Case Name: Minnie Wachtel, Respondent, v. The Equitable Life Assurance Society of the United States et al., Appellants
Court: New York Court of Appeals
Jurisdiction: New York
Decision Date: 1935-02-26
Citations: 266 N.Y. 345
Docket Number: 
Parties: Minnie Wachtel, Respondent, v. The Equitable Life Assurance Society of the United States et al., Appellants.
Judges: 
Reporter: New York Reports
Volume: 266
Pages: 345–359

Head Matter:
Minnie Wachtel, Respondent, v. The Equitable Life Assurance Society of the United States et al., Appellants.
(Argued January 9, 1935;
decided February 26, 1935.)
Peter C. Mann for The Equitable Life Assurance Society of the United States, appellant.
As a condition precedent to recover the double indemnity amount, proofs of death must be furnished showing a death resulting solely from a bodily injury effected solely through external, violent and accidental means. (O’Reilly v. Guardian Life Ins. Co., 60 N. Y. 169; Strang v. Prudential Life Ins. Co., 263 N. Y. 71; Epstein v. Mutual Life Ins. Co., 143 Misc. Rep. 587; 236 App. Div. 843; Bergholm v. Peoria Life Ins. Co., 284 U. S. 489; Ginell v. Prudential Life Ins. Co., 205 App. Div. 494; Page v. Commercial Travelers Eastern Accident Assn., 225 Mass. 335; Security Bank v. Equitable Life Assur. Society, 112 Va. 462; Gauche v. London & Lancashire Ins. Co., 10 Fed. Rep. 347; Continental Life Ins. Co. v. Searing, 240 Fed. Rep. 653; Metropolitan Life Ins. Co. v. Botto, 153 Va. 468; Travelers Ins. Co. v. Sheppard, 85 Ga. 751.) No proofs of accidental death were ever submitted, but on the contrary the proofs submitted showed death by disease and the defendants were entitled to a dismissal at the close of the plaintiff’s case and a directed verdict at the close of the whole case. (Strong v. Prudential Life Ins. Co., 263 N. Y. 71; O’Reilly v. Guardian Life Ins. Co., 60 N. Y. 169; McMartin v. Fidelity & Casualty Co., 264 N. Y. 220.) Plaintiff did not plead and consequently cannot prove a waiver. (Ryer v. Prudential Life Ins. Co., 185 N. Y. 6; Kelly v. St. Michael’s R. C. Church, 148 App. Div. 767; Hoffman v. Metropolitan Life Ins. Co., 135 App. Div. 739.) The proofs of death were not mere admissions but were necessary to plaintiff to prove compliance with the conditions precedent to recovery and were binding on her. (Rudolph v. John Hancock Life Ins. Co., 251 N. Y. 208; Redmond v. Industrial Benefit Assn., 150 N. Y. 167; Spencer v. Citizens’ Mut. Life Ins. Assn., 142 N. Y. 505; Hanna v. Connecticut Mut. Life Ins. Co., 150 N. Y. 526.)
Louis P. Galli and William J. Moran for The Travelers Insurance Company, appellant.
The proofs of death showed that the insured’s death was caused by disease; hence, plaintiff failed to comply with the condition precedent contained in the policy which required proof showing that the death resulted from bodily injuries effective directly and independently of all other causes through external, violent and accidental means. (O’Reilly v. Guardian Mut. Life Ins. Co., 60 N. Y. 169; Strang v. Prudential Life Ins. Co., 263 N. Y. 71; Page v. Commercial Travelers Eastern Acc. Assn., 225 Mass. 335; Ginell v. Prudential Life Ins. Co., 205 App. Div. 494; 237 N. Y. 554; Insurance Co. v. Newton, 22 Wall. 32; Irving v. Excelsior Fire Ins. Co., 1 Bosw. 507; Security Bank v. Equitable Life Assur. Society, 112 Va. 462; Maclin v. New England Mut. Life Assn., 33 La. Ann. 801; Sasse v. United Commercial Travelers, 168 App. Div. 746; Naseef v. Metropolitan Life Ins. Co., 230 App. Div. 610; Clark v. Employers’ Liability Assur. Co., 72 Vt. 458; Rathman v. New Amsterdam Cas. Co., 186. Mich. 115; Ackerman v. Minnesota Commercial Men’s Assn., 184 Minn. 522.) The defendants did not waive the condition precedent contained in its policy requiring proof of death exclusively by accidental means, nor were they required to demand additional proof of death. (Sasse v. United Commercial Travelers, 168 App. Div. 746; Todd v. Union Casualty & Surety Co., 70 App. Div. 52; Titus v. Glens Falls Ins. Co., 81 N. Y. 410; Armstrong v. Agricultural Ins. Co., 130 N. Y. 560; Palma v. National Fire Ins. Co., 240 App. Div. 454.)
John J. Cunneen for Manhattan Life Insurance Company, appellant.
Plaintiff made no plea of waiver of proofs of death nor of any mistake in the proofs of death served but to the contrary alleged that satisfactory proof of death in the manner and to the extent required by the policy was duly furnished the defendant. (Sasse v. United Commercial Travelers, 168 App. Div. 746; Todd v. Union Casualty & Surety Co., 70 App. Div. 52.)
Herman A. Gray, Nathan Grossman and Maxwell M. Booxbaum for respondent.
Plaintiff was not conclusively bound by the doctor’s original diagnosis, particularly when he himself repudiated it on the witness stand. (Rudolph v. John Hancock Mut. Life Ins. Co., 251 N. Y. 208; McMaster v. President of Ins. Co. of No. America, 55 N. Y. 222; Freese v. National Ben Franklin Ins. Co., 163 App. Div. 57; Schmitt v. National Life Assn., 84 Hun, 128; Howard v. Metropolitan Life Ins. Co., 18 Misc. Rep. 74; Boylan v. Prudential Ins. Co., 18 Misc. Rep. 444.) The defendants accepted the proofs of death as adequate and by their conduct precluded themselves from questioning their sufficiency. (Trippe v. Provident Fund Society, 140 N. Y. 23; Cornell v. Travelers Ins. Co., 120 App. Div. 459; 192 N. Y. 587; Partridge v. Milwaukee Ins. Co., 13 App. Div. 519; 162 N. Y. 597; Brink v. Hanover Fire Ins. Co., 80 N. Y. 108; Carthage T. P. Mills v. Village of Carthage, 200 N. Y. 1; City of New York v. N. Y. City Ry. Co., 193 N. Y. 543; Woolsey v. Funke, 121 N. Y. 87; Imperador Realty Co. v. Tull, 228 N. Y. 447; Glazer v. Home Ins. Co., 190 N. Y. 6; Dobson v. Hartford Fire Ins. Co., 86 App. Div. 115; 179 N. Y. 557; Sherri v. National Surety Co., 243 N. Y. 266; Karelsen v. Sun Fire Office of London, 45 Hun, 144; Kernochan v. N. Y. Bowery Fire Ins. Co., 17 N. Y. 428; Aiesenson v. Nat. Cos. Co., 237 App. Div. 855; 262 N. Y. 480; Fagerlie v. N. Y. Life Ins. Co., 129 Ore. 485.) Statements in proofs, while admissions, are not conclusive and may be overcome by other evidence. (Rudolph v. John Hancock M. L. Ins. Co., 251 N. Y. 208; White v. Royal Ins. Co., 149 N. Y. 485; Spencer v. C. M. L. Ins. Assn., 142 N. Y. 505; McMaster v. President of Ins. Co. of No. America, 55 N. Y. 222.)

Opinion:
Lehman, J.
The plaintiff is the beneficiary named in policies issued by the three defendant insurance companies, insuring the fife of her husband. The policies contain clauses, differing only in immaterial detail, providing for double indemnity to be paid upon due proof that the death of the insured resulted from bodily injuries caused directly, exclusively and independently of all other causes by external, violent and purely accidental means. The assured died on August 10, 1930. The companies did not dispute liability for the stipulated indemnity to be paid upon proof of the death of the insured. They have refused to pay the additional sums "payable upon due proof that the death was the result of accident, and this action was brought to obtain such double indemnity.
The beneficiary, before bringing suit, served upon each insurance company notice and proof of death of the assured. This , proof is not in each case the same, but all state in some form that the assured died of acute coronary thrombosis. Only in the proof served upon the Travelers Insurance Company is there any allegation or suggestion that death was due to an " accident to left leg early part of July, 1930," but even in that proof the claimant stated without qualification that the cause of death was acute coronary thrombosis and the attending physician's statement, which constitutes part of the proof, gives the same cause, without even any contributory causes. Coronary thrombosis is, concededly, a disease. Thus, the proofs of death were not only insufficient to show death caused exclusively by accidental means, but showed affirmatively that death was due to disease.
The claimant began this action without serving any additional proofs. The complaint alleges that she has complied with and performed all the conditions and terms of said policy on her part to be performed. Proof of death by accident is a condition precedent to liability for double indemnity and under the pleadings the plaintiff was required to show performance of this condition. The trial court dismissed the complaint because the plaintiff failed to show such performance. The Appellate Division has reversed on the ground that proof which showed that the defendants waived performance was received without proper objection.
At the trial the plaintiff was permitted to introduce, over the objection of the defendants, evidence that death was due to an accidental injury sustained some months before. We assume that the evidence would be sufficient to raise a question of fact as to the cause of death. If that is so, it would also be sufficient to make out a prima facie ease that the statement, in the proofs submitted to the companies, that death was the result of the disease of acute coronary thrombosis, was due to mistake. Admissions, in proofs of claims to insurance companies, like other admissions, are subject to explanation. They are not conclusive, and proof may be presented that they are erroneous. (Rudolph v. John Hancock Mut. Life Ins. Co., 251 N. Y. 208, 214.) The plaintiff maintains that proofs of death by disease, thus shown to be erroneous, may be regarded as sufficient proofs of death by accident, especially where the insurance companies demanded no additional proof.
Such contention carries its own refutation. The admission of the cause of death was binding until corrected or explained. (Rudolph v. John ancock Mut. Life Ins. Co., supra; Hanna v. Connecticut Mut. Life Ins. Co., 150 N. Y. 526; Spencer v. C. M. L. Ins. Assn., 142 N. Y. 505, 509.) Explanation of an admission in proofs submitted to an insurance company may completely destroy the effect of the admission Then the admission no longer has force to sustain an affirmative defense of the company (Parmelee v. Hoffman Fire Ins. Co., 54 N. Y. 193; Cummins v. Agricultural Ins. Co., 67 N. Y. 260, 262), or to nullify affirmative proof by the plaintiff. (Pythias Knights' Supreme Lodge v. Beck, 181 U. S. 49.) An admission erroneously made may be disregarded when proof of the error has been properly admitted. None the less, a party, required by contract to submit proof of certain facts as a condition of liability, does not perform the condition by submitting through error proof that these facts do not exist.
We have said in other cases that the requirement of due proof is to be liberally construed in favor of the insured. (Glatser v. Home Ins. Co., 190 N. Y. 6.) It may be satisfied where " such reasonable evidence [is furnished] as the party can command at the time, to give assurance that the event has happened, upon which the liability of the insurers depends. The purpose of the condition is that the insurer may be able intelligently to form some estimate of bis rights and liabilities before he is obliged to pay." (O'Reilly v. Guardian Mut. Life Ins. Co., 60 N. Y. 169,173.) We apply that test here. The proof submitted by the claimant showed, until explained, that the claimant was not entitled to double indemnity. No explanation of the admission that death was due to disease, and no proof that in fact death was due to accident, was ever furnished to these companies. They may have learned from other sources that death was due to accident, in spite of proof to the contrary submitted by the claimant. They may have decided, as a result of that independent investigation, that they would deny liability for double indemnity, even if formal proof that death was due to accident was thereafter presented. Nevertheless, it remains true that the claimant failed to comply with the stipulated condition to furnish the company with proof which would enable the insurer to frame an intelligent estimate of its rights and liabilities, and till such proof was given or waived, no liability for double indemnity could arise. The failure of an insurance company to object to the sufficiency of proof, when submitted, may, at times, preclude claim that the proofs did not comply with the terms of the policy. That is not the case where no proof has been submitted that " the event has happened, upon which the liability of the insurers depends " or where the proof submitted affirmatively shows that no liability exists.
The question remains whether the defendants waived the service of proof that death was due exclusively to accident. Waiver was not pleaded, and the letters from the defendant, which are relied upon to show waiver, were admitted over objection by the defendant. It is said that the objection was not sufficiently specific. It might well be argued that under the circumstances of this case, no other objection was called for. We need not decide that question now, for in our opinion the letters are insufficient to show waiver.
True, the letters reject any claim of liability for double indemnity, and ordinarily an unqualified rejection of liability by an insurance company before sufficient proofs of claim have been presented is a waiver of a condition that proofs must be presented. Here the letters of the defendants must be read in the fight of what had occurred. The plaintiff, as we have said, had not only failed to submit proof of death by accident, but had submitted affirmative proof of death by disease. The purpose of the condition that proof must be submitted was to enable the defendants to determine whether they were liable. The claimant's proof was not explained or corrected. The defendants acted upon it, as they had the right to do. They denied liability for double indemnity because, so they said, the proofs submitted, and independent investigation alike, showed that no such liability exists. They did not close the door to further proof which might establish such liability. They were not called upon to say that, if the plaintiff contradicted the proof of death she had submitted, liability might exist.
The order of the Appellate Division should be reversed and the judgment of the Trial Term affirmed, with costs in the Appellate Division and in this court.