Williams v. Insurance Co. of North America, 11348
| Decision Date | 20 December 1967 |
| Docket Number | No. 11348,11348 |
| Parties | Abe O. WILLIAMS, Plaintiff and Appellant, v. INSURANCE COMPANY OF NORTH AMERICA, Defendant and Respondent. |
| Court | Montana Supreme Court |
Richard J. Conklin (argued), White Sulphur Springs, for appellant.
Anderson, Symmes, Forbes, Peete & Brown, Sam E. Haddon (argued), Billings, for respondent.
This is an appeal from a summary judgment entered for defendant dismissing the complaint on the merits. The cause was heard in the district court at White Sulphur Springs, the Honorable Nat Allen, District Judge, presiding, sitting without a jury.
On February 15, 1963, the defendant issued to the plaintiff a certificate of insurance under a group policy insuring members of the group, including the plaintiff, against accidental total disability; the benefits being 60 percent of the base weekly salary, subject to a maximum of $150.00, less any benefits collectible under the Workmen's Compensation Act, and disability benefits applicable to the employee under the United States Social Security Act. The effective date and policy term commenced on February 15, 1963, and continued to the same date in 1964, and monthly thereafter on the payment of the premiums. The premiums were paid by the insured, here the plaintiff, through payroll deductions by the policy holder, the plaintiff's employer. The plaintiff had paid his premiums, the rate of which had not been alteredAnd the policy was in force at all times material here.
On July 25, 1964, the plaintiff was injured in an industrial accident, as a result of which it now appears that he is totally disabled. However, the defendant reserves the right to re-open this matter at some time in the future should the plaintiff cease to be totally disabled.
Commencing on July 25, 1964, under the terms of the policy defendant started to make payments to plaintiff in the sum of $290.76 per month and payments of this amount per month continued to February 22, 1966.
In figuring the amount to be paid to plaintiff under the policy, the defendant could properly deduct any benefits collected under the Workmen's Compensation Act. At the time of the injury the plaintiff was entitled to a weekly benefit under Workmen's Compensation of $45.00 per week. Subsequently, on a minor dependent attaining the age of 18 years, the plaintiff's compensation payments were reduced to $40.00 per week. At that time, the defendant properly increased the amount of its payment to take into consideration the reduction in Workmen's Compensation benefits.
At the time the disability occurred plaintiff was not entitled to Social Security benefits and on application in November of 1964 he was denied any benefits under the then existing Social Security Act. In September of 1965, the United States Social Security Act was amended and a new benefit created whereby plaintiff became eligible to and did receive in February of 1966 Social Security benefits which were not in existence at the time of the injury. In February of 1966, the plaintiff received $1,488.70 in a lump sum, for eligibility prior to February of 1965, under the terms of the new Social Security Act. In addition, under the terms of this new Act, plaintiff now receives a monthly disability benefit in the sum of $131.70. The defendant has refused to continue payment under the terms of the insurance contract until a total credit for the lump sum benefit received by the plaintiff offsets their weekly obligation, and refuses to make payment without a deduction of the $131.70 monthly disability benefits received by the plaintiff as a result of the new amendments to the Social Security Act.
The issue presented to the trial court and to this court on appeal is whether the defendant is within its rights in deducting from its payments to plaintiff the amount plaintiff now receives under Social Security...
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