Williams v. Benefit Trust Life Ins. Co.
| Decision Date | 11 December 1965 |
| Docket Number | No. 44088,44088 |
| Citation | 195 Kan. 579,408 P.2d 631 |
| Parties | Clarence H. WILLIAMS, Appellant, v. BENEFIT TRUST LIFE INSURANCE COMPANY, Appellee. |
| Court | Kansas Supreme Court |
Syllabus by the Court
1. In an action to recover on an 'Accident and Sickness Income' policy of insurance, provisions of the policy are examined and it is held that the inclusion of Section I. (2)(b) in the 'EXCEPTIONS AND REDUCTIONS portion of the policy is not in violation of K.S.A. 40-2202, (A)(5), all as set out in the opinion.
2. In an action on a policy as mentioned in paragraph 1 of this syllabus the record is examined and it is held that defendant insurance company's motion for a directed verdict in its favor at the close of plaintiff's evidence was erroneously sustained.
James L. Rose, Topeka, argued the cause, and George E. McCullough, W. L. Parker, Jr., Robert B. Wareheim, and Reginald LaBunker, Topeka, were with him on the brief for appellant.
Charles S. Arthur, Manhattan, argued the cause, and Charles D. Green, Manhattan, was with him on the brief for appellee.
This is an action on an 'Accident and Sickness Income' insurance policy.
The insured will be referred to as plaintiff and the insurance company as defendant.
Basically, the dispute arises over the question as to which benefits of the policy apply--sickness or accident.
At the close of plaintiff's evidence the court sustained defendant's motion for a directed verdict in its favor.
Plaintiff has appealed from that ruling.
A copy of the entire policy is not included in the record on appeal. Portions of it are abstracted. Other portions are set out in full. It was issued on August 1, 1960. It provides for a monthly sickness benefit of $100.00 for a maximum period of twelve months. The monthly accident benefit is $100.00 for a maximum period of 'lifetime'. Section 'E.' of the policy lists specific loss benefits such as for the loss of a hand, foot or eye--and with which we are not concerned.
We here quote or summarize other provisions of the policy.
'F. MONTHLY ACCIDENT BENEFIT
'(1) TOTAL DISABILITY--When 'such injury' shall, independently of any and all other causes, within twenty days of the date of the accident, totally and continuously disable you and prevent you from performing every duty of your occupation, the Association will pay you at the rate of the Monthly Accident Benefit for loss of time while you are so disabled, for a period not to exceed twelve months.
'At the end of such twelve months, the Association will continue to pay you at the same rate so long as you shall live and be totally and continuously disabled as the result of 'such injury' and be prevented from engaging in any occupation or work for wages or profit, but the total period of payment under this section F(1) shall not exceed the 'Monthly Accident Benefit-Maximum Period' shown in the Schedule.
'(2) DELAYED TOTAL DISABILITY--If 'such injury' shall not within twenty days but shall within one hundred days from the date of the accident wholly disable you, the Association will pay you for the period of continuous total disability (not exceeding three months) at the rate of one-half the Monthly Accident Benefit.
'(3) PARTIAL DISABILITY--If 'such injury' shall, commencing with the date of the accident or immediately following total loss of time, prevent you from performing one or more but not all of the daily duties of your occupation, the Association will pay you for such period of continuous partial disability (not exceeding three months) at the rate of one-half the Monthly Accident Benefit.
Section 'G.' concerns surgical and medical indemnity for non-disabling injuries, with which we are not concerned.
'H. MONTHLY SICKNESS BENEFIT
'When 'such sickness' shall, commencing during the term of this policy, wholly and continuously disable you and prevent you from engaging in any occupation or work for wages or profit, the Association will pay you for loss of time at the rate of the Monthly Sickness Benefit specified in the Schedule. Such payment shall be made for so long a time as you remain so disabled and are under the regular care and treatment of a legally qualified physician or surgeon other than yourself, but not exceeding during any one period of disability the amount of time specified in the Schedule as 'Monthly Sickness Benefit--Maximum Period.'
'Any period of disability due to sickness will, if such period commences during the term of this policy and results from the same or related cause or causes of a prior period for which benefits have been paid under this section H, be considered a continuation of the prior period unless the periods are separated by an interval of six months during which you continuously perform every duty of your regular occupation.
'Successive periods of disability due to sickness and resulting from different causes will, if such periods commence during the term of this policy, be considered as the same period unless they are separated by your return to active full time employment.
(Emphasis supplied.)
Plaintiff became disabled and made claim under the policy. Defendant contended that plaintiff had for many years been suffering from osteoarthritis and that the injury complained of simply aggravated such existing condition, and therefore under Section I. (2)(b) of the policy--above quoted with emphasis--the loss must be classified as being due to sickness. Under this theory and contention defendant paid to plaintiff the sum of $100.00 per month for twelve months--and refused further payment.
Plaintiff contended that his disability resulted solely through external, violent and accidental means, that he was totally disabled, and therefore should be paid $100.00 per month under the accident benefit provision of the policy for as long as his disability continues.
No settlement of the dispute being reached, plaintiff brought this action. The petition and answer alleged the foregoing contentions.
Plaintiff's evidence showed the following:
Plaintiff was fifty-seven years of age and had worked for a railroad for thirty-three years as a section-hand. The nature of his work called for a great deal of heavy lifting. He had never been absent from work because of any arthritic condition and he had never 'begged off' from any work assigned to him. On the morning of February 5, 1962, as he was going to work he slipped on the back steps of his home and fell, injuring both knees. After a few minutes he raised himself and, although still in pain, went to work. He was able to do some of his work in a sitting position. That evening both of his kness were greatly swollen. He went to work the next day but on February 7 went to see his doctor. The doctor prescribed treatment, which included lying in bed for three days and then using crutches for six months. Since then he has been able to walk only with the aid of a cane. He now has trouble walking up and down steps and is unable to do any heavy lifting.
His doctor testified that plaintiff's history showed that he had had an injury to his right knee some thirty years previously. The doctor's diagnosis was that he showed signs of osteoarthritis--a condition of joints normal to aging which is caused by 'wear and tear'. His testimony was that many people who have osteoarthritis 'live with it quite well' but that such condition makes the joint more susceptible to injury and when such a...
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