Spears v. Commercial Ins. Co. of Newark, New Jersey

• Decision Date: 12 May 1993
• Citation: 866 S.W.2d 544
• Court: Tennessee Court of Appeals
• Parties: Kearney D. SPEARS, Plaintiff/Appellant, v. COMMERCIAL INSURANCE COMPANY OF NEWARK, NEW JERSEY and Provident Life & Accident Insurance Company, Defendants/Appellees.

Page 544

866 S.W.2d 544

Kearney D. SPEARS, Plaintiff/Appellant, v. COMMERCIAL INSURANCE COMPANY OF NEWARK, NEW JERSEY and Provident Life & Accident Insurance Company Defendants/Appellees.

Court of Appeals of Tennessee Western Section, at Jackson.

May 12, 1993.

Application for Permission to Appeal

Denied by Supreme Court

Oct. 4, 1993.

James D. Causey, Memphis, for plaintiff/appellant.

B.J. Wade and Lori J. Keen, Glassman, Jeter, Edwards & Wade, P.C., Memphis, for defendant Commercial Life.

Prince C. Chambliss, Jr., Memphis, for defendant Provident Life.

TOMLIN, Presiding Judge, Western Section.

Kearney D. Spears ("plaintiff") brought this action in the Circuit Court of Shelby County against Commercial Insurance Company of Newark, New Jersey ("Commercial") and Provident Life & Accident Insurance Company ("Provident") to recover disability benefits allegedly due under a policy issued by each defendant. Both Commercial and Provident filed motions for summary judgment contending that coverage was not provided by its policy for plaintiff's claims. The trial court granted both summary judgment motions. On appeal, the dispositive issue is whether the trial court erred in granting summary judgment for both defendants. For the reasons hereafter stated, we affirm the action of the trial court as to Commercial. As to Provident, we reverse the order granting summary judgment and remand for a trial on the merits.

The same set of facts serves as a basis for plaintiff's claims against each defendant. However, the provisions of each policy are different and therefore produce different results. Accordingly, we shall lay out the basic pertinent facts and then examine the action of the trial court as to each defendant's policy.

Plaintiff experienced back problems as early as 1943, when, while unloading a ship during World War II as a serviceman, he felt sudden pain in his back. He was not disabled as a result of this incident, nor did he receive any medical treatment. The pain that he sustained went away shortly after its onset. Following the war, plaintiff attended college and dental school and began the practice of dentistry in 1956. He experienced no problems with his back until 1978. On an occasion in that year, plaintiff was raking grass clippings in his yard when he bent over and reached down for a bag on the ground. He felt a sudden pain in his back and was unable to straighten up. He stated that from that incident until the time of this litigation, he experienced back pain continuously.

In August, 1982, while working at his desk in his dental office, plaintiff re-injured his back. On this occasion he accidentally knocked a piece of paper off his desk and, as he put it, "inadvertently without thinking grabbed for it." In May, 1983, plaintiff again injured his back while engaged in his practice. He was sitting on a stool, when he turned around to pick up a patient's record hanging on the wall. At that time he felt a pain in his back. In September of that year, plaintiff sold his dental practice because he was unable to practice due to severe back pain.

In the case under consideration, each policy contains separate benefit provisions depending upon whether plaintiff's disability is due to accident or sickness. Each policy provides that if the total disability of the plaintiff is due to sickness, benefits will be paid monthly until he attains the age of 65. However, under the accident provisions of each policy, if plaintiff is found to be totally disabled, benefits will be paid for the remainder of his life.

Both Commercial and Provident paid disability benefits to plaintiff under the sickness provisions of their respective policies until the time of plaintiff's 65th birthday. At this time, both Commercial and Provident ceased paying benefits to plaintiff, contending he was not entitled to benefits for the balance of his life because his disability did not qualify for payments under the accident provisions of their respective policies.

Plaintiff brought this suit to recover monthly benefits for the remainder of his life from both Commercial and Provident, alleging that his disability resulted from an accidental injury. Plaintiff's original complaint alleged that he sustained an injury only on or about May 9 1983. Commercial filed its answer, followed by a motion for summary judgment. The trial court granted Commercial's motion, finding that plaintiff's alleged injury of May 9, 1983 was not "caused by accident" within the terms of Commercial's policy. However, the court granted plaintiff additional time to amend his complaint so as to set forth additional facts in an effort to state a claim for an injury "caused by an accident" within the meaning of Commercial's policy.

Plaintiff filed an amended complaint in which he alleged that on or about August 15, 1982, while doing paperwork at his desk, he inadvertently knocked off a piece of paper from his desk, and "reflexively and without premeditation" grabbed for it as it was falling to the floor. This, he asserts, caused or contributed to the total disability which now prevents him from practicing dentistry.

Commercial filed a second motion for summary judgment on the grounds that there were no genuine issues of material fact and that it was entitled to a judgment as a matter of law. Provident filed its first motion for summary judgment about the same time. The trial court granted Commercial's motion, holding that plaintiff was not "wholly and continuously disabled" by the 1982 incident as required by Commercial's policy. It likewise granted Provident's motion for summary judgment on the ground that the alleged injuries of 1982 and 1983 were not "accidental" within the meaning of Provident's policy. The trial court also found that the term "accidental bodily injury" as used in Provident's policy should be interpreted as "injury caused by accident."

In ruling on motions for summary judgment, both the trial court and this court must consider the matter in the same manner as a motion for a directed verdict made at the close of plaintiff's proof: i.e., we must view all affidavits and depositions in the light most favorable to the opponent of the motion, and draw all legitimate conclusions of fact therefrom in their favor. If, after so doing, a disputed issue of material fact is made out, the motion must be denied. Stone v. Hinds, 541 S.W.2d 598 (Tenn.App.1976).

I. THE COMMERCIAL POLICY

At all times during the evolution of this claim Commercial's policy contained the following provisions pertinent to the case under consideration:

Accident Indemnity for Total Disability, as provided by Part II-A of the policy, shall be amended to read--"When injury, commencing while the policy is in force as to the Insured, wholly and continuously disables and prevents the Insured from performing the duties of his profession or occupation, the Company will pay the Monthly Indemnity ... for the period the Insured shall be so disabled.... [T]he Company will continue the payment of Indemnity so long as the Insured shall live and be wholly and continuously disabled by reason of such injury from performing the duties of any gainful occupation for which he is reasonably fitted.

The policy also contains the following definitions:

"Injury" whenever used in the policy means bodily injury caused by an accident occurring while the policy is in force as to the Insured. "Sickness" whenever used in the policy means sickness or disease which causes total disability commencing while the policy is in force as to the Insured.

(Emphasis added).

Many years ago our Supreme Court recognized the distinction between "accidental means" and "accidental results" as those terms are used in insurance policies. In Stone v. Fidelity & Casualty Co. of New York, 133 Tenn. 672, 182 S.W. 252 (1916), the court stated:

The general rule is that an injury is not produced by accidental means, within the meaning of this policy, where the injury is the natural result of an act or acts in which the insured intentionally engages. A person may do certain acts the result of which produces unforeseen consequences resulting in what is termed an accident; yet it does not come within the terms of this contract. The policy does not insure against an injury that may be caused by a voluntary, natural, ordinary movement, executed exactly as was intended.

Therefore, to determine the matter, we look, not to the result merely, but to the means producing the result. It is not sufficient that the injury be unusual and unexpected, but the cause itself must have been unexpected and accidental.

Id.

In Stone, plaintiff ruptured the retina of his left eye when he raised a newspaper above his head while lying in bed. The court held that he had not sustained an injury by accidental means as the movement producing the injury was executed exactly as he intended. The court said "while the result was not foreseen, the causes producing that result were not accidental." Id. at 253.

In Seeley v. Pilot Fire & Casualty Co., 222 Tenn. 33, 432 S.W.2d 58 (1968), this same distinction was again made. The insurance policy under consideration in Seeley provided coverage for "bodily injury, caused by accident (a) while occupying the owner automobile...." Id. at 60. The insured strained his back when he stepped from the ground into the truck without stepping on the running board, thereby twisting his back.

The court pointed out that there were no Tennessee cases construing the term "injury caused by accident," but recognized the similarity between the terms "accidental means" and "injury caused by accident." The court held that the terms were interchangeable and ruled that plaintiff's injuries were not caused by accident as his actions in stepping directly to the floorboard of the truck were intentional and voluntary. It stated:

We find nowhere in plaintiff's allegations any hint or inference that anything untoward, unforeseen, unexpected or...