Tracey v. Standard Acc. Ins. Co.

• Decision Date: 04 April 1920
• Citation: 109 A. 490
• Parties: TRACEY v. STANDARD ACC. INS. CO.
• Court: Maine Supreme Court

109 A. 490

TRACEY

v. STANDARD ACC. INS. CO.

Supreme Judicial Court of Maine.

April 4, 1920.

Exceptions from Supreme Judicial Court, Penobscot County, at Law.

Action by James Dwight Tracey against the Standard Accident Insurance Company, resulting in plaintiff's favor, and defendant brings exceptions. Exceptions overruled.

Argued before CORNISH, C. J., and SPEAR, HANSON, DUNN, WILSON, and DEASY, JJ.

P. L. Aiken, of Bangor, for plaintiff.

A. S. Littlefleld, of Rockland, for defendant.

SPEAR, J. This is an action upon an insurance policy combining the phases both of accident and health indemnity. On the accident side the plaintiff was classified as "select" and described in his duties and occupation as "office manager, office duties only," in a business designated as "lumber."

On the 30th or 31st day of August, 1917, the plaintiff while riding a motorcycle ran through a swarm of. flies or insects, one of which struck his right eye with such force as to give him immediate and continued annoyance and distress, but not sufficient at first to prevent him from the pursuit of his occupation as bookkeeper. It was not long, however, before it so impaired his capacity to work at his usual occupation that he had to give it up, and pursue a business that did not tax his eye. The eye grew gradually worse until at last it became so blind that he could only distinguish light from darkness, without any ability whatever to distinguish one object from another. In other words, the eye became what we call blind and had continued so to the time of the trial, without hope of improvement or recovery. Upon this state of facts the case resolves itself into the following propositions:

(1) Was the injury to the eye accidental within the meaning of the policy?

(2) Was the notice of the accident invalid on account of delay in giving it?

(3) Was notice when given sufficient in substance and form, if given in time?

(4) Was the plaintiff engaged in an overhazardous employment?

(5) Did he lose the entire sight of his eye?

1. It is hardly necessary to consume any time to establish the affirmative of the first proposition. That the injury was accidental is amply proven.

2. The second proposition will be discussed upon the assumption that the notice, when given, was regarded by the plaintiff and agent as valid and sufficient.

3. The defendant contends that the first notice being, in fact, erroneous, precludes the validity of the future notice by reason of delay.

In the present case the plaintiff within 10 days informed Mr. Dyer, the agent of the company, of the accident with which he had met. On September 10th, not exceeding 12 days after the accident, he filled out and delivered to the agent a blank furnished by the company. This blank was the form to be filled out in case of sickness, instead of in case of accident. And the plaintiff so filled it out stating in answer to the question, "What disease disables you?" "Inflammation of the right eye." This answer we conceive might follow from a condition of the eye produced by an accident as well as by disease. Hence no evidence is deducible from the answer, which convincingly shows that the plaintiff ought to have distinguished the sickness blank from the accident blank, especially as he had no previous knowledge of either form.

This being the case, we think the plaintiff may have been fully justified in using the wrong blank. The uncontradicted evidence proves that the plaintiff, before he received the blank, and "within a day or two after the accident," had fully informed Mr. Dyer, the agent, what had happened; to put it in his own language, "I told him of my accident —told him what it was."

He then, as he testified, proceeded further, and gave the agent every detail of the accident and injury. Upon this full description the agent said:

"That is all right; if you have a claim, bring it in. That is what we are here for."

"In the next three or four days we had gone over the thing several times." He says: "You better get your claim in on time." The plaintiff said: "I will go right to your office and make it out now." In regard to making out the notice, the agent said: "Do as well as you can. We don't know the result it is up to the company to come back and find out what was the matter."

Thereupon, the agent, of his own volition, without any request from the plaintiff, "reached in his drawer and gave me that blank." There was evidently no purpose or disposition on the part of the agent to mislead or defraud. He simply made a mistake, but his mistake was the mistake of the company, as will later appear.

Assuming still that both parties regarded the notice as proper in form, the plaintiff then had the same right to rely upon it as if it was proper in form, until the contrary appeared.

Matters stood in statu quo until the 8th of February following, when the plaintiff, as he states it, "made a formal report and the application on February 8th, and explained fully the whole details to the company, and right away after that, as I remember it, they sent me the blanks."

This communication, called a "report," is prefaced by the following statement:

"You have already been advised that claim was to be made under policy A D C—R 2075, delay being due to the fact that the ultimate result of the accident was uncertain. The time has now come, when the condition seems reasonably definite and final."

Then follows a detailed statement of the accident, the cause, the injury, the progression, impairment of the sight of the eye, the treatment, and the final result.

This report, and, it may be here said, all other papers given to the agent, were at once forwarded by him to the company.

After making this report, the plaintiff received blanks for proof of claim, as near as may be ascertained from the record, about March 6th. About this time, probably upon receipt of the blanks, the plaintiff discovered "that the health blank was not what he wanted." We place no stress in the decision of this case upon the legal construction that the sending of the blank proofs was a waiver, on the part of the defendant, of any question of liability.

On March 25th, the plaintiff sent to the agent a proof of claim or notice upon the accident blank furnished by the company.

From the rehearsal of the facts we are of the opinion that the voluntary production of the health blank on September 10th by the agent was the act of the company. The agent knew all the facts, in detail, of the injury, and, in law, is charged with knowledge that the blank was the wrong one. The company is charged with the knowledge of the agent. Thorne v. Casualty Co., 106 Me. 274, 76 Atl. 1106, and cases there cited. The plaintiff had a right to rely on the agent to furnish him with the proper blank. R. S. c. 53, § 119, applies.

As was said in Le Blanc v. Standard Insurance Co., 114 Me. 6, 05 Alt. 284:

"There is no limitation in the statute, and we perceive none in the reason of the thing.

"The statute recognizes what common experience teaches. Men commonly do all their insurance business with agents. * * * They have no direct dealings with the companies. * * * They go to the agent when losses have occurred, and pursue the steps pointed out by them in proving the losses."

This is precisely what the plaintiff did. He was led into error and consequent delay by the act of the agent, in furnishing the wrong blank. The error, however, in filing the sickness blank may be regarded, not inappropriately, as a mutual mistake. The agent mistook the proper form of blank, else his act was a fraud. The plaintiff confided in the honor and knowledge of the agent, who knew all the facts, to furnish him the proper blank. Hence the plaintiff's mistake. But a mutual mistake always excuses. It therefore follows that the only effect of the first notice purporting to be a proof of disease instead of injury, although believed to be right, was to operate in causing a reasonable excuse for mutual delay upon the part of both the plaintiff and defendant. It would be clearly wrong for the defendant to have the advantage of this delay to the detriment of the plaintiff, under the admitted facts of the case. The company knew that it was a case of accident, not of disease; of injury, not of sickness; that it required an accident, not a health form of notice; voluntarily furnished the form; intended the plaintiff to act upon it; received the notice; retained it; made no objection; requested no further information; had full opportunity to examine the form of blank before furnishing it; was in duty bound to see that it was correct, and not misleading; in fine, knew all the facts, regardless of any form of notice. Whatever the intention, in voluntarily passing out the wrong form, it lead the plaintiff to do to his injury what he would not have done but for the negligent act of the defendant by its agent. The plaintiff by this act was induced to do what defeated the entire indemnity of his policy, if the plaintiff's contention prevails, and inured in equal measure to the benefit of the company. We have already noted that the plaintiff was not at fault; that he had a right to rely on the conduct of the agent. We are accordingly of the opinion that the doctrine of estoppel aptly applies. The very essence of estoppel is to prevent a party from taking advantage of misleading another party to his injury, when injury will result if estoppel is not declared. 10 R. C. L. Estoppel, § 25. The law will not stand by in silence and see one party mislead another to his injury, whether by ignorance, negligence, or design. 10 R. O. L. Estoppel, § 24, upon this point says:

"Yet ordinarily he will be estopped though he has acted or spoken in forget fulness or ignorance of the facts, particularly when he had the means at hand of knowing all the facts, or when he was in such a position that he ought to have known them."

This case therefore comes directly within the rule of negligence...