Yeager v. Pacific Mut. Life Ins. Co.

• Citation: 139 N.E.2d 48,1 O.O.2d 204,166 Ohio St. 71
• Decision Date: 26 December 1956
• Docket Number: No. 34798,34798
• Parties: , 1 O.O.2d 204 YEAGER, Appellee, v. PACIFIC MUTUAL LIFE INS. CO., Appellant.
• Court: United States State Supreme Court of Ohio

Page 71

166 Ohio St. 71

139 N.E.2d 48, 1 O.O.2d 204

YEAGER, Appellee, v. PACIFIC MUTUAL LIFE INS. CO., Appellant.

No. 34798.

Supreme Court of Ohio.

Dec. 26, 1956.

Syllabus by the Court.

1. An insurance policy prepared by the insurer must be liberally construed in favor of the insured, and, in case of ambiguity, such ambiguity must be resolved against the insurer.

2. An insurance policy constitutes a contract, its terms must be given a reasonable construction, and an ambiguity which is created by giving a strained or unnatural meaning to phrases or by mere casuistry does not constitute an ambiguity requiring construction.

3. Where a contract of insurance provides that the insured shall be paid a weekly indemnity during a period when he is wholly and continuously disabled and prevented from performing every duty pertaining to his occupation, and the insured works for more than 14 months continuously at his occupation as a cone grinder, earning as a pieceworker an average of $75 per week during that period, working not only every working day, with the exception of a few days now and then, but at times doing overtime work and performing his work under an O.K. from his physician, a jury question does not arise as to whether such insured was wholly and continuously disabled and prevented from performing every duty pertaining to his occupation during such period, even though the insured suffered pain while doing his work and received some help from fellow workmen in lifting heavy pans of cones, which help was not against the rules of the employer.

On October 23, 1952, Paul A. Yeager, appellee herein, hereinafter designated plaintiff, instituted an action against the Pacific Mutual Life Insurance Company, appellant herein, hereinafter designated defendant.

In his amended and supplemental petition, filed November 8, 1954, plaintiff alleges that defendant issued to him a policy of insurance for a term of six months, commencing on July 10, 1948, in consideration of the payment by plaintiff of the premium of $22.70; that such policy was renewed in consideration of renewal of premiums and was in full force and effect on October 19, 1949, and is still in full force and effect; that by and under the terms of such policy defendant insured plaintiff against loss resulting directly, and independently of all other causes, from bodily injuries sustained during the term thereof and effected solely through accidental means, and against sickness or disease contracted after 14 days from the date of the policy and during the term thereof; that the weekly indemnity provided by such policy is in the amount of $25; that such policy provides that, if such injuries shall, within 20 days after the date of the accident, wholly and continuously disable plaintiff and prevent him from performing every duty pertaining to his occupation, defendant will pay such weekly indemnity for the period of such continuous total disability for not to exceed 52 weeks and thereafter will continue the payment of such weekly indemnity as long as plaintiff shall be wholly and continuously disabled and prevented by such injuries from engaging in any occupation or employment for wage or profit; that on October 19, 1949, while plaintiff was at his work he sustained loss resulting directly, and independently of all other causes, from bodily injuries when he slipped on some oily water and went into a twisting fall; that thereafter, and to the present time, plaintiff has been and still is wholly and continuously disabled and prevented by such injuries from engaging in any occupation or employment for wage or profit; that from October 19, 1949, to date, defendant has paid to plaintiff such weekly indemnity at the rate of $25 per week for the weeks from October 28, 1949, to January 3, 1950, and from January 9, 1950 to July 9, 1950; that defendant has paid plaintiff at the rate of $12.50 per week for the weeks commencing September 25, 1951, and ending October 28, 1951; and that defendant refuses to pay such weekly indemnity at the rate of $25 per week for the period from October 19, 1949, to October 28, 1949, from January 3, 1950, to January 9, 1950, and from July 9, 1950, to date, by reason whereof plaintiff has been damaged in the sum of $5,666.08. Plaintiff prays for judgment in that amount, plus interest.

Defendant filed an answer to the amended and supplemental petition, in which it admits or alleges that it issued the policy of insurance in consideration of the payment of $22.70 for a term of six months; that such policy was renewed for successive terms and was in full force and effect on October 19, 1949; that under the terms of the policy defendant insured plaintiff against loss resulting directly, and independently of all other causes, from bodily injuries effected solely through accidental means and against sickness or disease contracted during the term of the policy; that the weekly accident indemnity is in the amount of $25 and the weekly sickness benefits are in the amount of $25 for total disability with house confinement and the weekly sickness benefits for total disability without house confinement are in the amount of $12.50; that the policy provides that, if the injuries should, within 20 days after the date of the accident, wholly and continuously disable the plaintiff and prevent him from performing every duty pertaining to his occupation, defendant will pay the weekly indemnity for the period of such continuous total disability for not to exceed 52 weeks and, thereafter, will continue the payment of such weekly indemnity as long as the plaintiff shall be wholly and continuously disabled and prevented by such injuries from engaging in any occupation or employment for wage or profit; that plaintiff sustained an injury while at his employment on October 19, 1949 (but defendant denies that he has been wholly and continuously disabled from the date of such accident and prevented from engaging in every duty pertaining to his occupation); that on October 28, 1949, plaintiff stopped work and was paid weekly accident indemnity until January 3, 1950, on which date plaintiff returned to his employment; that on January 13, 1950, plaintiff again stopped work and was paid weekly accident indemnity until July 10, 1950, on which date plaintiff returned to his employment; that plaintiff was employed from July 10, 1950, to September 25, 1951, a period of over 14 months, and then stopped work and was paid weekly sickness indemnity from September 25, 1951, to October 29, 1951, on the basis of four days at the rate of $25 per week and 29 days at the rate of $12.50 per week; that plaintiff returned to work on October 29, 1951, and was employed until February 7, 1952, at which time he stopped work; that defendant sent to plaintiff its draft covering sickness indemnity from February 7, 1952, to March 28, 1952, but such draft was not cashed, plaintiff claiming the right to receive accident rather than sickness indemnity; and that defendant is ready and willing to continue payment of sickness indemnity, in accordance with the terms of the policy, but has refused to make any payments of accident indemnity based upon the accident of October 19, 1949, for the reason that plaintiff was not wholly and continuously disabled by such accident and was not prevented from performing every duty pertaining to his occupation.

Defendant denies generally all allegations not admitted to be true.

In his amended reply plaintiff admits that the weekly sickness benefits were as stated in defendant's answer; admits the payments and his returns to work as alleged in plaintiff's answer; admits receiving and not cashing the sick benefit draft as alleged in plaintiff's answer; admits that defendant is ready and willing to continue payments of the weekly sickness indemnity provided in the policy; and denies all allegations the truth of which he does not admit in his amended and supplemental petition and his amended reply.

The policy of insurance referred to in the pleadings, so far as the accident indemnity is concerned, contains a provision that if 'such injuries shall, within 20 days after the date of the accident, wholly and continuously disable the insured and prevent him from performing every duty pertaining to his occupation, the company will pay weekly indemnity at the rate hereinbefore specified for the period of such continuous total disability, but for not exceeding 52 consecutive weeks. After the payment of weekly indemnity for 52 weeks as aforesaid, the company will continue the payment of weekly indemnity at the same rate thereafter so long as the insured shall be wholly and continuously disabled and prevented by such injuries from engaging in any occupation or employment for wage or profit.'

The injury which plaintiff suffered on October 19, 1949, was a severe one to his back, while he was at work. It resulted in a herniated disk in his spinal column.

Plaintiff was a grinder employed by the Timken Roller Bearing Company, and his job was to rough-grind and finish cones which he took from pans which had to be placed on a rack. After the cones were ground, plaintiff put them in another pan and continued that process until enough cones had been roughed out, and then the same procedure was repeated and the cones ground out a second time.

The pans of cones which had to be lifted on to the racks varied from comparatively light-weighted pans to those weighing as much as 100 pounds or more.

Plaintiff was on neither a...