Wheeler v. Mutual Benefit Health & Accident Ass'n

• Decision Date: 01 December 1941
• Docket Number: No. 20035.,20035.
• Court: Missouri Court of Appeals
• Parties: WHEELER v. MUTUAL BENEFIT HEALTH & ACCIDENT ASS'N.

157 S.W.2d 554

WHEELER v. MUTUAL BENEFIT HEALTH & ACCIDENT ASS'N.

No. 20035.

Kansas City Court of Appeals. Missouri.

December 1, 1941.

Rehearing Denied January 5, 1942.

Appeal from Circuit Court, Howard County; A. R. Hammett, Judge.

"Not to be published in State Reports."

Action by Orva C. Wheeler, administratrix of the estate of Richard A. Wheeler, deceased, against the Mutual Benefit Health & Accident Association to recover benefits allegedly accrued on account of total disability occasioned by disease under the terms of a health and accident policy issued by defendant to plaintiff's deceased husband. From a judgment for plaintiff, defendant appeals.

Affirmed.

Price, Major & Alexander, of Columbia, for appellant.

Jerome M. Joffee and Henry Bear, both of Kansas City, and Luman Spry, of Fayette, for respondent.

BOYER, Commissioner.

In this case defendant filed a demurrer to the petition on the ground that it failed to state facts sufficient to constitute a cause of action. The demurrer was overruled, defendant declined to plead further, and on motion of plaintiff to assess damages the court heard evidence and rendered judgment for plaintiff and against defendant in the total sum of $2,072.30, and costs.

The only question on appeal is the propriety of the ruling on the demurrer to the petition. Plaintiff sued as administratrix to recover benefits alleged to have accrued on account of total disability occasioned by disease, and under the terms of a policy issued by defendant to Richard A. Wheeler, her deceased husband. After preliminary statements showing the qualification of plaintiff and the corporate character of defendant and that defendant was engaged in writing health and accident insurance in the State of Missouri and elsewhere, the petition states that defendant issued and delivered to Richard A. Wheeler its written contract for a policy of insurance on March 14, 1935. The terms and conditions of the policy are shown in full by a photostatic copy.

It is further alleged that in consideration of the payments of specified premiums, defendant insured the said Wheeler against loss of time beginning while said policy was in force and resulting from disease contracted during any term of the policy; that specified amounts were to be paid for confining illness and disability resulting from disease, and another specified amount per month for a limited time for non-confining illness and disability resulting from disease. It is further stated that while the policy was in full force and effect, and on May 1, 1937, Richard A. Wheeler became insane and was adjudged to be incompetent and insane on the 6th day of August, 1937, on which last date he was admitted to and confined in State Hospital No. 1 at Fulton, Missouri, where he remained until the date of his death, February 10, 1940. It is further alleged that the insanity of the said Wheeler originated more than thirty days after the effective date of the policy and confined him continuously within doors. All other allegations necessary to recovery are made, provided the policy affords coverage for total disability and loss of time occasioned by the disease of insanity.

It is the position of appellant that the policy does not afford such coverage on account of a restrictive clause hereafter shown. A description of the general appearance and form of the policy and specific parts and provisions referred to by appellant and respondent will be set forth. At the top of the first page of the policy, in prominent type, is the recital that "this policy provides benefits for loss of life, limb, sight or time, by accidental means, or loss of time by sickness as herein provided." The first paragraph of the policy recites that: "Mutual Benefit Health and Accident Association Omaha does hereby insure Richard A. Wheeler (Herein called the Insured) of City of Glasgow, State of Missouri, against loss of life, limb, sight or time, resulting directly and independently of all other causes, from bodily injuries sustained during any term of this Policy, through purely Accidental Means (Suicide, sane or insane, is not covered), and against loss of time beginning while this Policy is in force and resulting from disease contracted during any term of this Policy, respectively, subject, however, to all the provisions and limitations hereinafter contained."

On one side of the words "Does Hereby Insure" appears in prominent words and figures "Monthly Benefits $60.00, Maximum Monthly Benefits $120.00." And on the other side, "Death Benefit $1,500, Maximum Death Benefit $3,000." Following the first paragraph above quoted are various sub-divisions of the policy designated alphabetically as Parts A to O, inclusive. Parts A to J, inclusive, provide mainly for accident indemnities, and parts K to O, inclusive, provide specially for illness indemnities. Part K in its entirety reads as follows:

"Part K. Confining Illness Benefits for Life

"The Association will pay, for one day or more at the rate of Thirty ($30.00) Dollars per month for the first fifteen days and at the rate of Sixty ($60.00) Dollars per month thereafter for disability resulting from disease, the cause of which originates more than thirty days after the effective date of this policy, and which confines the Insured continuously within doors and requires regular visits therein by legally qualified physician; provided said disease necessitates total disability and total loss of time."

Following the fifteen alphabetical parts are seventeen paragraphs numbered numerically. None of them pertain to any question that arises on this appeal. Following the seventeen paragraphs are "Additional Provisions" lettered (a) to (f) inclusive. The first additional provision, lettered (a), is in these words: "(a) This policy does not cover death, disability, or other loss sustained in any part of the world except the United States and Canada, or while engaged in military or naval service in time of war, or any act of war, or while the Insured is not continuously under the professional care and regular attendance, at least once a week, beginning with the first treatment, of a licensed physician or surgeon, other than himself; or received because of or while participating in aeronautics, except as provided in Part H; or while suffering from insanity or mental infirmity; or while the Insured is suffering from syphilis or venereal disease. Disability resulting from tuberculosis or heart trouble shall be covered only if the disease originates after the policy has been in continuous force for the six (6) preceding months."

Counsel for appellant state that "the question presented by this appeal is whether or not the provision of the insurance policy sued on excepting liability for loss for disability resulting from insanity or mental infirmity is a valid and binding provision and, if so, is such provision applicable to the case at bar." It is insisted that this particular provision is valid and binding and applicable to the case at bar, and prevents recovery because the petition alleges that the disability complained of resulted from insanity and thereby fails to state a cause of action. The additional provision relied upon by appellant as barring recovery for disability while suffering from insanity is characterized in argument as a permissible exception of a specified kind of disease and should be given force and effect under the first paragraph of the policy which affords insurance for loss of time, but "subject, however, to all the provisions and...