Opinion ID: 2609917
Heading Depth: 1
Heading Rank: 1

Heading: additional medical and hospital indemnity any accident

Text: If Such Injuries shall be sustained by the Insured, and do not result in any loss for which indemnity is payable under Sections A or B, but shall, during any period of total disability or partial disability for which benefits are payable under Sections C or D, necessarily confine the Insured within a hospital and shall necessitate: Any medical, hospital, x-ray, operation or other expense of any kind at a hospital; the Company in addition to the indemnity payble under Sections C or D of this policy will pay a maximum daily indemnity limit of $8.00, subject to an aggregate maximum limit of indemnity of ... ... .... ... $240.00. At the outset we note that where, as here, medical and hospital benefits under Section E are claimed on the basis of total disability coverage under Section C, benefits payable under the former depend upon coverage under the latter. Accordingly we must direct our attention to Section C. In our view the language of Section C is plain, unambiguous, direct, and certain. Benefits are payable only in cases involving continuous and total disability within 30 days of the date of the accident preventing performance of every duty pertaining to the insured's occupation. It is difficult to conceive how any more explicit or limiting language could be used. The language of a contract governs its interpretation, if the language is clear and explicit. Section 13-704, R.C.M. 1947. The intention of the contracting parties is to be ascertained from the contract itself, if possible. Section 13-705, R.C.M. 1947. Where, as here, the language admits of only one meaning there is no basis for interpretation of the policy coverage under the guise of ambiguity. In the construction of a[n]    instrument, the office of the judge is simply to ascertain and declare what is in terms or in substance contained therein, not to insert what has been omitted, or to omit what has been inserted   . Section 93-401-15, R.C.M. 1947. Applying the undisputed facts of this case to the policy coverage discussed in the preceding paragraph, it is apparent that no benefits are payable here. The insured, by his own admission, worked continuously on his job as a tire recapper for a period of 3 to 3 1/2 months following a week layoff immediately after his injury. He testified, in substance, that he was able to do about one third of what he could do formerly on his job. While there were many duties connected with his job that he could not perform after his accident because they involved heavy lifting, he could do some of the tire buffing, some of the tire building, handle the customers, order supplies and some of the lighter duties of his job. This is not continuous and total disability to perform each and every duty pertaining to his occupation, incurred within 30 days of the accident. Any other conclusion is pure sophistry. Other courts have arrived at the same conclusion under similar facts and policy provisions. A draftsman who injured his back when the high stool on which he was sitting broke, and who worked approximately 41 out of 55 working days in an 11 week period following injury was held not entitled to benefits under an occupational disability policy that covered injuries that, wholly, and continuously disable the [Plaintiff] from the date of the accident from performing any and every kind of duty pertaining to his occupation. Grau v. Travelers Ins. Co. of Hartford, Conn., 303 Ill. App. 212, 24 N.E.2d 882. In Grau, the court grounded its decision in the following language: We think the statement of counsel for plaintiff, which we have quoted, states the controlling question in the case. Plaintiff's own testimony shows that after plaintiff was injured he worked approximately 41 days out of 55 over a period of 11 weeks. In this state of the record, we think it obvious that plaintiff was not `wholly and continuously disabled from the date of accident' and therefore the court did not err in directing a verdict. (Citing cases) While many jurisdictions outside Montana have interpreted total disability to signify something less than its literal meaning (See 24 A.L.R.3d 8, for collection of cases from all jurisdictions covering the effect of resumption of work), such cases do not in the main, as here, involve further limiting language such as preventing the policyholder from performing each and every duty pertaining to his usual occupation. See 23 A.L.R.3d 1117 § 3, and 1141 § 14, for collection of cases from all jurisdictions. In Montana under general disability policies, we have previously recognized that in order to recover total disability benefits one need not be incapable of performing any mental or physical task. Cacic v. Slovenska Narodna, etc., 102 Mont. 438, 59 P.2d 910; Seaman v. New York Life Ins. Co., 112 Mont. 328, 115 P.2d 1005. But the controlling point here is not whether the policyholder is totally disabled in terms of abject helplessness, but whether the insured's injuries did (1) continuously, necessarily and wholly disable the Insured and (2) prevent him from performing each and every duty pertaining to his usual business or occupation within 30 days of the accident as required by the policy. An Ohio case denying recovery to a cone grinder in a roller bearing plant who worked for more than 14 months continuously on a piecework basis averaging $75 per week following his alleged total disability, puts the matter this way: It seems to us that the plain and simple meaning of `wholly and continuously disable the insured and prevent him from performing every duty pertaining to his occupation' is entire disability and prevention from performing each one of the duties pertaining to his occupation;    The phrase does not say, `wholly and continuously disabled the insured so as to prevent him from performing every duty pertaining to his occupation,' but it does say, `wholly and continuously disable the insured and prevent him from performing every duty pertaining to his occupation,' that is to say, in order not to have his weekly indemnity cease he must be both wholly and continuously disabled and prevented from performing every duty pertaining to his occupation. Yeager v. Pacific Mutual Life Ins. Co., 166 Ohio St. 71, 139 N.E.2d 48. The coverage clause in the instant case is almost identical in pertinent parts. Accordingly, we hold as a matter of law, under the undisputed facts here, that the policyholder did not come within the policy coverage and is entitled to no benefits thereunder. We observe in passing that the coverage here afforded by the policy is very narrow and restrictive. We leave it to the legislature to determine whether it is good public policy to permit this type of policy to be sold in Montana. As long as it is permitted, as now, such policies must be governed by their restrictive terms. As no coverage exists in this case and plaintiff is entitled to no benefits thereunder as a matter of law, punitive damages are not recoverable in any event. Accordingly, no further discussion of this issue is necessary. The judgment of the district court is reversed and the case dismissed. Lest the reader be misled by the dissent of Mr. Justice John Conway Harrison, which was prepared subsequent to the foregoing majority opinion, a brief comment on the facts appears appropriate. The policyholder here raised no claim, contention or issue at the trial concerning partial disability coverage or failure of the insurance company to pay $50 in benefits thereunder. This issue is wholly extraneous to this lawsuit and constitutes nothing more than counsel's belated attempt to justify the verdict herein. JAMES T. HARRISON, C.J., and CASTLES, J., concur.