Title: Mutual Benefit Health & Acc. Ass'n of Omaha v. Reid
Citation: 182 So. 2d 869
Docket Number: N/A
State: Alabama
Issuer: Alabama Supreme Court
Date: February 10, 1966

182 So. 2d 869 (1966)
MUTUAL BENEFIT HEALTH AND ACCIDENT ASSOCIATION OF OMAHA
v.
Edith L. REID.
6 Div. 957.

Supreme Court of Alabama.
February 10, 1966.
*870 J. Kirkman Jackson, Birmingham, for appellant.
Murray A. Battles, Atlanta, Ga., and Fred C. Folsom, Cullman, for appellee.
*871 LIVINGSTON, Chief Justice.
This appeal is from a judgment for the plaintiff for $5,000 of the Circuit Court of Cullman County, Alabama, based on a health and accident insurance policy issued by the appellant (defendant below), insuring the life of one Cannie T. Reid against accidental death. The death benefit was contained in a Rider attached to the health and accident policy.
The original complaint consisted of five counts, which was later amended by the addition of Counts 6, 7 and 8. Count 8 set out the policy sued on in haec verba. To the complaint as initially filed, and as amended, appellant filed a demurrer. The demurrer to Counts 1, 2, 3, 4, 5 and 6 was sustained, and overruled as to Counts 7 and 8. To Counts 7 and 8, the defendant filed first, a plea of the general issue; second, that the insured of the policy sued on came to his death by suicide; and third, Standard Provision 15 of the policy, which, in words and figures, is as follows:
In connection with the third plea, the defendant tendered and paid into court the sum of $10.00, which it was stipulated was the amount required to be refunded under the provisions of the policy in the event it was decided that Standard Provision 15 applied.
The appellee (plaintiff below) took issue on those three pleas.
It was stipulated at the outset of the trial between counsel for plaintiff and defendant that the policy sued on was in force and effect at the time of the insured's death, and that the appellant had received appropriate notice and proof of his death, resulting from gunshot wounds sustained on May 4, 1961, and the plaintiff was the wife of the deceased and the beneficiary named in the policy, and that the policy was her property.
The case was tried by the court without a jury and the evidence was taken ore tenus before him. The circuit court entered a judgment for the plaintiff for $5,000 and the costs of court, and the defendant duly and seasonably perfected its appeal from that judgment.
The appellant assigns 10 alleged errors.
Appellant states in brief:
"The application of the assignments of error to these three phases of the
The policy sued on became effective June 6, 1959. Undeniably, Cannie T. Reid was killed by the blast of an automatic shotgun on the morning of May 4, 1961.
The pleadings in the case are adequate to raise the three questions presented by appellant for decision of this Court, and we will discuss them as raised.
In Alabama, it is well established that where the evidence is taken ore tenus before the trial judge, this Court will not disturb the trial court's conclusion on issues of fact, which is likened unto the verdict of a jury unless plainly and palpably wrong.
The first question is: Did Reid commit suicide, or was his death accidental?
The trial court found the following facts:
There was also evidence tending to prove that Reid had had the safety on this particular *873 gun changed from a right-hand position to a left-hand position; that the gun had a "soft trigger," or fired easily; that at times there was a malfunction in the ejectment system of the weapon, and that as a result of same, the weapon had been accidently fired at times when it was thought to be empty of shells.
There are presumptions favoring love of life, avoidance of harm or danger, and with some limitations, exercise of ordinary care. While the presumption against suicide is a strong one, and while such presumption, the courts have declared, stands until overcome by testimony, it is prima facie only, rebuttable, and not a rigid rule of law. The presumption operates to its fullest extent only where there is no proof as to whether the death was accidental or suicidal. 31A C.J.S. Evidence § 135.
In the case of New York Life Insurance Co. v. Beason, 229 Ala. 140, 155 So. 530, the evidence relied upon to show self-destruction, as well as that tending to disprove suicide, was wholly circumstantial and afforded conflicting inferences, this Court said:
It was said in Penn Mut. Life Ins. Co. v. Cobbs, 23 Ala.App. 205, 123 So. 94:
And in the case of Fleetwood v. Pacific Mutual Life Ins. Co., 246 Ala. 571, 21 So. 2d 696, 159 A.L.R. 171, it was said:
After carefully considering all of the evidence in this record, we are clear to the conclusion that the trial court did not *874 err when he found that the death of Cannie T. Reid was accidental. There is ample evidence to sustain such a finding.
We come now to the second question posed.
The health and accident policy issued by the appellant to appellee's husband, and the subject of this suit, provided for total disability payments, partial disability payments, specific benefits, such as the loss of a hand, arm or eye, and for disability benefits in the event of sickness, and for injuries due to the hazards of airline travel. A rider attached to the policy provided for the payment of $5,000 in the event the insured died as the result of an accident. The policy, when it was delivered, had attached to it the application therefor and the answers to questions asked in said application and which answers were supplied by Reid, the insured.
We say here that the policy in suit is a simple accident and health policy, providing for the payment of $5,000 in the event of death of the insured by accidental means.
The question now under discussion arises from Reid's negative answer to Question 6(a) of the application. The question: Are you or your listed dependents, if any, now covered by other personal insurance, or are applications now pending for such insurance? (monthly indemnity, hospital benefits, etc.).
At the time Mr. Reid answered Question 6(a) in the negative, he had in force with The Travelers Insurance Company of Hartford, Connecticut, a group policy of insurance providing for the payment to a named beneficiary the sum of $5,000 in the event of Reid's death. The group policy, in addition to death benefits, provided additional benefits in the event of death, dismemberment or loss of sight by accidental means; that is, that in the event any of the above enumerated losses occurred through accident, the company would pay the named beneficiary or the named insured, as the case might be, additional benefits over and above those provided in the event of death from whatever cause. This, of course, included death by accident.
This was simply a life policy with other incidental benefits and was issued to Mr. Reid solely by virtue of the fact that he was a Shell Oil Company dealer.
So far as we have been advised, the question now under discussion is one of first impression in this jurisdiction.
Our cases are to the effect that when an application for insurance, and the answers to questions contained in the application are attached to the policy when delivered to the insured and retained by him, they all constitute the contract between the parties. Penn Mutual Life Ins. Co. v. Cobbs, supra.
Therefore, the policy, the application and the answers to questions contained in the application, must be construed together in determining whether the policy sued on was limited by proration under Standard Provision 15, set out above.
Several factors must be considered: (1) the types of insurance provided for in both the policy of insurance issued by the defendant company and the group policy issued by The Travelers Insurance Company of Hartford, Connecticut; (2) the meaning of Question 6(a) in the application for the policy in suit; and (3) the meaning of Standard Provision 15 of the policy in suit. Admittedly, The Travelers policy was in force at the time Mr. Reid died and the defendant had no notice of it.
Basically, the defendant's policy was for income protection, the payment of monthly benefits due to sickness or injury. The other benefits provided for in said policy, one of which was for accidental death, were only incidental; whereas, basically, The Travelers policy was a life policy providing for payment on the death of Reid regardless of how he died. True, the two policies had some overlapping benefits.
*875 When the policy in suit is construed, as it must be, in the light most favorable to the insured, it is clear that notice of The Travelers policy was not required under it. The requirement that the defendant be notified of the existence of additional insurance, or of pending application therefor, had reference to the kind of insurance covered by the policy in suit, i. e., accident or health insurance. The policy in suit must be construed in the light of the interpretation the ordinary man might place on it in view of the usage of the insurance business and under the rule that any ambiguity must be resolved against the company.
It is clear that there is a difference between a life policy with double indemnity and disability benefits and an accident and health policy, such as we have here providing for death benefits. The dominant purpose of the two kinds of policies is entirely different, the risks they cover overlap in only a small segment, and it would not occur to the ordinary man that one was additional insurance of the sort covered by the other.
A case very much in point is Mutual Reserve Life Ins. Co. of New York v. Dobler, 9 Cir., 137 F. 550, p. 553, where it was said:
We could well rest the decision here on this phase of the instant case. But it is not necessary that we rest it here. We think the most that can be claimed on behalf of the defendant for Question 6(a) was that it was so worded as to leave uncertain as to whether or not it called for disclosure of the life policy which was in force at the time. If the insurance company, in the application, employed ambiguous terms or words of doubtful import, it cannot complain that they were construed by the applicant as they were.
Question 6(a) of the application asked Reid to list his other personal insurance. Had the question stopped here, it would be clearly ambiguous. But the question went further and placed a further limitation thereof of "monthly indemnity, hospital benefits, etc." Clearly, the group policy held by Reid at the time of his death did not provide for monthly benefits or hospital benefits, and the meaning of "etc." is ambiguous to one who has no knowledge of insurance, and there was no evidence whatever to show the meaning of Question 6(a) was made clear to Reid.
*876 If there is any ambiguity in a policy of insurance, and here that included the application for it, it is the fault of the insurance company. If the language used is susceptible to two interpretations, the one will be adopted most favorable to the insured.
When, in addition to this, those skilled in insurance are in disagreement as to whether life insurance with double indemnity and disability features should be counted as additional health or accident insurance, language of a health and accident policy requiring disclosure of additional insurance of such a character cannot be held to embrace life insurance policies with double indemnity and disability features without doing violence to the well-settled rule of construction to which we have referred.
Insurance men who testified at the trial below disagreed as to the interpretation of Question 6(a). A life insurance policy providing for specific benefit for the loss of an eye or leg, and double indemnity for accidental death, were not included in Question 6(a) of defendant's application relative to other insurance. Bowles v. Mutual Benefit Health &amp; Accident Association, CCA 4th, 99 F.2d 44, 119 A.L.R. 756, and cases therein cited.
We conclude, therefore, that whether or not the double indemnity and disability features of a group life insurance policy should otherwise be construed as being within the requirements of notice of other insurance contained in the accident and health policy, the testimony as to the understanding of insurance men shows that there is real ambiguity in the language as used in the application for the policy sued on; resolving that ambiguity as we must, in favor of the insured, we hold that the language has no reference to life policies containing double indemnity and disability features, and that the policy sued on was not avoided under Standard Provision 15 by reason of the failure to give notice of The Travelers Insurance policy.
The last argument referred to in appellant's brief is based on the exclusion of page 1 of the coroner's report which includes "10," and what is appended under "Remarks":
"10. Cause of death 16 guage shot gun wound in chest-suicide.
The entire argument of appellant on this point is as follows:
This case was tried by the court without a jury. The question of suicide was litigated, argued, and, we think, fully understood by the trial court. Supreme Court Rule 45 provides that no judgment may be reversed or set aside on the ground of improper admission or rejection of evidence, unless in the opinion of the court to which the appeal is taken or application is made, after an examination of the entire cause, it should appear that the error complained of has probably injuriously affected substantial rights of the parties.
*877 If the exclusion of page 1 of the coroner's report was error, which we do not decide, it was clearly error without injury. Supreme Court Rule 45.
We find no error to reverse and the judgment of the lower court is affirmed.
Affirmed.
SIMPSON, MERRILL and HARWOOD, JJ., concur.