided by the policy). Plaintiff refused the check. January 3, 1945, defendant's agent wrote defendant plaintiff was still totally disabled and 'there has been a big mistake someplace.'
January 10 defendant replied it could not 'throw the matter open completely' and instructed the agent to offer payment for two additional months in full settlement. January 24 defendant wrote the agent that plaintiff would not be totally disabled if he was able to do some supervising, that the $123.33 check covered everything owed plaintiff, that he should contact and notify plaintiff the offer to pay for two additional months would be withdrawn in three weeks.
February 20 defendant was furnished a report by Dr. Gerard, M. D., dated January 26, which recited plaintiff had a rheumatic heart with a systolic murmur and that the electrocardiagraph showed some myocardial damage. The agent wrote defendant that if it would send plaintiff the check for three months disability, 'last fall,' he would try to get plaintiff to take that in settlement up to January 26 but suggested the case be reopened as of January 26. March 1 defendant wrote the agent stating 'a new claim is to be entered as of January 26.' The letter stated 'we haven't contended at all that he was able to do any appreciable amount of physical labor in connection with his farm work,' however, plaintiff wouldn't be totally disabled while doing lighter work, and defendant would not 'throw the matter open' on the theory plaintiff was totally disabled. The agent was instructed to tell plaintiff to write defendant 'fully about what he is doing to get a job.'
March 4 plaintiff wrote defendant expressing disappointment that he had not received his monthly disability checks and stating 'I have been unable to work since July 6, 1944, and the doctor tells me I may never be able to work again,' that plaintiff would welcome any examination or investigation defendant would like to make and hoped he could start receiving checks soon.
May 17 defendant wrote plaintiff enclosing preliminary claim forms for the period of disability beginning January 26, 1945. May 23 plaintiff wrote defendant he saw no sense in starting another claim in January but would do so if paid up till then. He asked defendant, 'Frankly why have you questioned my disability claim?' Apparently this question was not answered.
June 4 plaintiff again furnished defendant formal proofs of loss. July 12, 1945, the agent reported plaintiff had complained his letters were unanswered and was becoming impatient to get the matter settled. Late in July defendant advised plaintiff it would have a claim adjuster call upon him. A month later the agent reported plaintiff complained of defendant's failure to do this, that plaintiff was 'very put out,' insisted he was entitled to a full years disability benefits and threatened to consult an attorney. September 7, 1945, defendant wrote plaintiff, stating no information had been submitted indicating he had been totally disabled for more than a short time and offering to pay plaintiff $30 in addition to $123.33, in final payment of his claim.
The policy provides for such proofs of sickness as defendant may reasonably require, including proofs after the termination of the disability period. The function of proofs of loss is to advise the insurer of the essential facts upon which its liability depends. Generally speaking, provisions for the furnishing of such proofs will be liberally construed in favor of the insured. 29 Am.Jur. 840, Insurance, § 1120. The insurer may not arbitrarily demand any particular form of proofs and is not the sole judge of their sufficiency. Robertson v. Mutual Life Ins. Co., 232 Iowa 743, 748, 6 N.W.2d 153; Garden v. New England Mut. Life Ins. Co., 218 Iowa 1094, 1098, 254 N.W. 287; Forman v. New York Life Ins. Co., 267 Mich. 426, 255 N.W. 222; Annotation in 109 A.L.R. 825.
In the case at bar proofs of loss made upon defendant's forms were furnished defendant in August and December, 1944, and in June,...
To continue reading
Request your trial