Case Name: MUTUAL LIFE INSURANCE COMPANY OF NEW YORK v. BARRON et al.
Court: Court of Appeals of Georgia
Jurisdiction: Georgia
Decision Date: 1943-12-04
Citations: 70 Ga. App. 454
Docket Number: 30041
Parties: MUTUAL LIFE INSURANCE COMPANY OF NEW YORK v. BARRON et al.
Judges: Gardner, J., concurs. Broyles, C. J., dissents.
Reporter: Georgia Appeals Reports
Volume: 70
Pages: 454–465

Head Matter:
30041.
MUTUAL LIFE INSURANCE COMPANY OF NEW YORK v. BARRON et al.
Decided December 4, 1943.
Rehearing denied December 20, 1943.
Grover Middlebrooks, Louis W. Dawson, Beck, Goodrich & Beck, for plaintiff in error. William, M. Dallas, contra.

Opinion:
MacIntyre, J.
This was a suit on an insurance policy for total-disability benefits by Dr. Henry A. Barron against the Mutual Life Insurance Company of New York. The policy provided that upon the insured' (before'reaching the age of 60 years) furnishing the company with proof that he was totally and permanently disabled as'provided in said policy, the company wbuld: (1) waive each premium' as it- thereafter became due during' such disability; and (2) pa'y to the insured monthly benefits of $50 per month for the first 60 monthb of said disability, $75 per month for the second 60 months of said disability, and thereafter $100 per month during thé remaining life of- said insured;,' so' long as said disability'continued. The insured furnished the company proof that he was totally disabled'on January 1,A927. The company waived the premiums, and began the payment of total-disability benefits according to the provisions of the policy, and paid the same continuously until after the February, 1942, payment had been made, when it refused to make further payments.
The rule as .to total disability stated in Cato v. Ætna Life Insurance Co., 164 Ga. 392 (138 S. E. 787), and explained in Metropolitan Life Insurance Co. v. Johnson, 194 Ga. 138 (20 S. E. 2d, 761), is that so long as the insured has capacity to perform any -substantial part of his duties, he is not totally disabled. "Total disability is inability to do substantially all of the material acts necessary to the transaction of the insured's occupation, in substantially his customary and usual manner. Total disability does not mean absolute physical inability to work at one's occupation, or to pursue some occupation for wages or gain; but it exists if the injury or disease of the insured is such that common care and prudence require him to desist, and he does in fact desist, from transacting his business. In such circumstances, total disability exists." Cato v. Ætna Life Insurance Co., supra. The rule stated in the'--Cato ease involved only one occupation, that of a weaver, and that was the occupation at which the claimant in that case was working at the time the disability occurred; More .than one occupation- is involved in the instant case, to wit: doctor of medicine, chairman of the-board .of county commissioners, and city councilman. The occupation in which the claimant here was engaged at the time of his total disability (January 1, 1927) was that of a doctor of medicine. His net earnings were $700. to $800- per month. On a showing made by the claimant, in accordance with a provision of the policy, the company waived the premiums, and -paid, total-disability benefits up to and -including the month of February, 1942, after which it discontinued- paying on the ground that the plaintiff had recovered to such an extent that he -was no longer totally disabled within the provisions of the policy. The question here is, what is the rule where the claimant has recovered -from his disability to a named extent, but has not resumed the practice of medicine, the employment in which he was engaged at the time of the occurrence of the total disability. In Keith v. Chicago, B. & Q. R. Co. (82 Neb. 12, 116 N. W. 957, 130 Am. St. R. 655, 23 L. R. A. (N. S.) 352), it is said: "If an injured member of the relief department recovers to the extent that he is no longer disabled in the performance of the work contemplated or similar worky — that is, employment equally as desirable and remunerative, — then the obligation of the defendant to pay disability benefits ceases." In Prudential Insurance Company v. South, 179 Ga. 653, 658 (177 S. E. 499, 98 A. L. R. 781), the Supreme Court speaking through Mr. Justice Bell stated: "The expressions 'any occupation' and 'any work' were thus converted into words of concrete signification, and should be construed to mean the ordinary employment of the particular person insured, or such other employment, if any, approximating the same livelihood, as the insured might fairly be expected to follow, in view of his station, circumstances, and physical and mental capabilities." While the writer has read a number of foreign cases on this point, the rule in the South case, just quoted, appears to him to be the most helpful statement of the law of total disability as it applies to the facts of the instant case; for the explanation in the South case of what some decisions call "similar employment," is clearer to the writer than in the other cases read. And when we apply the rule quoted from the South case to the instant case, where different kinds of occupations are involved, in order for the insurance company to be justified in refusing to continue the total-disability payments, by merely showing that the insured is engaged in the other occupations, it must appear: (1) that he never became physically able to (nor did he) resume his work as a doctor of medicine; (2) that he engaged in employments which were to him desirable, and as he might be fairly expected to follow in view of his station, circumstances, and mental and physical capabilities; (3) and that the employment produced a like remuneration or approxU mated the same livelihood. Under the circumstances of this case, 'it was necessary that the proof show all three of these essentials. The defendant contended that it refused to make total-disability payments after February, 1942, on the ground that after investigation it learned that the insured was not totally and permanently disabled within the- policy definition. After verdict, that view of the evidence which is most favorable to the plaintiff must be taken, for every presumption and every inference is in favor of the verdict. The evidence, when so construed, authorized a finding that in 1927 the insured made claim for total-disability benefits, which were paid until February, 1942; that during the period for which the dis continued benefits were sued for, he was chairman of the board of county commissioners of Upson County, and had been re-elected for another term of three years; that he had an office in the courthouse, and wenc there almost every day; that he was performing the duties of chairman of the board of commissioners satisfactorily, and received a salary of $75 per month for his services; that during the period in question, he was also a member of the city council, mayor pro tern, and chairman of the street committee of Thomas-ton; that he was also performing the duties of those offices satisfactorily and received a salary of $60 per month for his services; and that he was serving oil other committees of the city council of Thomaston. Tim insured testified in part: "I was born on August 4, 1889. I was a practicing physician before I became disabled. I practiced in this county from 1913 to 1927. I did a general practice, a little of everything that a doctor does, and was on duty from 12 to 15 hours a day on up to 24 hours a day. I made an average of seven or eight hundred dollars net a month before I became disabled. I overworked myself and became disabled. . . I made proofs of my disability to the Mutual Life Insurance Company of New York, and they recognized my disability and began to pay me in 1927. They paid me to February 1942, and then they stopped the payments. . . I am a very nervous man. I only get about three or four hours sleep at night. I rest some during the day when I feel bad, that is, I lie down, but I don't sleep during the day time. . . I am very weak to what I was. I can not sleep if I exert myself at all. I stopped the practice of medicine about Christmas time, 1926. I made an average of seven or eight hundred dollars per month. None of my duties connected with the city or county require any physical exertion. My duties do not require me to do anything at any particular time. None of my duties prevent me from resting at any time during the day if I desire to do so. The reason I get up in the night and come up -town in my car is because I wake up and can not sleep, and I get tired of lying in bed. The amounts he asked me about that I got from the city and the county is my gross salary. I do not have to do anything at any particular time. If I don't feel like it I don't have to go to the office, and I can absent myself from the city council for the next five weeks if I want to. I do not supervise and oversee the hands in my capacity as street chairman, or as chairman of the street committee. I-tell Chief Bogers,- the chief of police, what to do and he has charge of the street hands. If you were to report to me that the street you live on was in need of repairs, the only exertion I would have, would be to pick up the telephone and call Chief Bogers. I could do all of that sitting at home or in bed. If I -had a report from somebody living out in the county as to any road, I could attend to it by sitting in a chair at my home and telephoning the camp, and have it fixed that same day. I would not know whether it was fixed right or mot if I went out there, because I am not an engineer, and I do not supervise the actual work. The warden does most of the riding that is required of the county commissioners. The other two commissioners do a great deal of riding over the county, looking after the county's affairs." Notwithstanding the conflicting evidence, particularly that of the doctor's, the jury were authorized to find, that at the time the insurance company ceased paying the disability benefits,'the claimant was totally disabled according to the provisions of the insurance policy, under the rules stated in the Cato and-the South-cases. Irrespective of . whether the insurance company proved the first two essentials stated above, it failed to prove the third, to wit: that the employment produced a like remuneration or approximated the same livelihood. The jury were authorized to find from the evidence as a whole that at the time of the disability, the claimant was making $700 to $800 net per month, as a doctor of medicine, and that at the time the company ceased paying the compensation benefits, the insured, as a member of the board of county commissioners and as a member of the city council, was "making only $135 per month, which was less than one-fifth of the remuneration he was receiving at the time of the' disability. Under the rules in force in this State, as announced in the Cato and South cases, the verdict finding that the insured was totally disabled as alleged was authorized,
Under the foregoing ruling the following charge, to wit: "The words Total disability' mean inability to do substantially or practically all of the material acts necessary to the transaction of the insured's business, or his occupation, or whatever line he is following, and in the customary and usual manner," is not reversible error, because "it in effect instructs the jury that recovery should be had even though his disability is only partial and not total. It instructs the jury that recovery should be had unless the insured is able .to follow Ms'usual:occupation; regardless of. whether or not any other, occupation is open to him." :v. This'charge, if error, is not reversible-'error as against dhe plaintiff1 in error, the complaining party. . The'charge, did' not limit "whatever, line:he-is. following" to one approximating the same livelihood: Thus, under the South case; supra, the error, if -any, was favorable to the .defendant, as it in'effect instructed .the jury that, if the insured-was-then'-following any line of endeavor, he would: not be totally disabléd unless'-'he was unable to do substantially or practically all-the-material acts necessary to-the transaction of said line of work or endeavor.- Under this charge the jury- was an effect instructed that if the- insured was • following'the line, of'selling pencils "in the customary and usual manner," he could not- be totally and permanently -disabled.
There 'are other exceptions in the record but we think that the foregoing rulings cover all exceptions made.
The term "bad faith," as used in the Code, § 56-706, is not the equivalent- of actual fraud, but means any frivolous or unfounded, refusal in law, or in fact, to comply with-the requisition of the policyholder to pay according to the terms of his contract and the conditions imposed-by statute. Cotton States Life Ins. Co. v. Edwards, 74 Ga. 220 (4). We do not think the evidence authorized a finding in the instant case that the insurance company's refusal to pay was in "bad .faith."
As the verdict against the insurance company was authorized by the evidence, and no material error was committed which affected the plaintiff's right to recover, the judgment is affirmed on condition that the plaintiff write off the sums recovered as a penalty and attorney's fees; otherwise the judgment is reversed.
Judgment affirmed on condition.
Gardner, J., concurs. Broyles, C. J., dissents.