Case Title: Todd v. Occidental Life Ins. Co.

Citation: 208 Or. 634, 303 P.2d 492

Docket Number: 

State: oregon

Court: Oregon Supreme Court

Date: 1956-11-14T00:00:00Z

Document:
Argued on rehearing October 3, 1956.
Reversed April 11, 1956.
Former opinion withdrawn, reversed and remanded November 14, 1956.
*635 James H. Clarke, Portland, argued the cause for appellant. With him on the briefs were Koerner, Young, McColloch & Dezendorf, and Wayne Hilliard, all of Portland.
Nels Peterson, Portland, argued the cause for respondent. On the brief were Peterson & Pozzi, Berkeley Lent, and Norman N. Griffith, all of Portland.
Before TOOZE, Acting Chief Justice, and LUSK, BRAND, and PERRY, Justices.
*636 REVERSED.
PERRY, J.
The plaintiff, having suffered from an accident, commenced this action to recover weekly indemnity payments as provided in defendant's accident policy.
This policy contract provided, if plaintiff sustained bodily injuries, that payment of benefits would be made:
*637 and the policy excluded "death, disability or other loss caused or contributed to (1) by bodily or mental infirmity, * * * or (3) by any kind of sickness, * * *."
The defendant had paid to the plaintiff the weekly indemnity of $50 per week for a total occupational disability to the extent of $807.14, and then refused to acknowledge further liability under the contract.
In answer to the plaintiff's complaint, the defendant alleged that the disability suffered by the plaintiff was caused or contributed to by bodily infirmity and sickness as excluded from coverage in the exception clause, and further asked for affirmative relief, seeking recovery of the payments as previously made.
A jury trial was waived, and the trial court made the following Findings of Fact:
Upon these Findings of Fact, the trial court concluded that the plaintiff should recover judgment against the defendant in the sum of $2,221.42, as total disability payments due under the contract accruing subsequent to the last payment made by the defendant on March 5, 1953. Judgment was entered accordingly, and the defendant has appealed.
In general, the defendant contends there is no substantial evidence that the accidental bodily injuries suffered by the plaintiff entitle him to a recovery within the terms of the policy contract.
The solution of the problem lies in the evidence adduced as applied to the interpretation placed upon the insuring clauses and their restrictions. The evidence discloses that plaintiff, 61 years of age, while employed as a taxi driver, and at a time when the policy was in full force and effect, was injured when the rear of his parked taxi, in which he was sitting, was struck by another automobile. In this accident the plaintiff suffered a sprain of the right shoulder and neck, and a slight cerebral concussion, which rendered him momentarily unconscious.
*639 The parties are agreed that at the time of the accident the plaintiff had osteo-arthritis, which was aggravated by the injuries received.
Dr. R. Lloyd Tegart, the plaintiff's attending physician, testified as follows:
Dr. Richard F. Berg, who examined the plaintiff at the request of the defendant, testified as follows:
1. The evidence establishes the fact that the plaintiff was disabled from performing his duties as a taxi driver, and that his disability is due to the pain and *643 impaired body motion caused by the osteo-arthritic condition existing in plaintiff's body.
In the case of Hutchison v. Aetna Life Ins. Co., 182 Or 639, 648, 189 P2d 586, this court, in construing the coverage provided in an insurance policy under wording similar to that contained in the policy under consideration here, adopted from the case of Penn v. Standard Life Insurance Co., 160 NC 399, 76 SE 262, 42 LRA NS 597, the following rules by which the facts of each case are measured in determining the policy coverage:
2, 3. Under these rules, pre-existing disease or bodily infirmity are eliminated as factors in determining liability, unless it can be said that the disease cooperates to create the ultimate condition, that is, disability or death. In other words, if both the accidental injury and the existing disease are necessary to produce the disability or death, no recovery may be had.
It is quite evident that all of the evidence points exclusively to the continuing disability of the plaintiff as falling within the third class. The plaintiff, however, contends that the osteo-arthritis of the plaintiff *644 is merely a part of the normal process of aging, and is not contained within the definition of the words "bodily * * * infirmity or * * * sickness" as used in the exclusion clause. Long v. Railway Mail Ass'n, 145 Neb 623, 17 NW2d 675; Silverstein v. Metropolitan Life Ins. Co., 254 NY 81, 171 NE 914; McGrail v. Equitable Life Assurance Society, 292 NY 419, 55 NE2d 483; Prudential Ins. Co. of America v. Carlson, 126 F2d 607.
4. Generally, "bodily infirmity" as used in accident insurance policies is construed to be practically synonymous with "disease," and each is understood to refer to a bodily ailment of an established or settled character from which an insured is suffering. 29 Am Jur 747, Insurance § 995.
"* * * an `infirmity' indicates weakness, feebleness, debility, fraility, disease  something that materially impairs bodily powers." Taylor v. New York Life Insurance Co., 176 Minn 171, 174, 222 NW 912, 60 ALR 959.
Mr. Justice Cardozo in Silverstein v. Metropolitan Life Ins. Co., supra, 254 NY 81, 84, in determining what was intended by the parties to an insurance contract in the use of the words "disease or bodily or mental infirmity" in the exclusion clause, said:
*645 The evidence discloses the fact that osteo-arthritis appears to some degree in practically all people from the age of 50 years upward, and may be classified as a part of the process of growing old. If we were dealing solely with the exclusion clause of the policy, weight might be given to plaintiff's argument, but we must also consider clause "A." of the policy which sets forth the coverage provided in case of disability, and which forms the basis of plaintiff's claim under this policy.
5. The coverage in this type of policy is expressly limited. The disability coverage provided does not cover the unintended injury alone, but only applies when the unintended injury occurs and a disability results directly and independently of all other causes. Davis v. North American Acc. Ins. Co., 42 Wash2d 291, 254 P2d 722; North America Acc. Ins. Co. v. Allentharp, 164 F2d 9; Davis v. Jefferson Standard Life Ins. Co., 73 F2d 330.
We cannot ignore the express provisions of the policy and, therefore, the judgment for the plaintiff must be set aside and judgment entered for the defendant.
6. Defendant, however, may not prevail upon its cross-complaint for there is ample evidence to sustain the trial court's judgment that over the period of time payments were made for disability the plaintiff was suffering from dizziness and imparied vision as a result solely of the accidental injury which disabled him from carrying on his occupation as a taxi driver.
Reversed and remanded with instructions to enter judgment in accordance with this opinion.
*647 James H. Clarke, Portland, argued the cause for appellant. With him on the briefs were Koerner, Young, McColloch & Dezendorf, and Wayne Hilliard, Portland.
Nels Peterson, Portland, argued the cause for respondent. On the brief were Peterson & Pozzi, Berkeley Lent, and Philip A. Levin, all of Portland.
REVERSED AND REMANDED. FORMER OPINION WITHDRAWN.
PERRY, J.
Believing that we were perhaps in error in our former opinion we granted a rehearing, and having concluded that we were in error, our previous opinion is herewith withdrawn and the following now becomes the opinion of the court.
The plaintiff, having suffered from an accident, commenced this action to recover weekly indemnity payments as provided in defendant's accident policy.
*648 This policy contract provided, if plaintiff sustained bodily injuries, that payment of benefits would be made:
The policy excluded "death, disability or other loss caused or contributed to (1) by bodily or mental infirmity, * * * or (3) by any kind of sickness, * * *."
The defendant had paid to the plaintiff the weekly *649 indemnity of $50 per week for a total occupational disability to the extent of $807.14, and then refused to acknowledge further liability under the contract.
In answer to the plaintiff's complaint, the defendant alleged that the disability suffered by the plaintiff was caused or contributed to by bodily infirmity and sickness as excluded from coverage in the exception clause, and further asked for affirmative relief, seeking recovery of the payments as previously made.
A jury trial was waived, and the trial court made the following Findings of Fact:
Upon these Findings of Fact, the trial court concluded that the plaintiff should recover judgment against the defendant in the sum of $2,221.42, as total disability payments due under the contract accruing subsequent to the last payment made by the defendant on March 5, 1953. Judgment was entered accordingly, and the defendant has appealed.
In general, the defendant contends there is no substantial evidence that the accidental bodily injuries suffered by the plaintiff entitle him to a recovery within the terms of the policy contract.
The solution of the problem lies in the evidence adduced as applied to the interpretation placed upon the insuring clauses and their restrictions. The evidence discloses that plaintiff, 61 years of age, while employed as a taxi driver, and at a time when the policy was in full force and effect, was injured when the rear of his parked taxi, in which he was sitting, was struck by another automobile. In this accident the plaintiff suffered a sprain of the right shoulder and neck, and a slight cerebral concussion, which rendered him momentarily unconscious.
The parties are agreed that at the time of the accident the plaintiff had osteoarthritis, which was aggravated by the injuries received.
In the case of Hutchison v. Aetna Life Ins. Co., 182 Or 639, 648, 189 P2d 586, this court, in construing the *651 coverage provided in an insurance policy under wording similar to that contained in the policy under consideration here, adopted from the case of Penn v. Standard Life Insurance Co., 160 NC 399, 76 SE 262, 42 LRA NS 597, the following rules by which the facts of each case are measured in determining the policy coverage:
Under these rules, pre-existing disease or bodily infirmity are eliminated as factors in determining liability, unless it can be said that the disease cooperates to create the ultimate condition; that is, disability or death. In other words, if both the accidental injury and the existing disease are necessary to produce the disability or death, no recovery may be had.
The plaintiff contends that the osteoarthritis of the plaintiff is merely a part of the normal process of aging, and is not contained within the definition of the words "bodily * * * infirmity or * * * sickness" as used in the exclusion clause. Long v. Railway Mail Ass'n, 145 Neb 623, 17 NW2d 675; Silverstein v. Metropolitan Life Ins. Co., 254 NY 81, 171 NE 914; McGrail *652 v. Equitable Life Assurance Society, 292 NY 419, 55 NE2d 483; Prudential Ins. Co. of America v. Carlson, 126 F2d 607.
Generally, "bodily infirmity" as used in accident insurance policies is construed to be practically synonymous with "disease," and each is understood to refer to a bodily ailment of an established or settled character from which an insured is suffering. 29 Am Jur 747, Insurance § 995.
"* * * an `infirmity' indicates weakness, feebleness, debility, frailty, disease  something that materially impairs bodily powers." Taylor v. New York Life Insurance Co., 176 Minn 171, 174, 222 NW 912, 60 ALR 959.
Mr. Justice Cardozo in Silverstein v. Metropolitan Life Ins. Co., supra, 254 NY 81, 84, in determining what was intended by the parties to an insurance contract in the use of the words "disease or bodily or mental infirmity" in the exclusion clause, said:
Therefore, if the osteoarthritis, which did not in anywise disable the plaintiff until after the accident, is a disease or bodily infirmity within the meaning of the exclusion clause, the plaintiff cannot recover.
7. In construing a contract of insurance, the courts will give as favorable a construction for the benefit *653 of the insured as is cognizable in the words used to prevent forfeiture. Smith v. Ind. Hosp. Assn., 194 Or 525, 242 P2d 592.
The medical testimony in this case is to the effect that everyone over 50 years of age has, to some degree, osteoarthritis. The plaintiff was 60 years of age at the time he applied for insurance.
8. An accident insuring agency is not required to accept every person as a risk, and in preparing its policies it may exclude any risk as to any individual, but, unless it clearly points out the risks not assumed, it seems only logical that it accepts the risks of infirmity which are generally considered normal to mankind at the various stages of life, and, therefore, that osteoarthritis, which in common parlance may be considered normal from that which would be considered abnormal, cannot be considered as a concurring cause of disability. Therefore, under the evidence in this case, there was a question of fact to be determined.
The defendant assigns as error the entering of a judgment by the trial court in the amount of $3,271.99, "because the judgment is not supported by the pleadings or the findings."
Material to this issue, the plaintiff alleged in his complaint:
Plaintiff demanded judgment accordingly. By an alleged supplemental complaint, plaintiff adopted all of the allegations of paragraphs I, II, and III of the original complaint, and in the same language of paragraph IV (being paragraph II in the supplemental complaint) alleged the indebtedness of the defendant to be $2,000.
The plaintiff's original complaint alleges a contract of insurance which provided "for the payment of weekly indemnity benefits in the sum of $50.00 per week in the event that the plaintiff should be injured by accident and should be wholly and continuously *655 disabled and said injuries should prevent him from performing each and every duty pertaining to his occupation." (Italics supplied). This allegation clearly states that the claim is based upon the first sentence of section A of the insurance contract, which provides for occupational disability, and not to the second sentence, which refers to general disability. The policy itself is not pleaded, and, therefore, demand pleaded in paragraph IV of the original complaint and paragraph II of the supplemental complaint refers to the injury which prevents him from performing his usual and customary occupation.
The words added in paragraph IV of the original complaint and in paragraph II of the supplemental complaint, "that plaintiff will be wholly and continuously disabled for an indefinite time in the future", likewise, can refer solely to the occupational disability, for nowhere in the complaint is there any statement that the contract of insurance provided insurance against disabling injuries that prevented him from engaging in any occupation or employment for wage or profit. The plaintiff contends, however, that since no demurrer or motion was filed to the supplemental complaint this objection was waived.
9, 10. The rule of aider by verdict approved and followed by this court was well-stated by Mr. Justice ROBERT S. BEAN in Booth v. Moody, 30 Or 222, 225, 46 P 884:
11. It is a well-established rule of law that, where no attack has been made upon a pleading by demurrer, the complaint will be liberally construed to state a cause of action after verdict. Nicholson v. Jones, 194 Or 406, 242 P2d 582.
12-14. The difficulty with plaintiff's position is that the policy of insurance contemplates coverage for different circumstances. The first sentence of section A of the policy provides indemnity for a period of 52 weeks to the assured for loss suffered in being unable to carry on his usual and customary occupation; the sentence following indemnifies him at the expiration of the 52 weeks as an individual who is so disabled as to be unable to perform any work or follow any occupation for wages or profit. They are separate and distinct in their intended coverage. Dullum v. Northern Life Ins. Co., 169 Or 233, 127 P2d 749; see also annotation 149 ALR 7. Each coverage is a separate cause of *657 action or right arising out of the policy. Walker v. Fireman's Fund Ins. Co., 114 Or 545, 234 P 542.
At the time the original cause of action was filed for recovery under the policy for occupational disability, no right of recovery existed for total disability and this could only be brought in by supplemental complaint. Walker v. Fireman's Fund Ins. Co., supra.
ORS 16.360 reads as follows:
This statute permitting supplemental pleadings requires the setting forth of the new facts that have occurred since the filing of the original complaint which will enlarge or change the kind of relief to which a plaintiff may be entitled. May Stores, Inc. v. Bishop et al., 131 Or 670, 282 P 1080.
It will be noted that no new facts are alleged in the supplemental complaint which are not contained in the original complaint. The plaintiff in his original complaint stated a good cause of action to recover for occupational disability under the policy. His supplemental complaint asks only for additional sums of money in the identical wording of the original complaint. While this may be sufficient pleading to include the accruing weekly sums provided in the first sentence in the policy, we are of the opinion that, having stated a good cause of action which was not demurrable under his original complaint, the plaintiffs' supplemental complaint was not sufficient to enlarge the original complaint to include therein a new cause of action upon an entirely different coverage included in the policy *658 that could not have been maintained when the suit was commenced.
The defendant also complains that the trial court failed to make specific findings of fact sufficient to sustain the judgment.
Had the trial court made a sufficient finding of fact to the effect that the plaintiff was disabled from engaging in any occupation or employment for wage or profit, such a finding could not stand as it lay beyond the issues raised by the pleadings. McMillan v. Montgomery, et al., 121 Or 28, 253 P 879.
An examination of the judgment shows that the trial court must have considered and adjudicated upon the plaintiff's inability to engage in any occupation for wage or profit. Therefore, this cause must be reversed with leave for the plaintiff to apply to the trial court for permission to file a supplemental complaint. Larsen v. Martin, 172 Or 605, 143 P2d 239.
Since this case must be retried, we have refrained from discussing the evidence as much as possible.
Reversed and remanded.