Court Opinion

ID: 9630125
Source: CourtListenerOpinion
Date Created: 2023-08-22 10:01:20.781725+00
Date Added: 2024-06-11T18:07:31.517061
License: Public Domain

McCOMB, J., Dissenting.
I dissent: Prom a judgment in favor of plaintiff after trial before a jury in an action to enforce an insurance policy providing for payments to plaintiff if he be continuously and permanently unable to engage in any occupation or perform any work for any kind of compensation of financial value, defendant appeals.
The essential facts are:
Defendant issued a policy of insurance to plaintiff containing among others the following provisions:
“If the Insured shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such- an extent that he (or she) is rendered wholly, *83continuously and permanently unable to engage in any occupation or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime, and if such disability shall occur at any time after the date hereof, while this Policy is in full force and effect, and while the Insured is less than sixty years of age, and before any non-forfeiture provision shall become operative, the Company, upon receipt of due proof of such disability, will grant the following benefits: ...”
After the policy was issued plaintiff, who was engaged in the hardware business, became physically unable to continue in his business and, upon his making proper proof, defendant made disability payments to him from October 14, 1929, to October 17, 1938. October 21, 1938, defendant advised plaintiff that he was no longer entitled to disability benefits and declined to make further payments. A number of doctors testified at the trial that in their opinion plaintiff’s health would permit him to engage in some occupation not involving physical exercise but of financial value.
Defendant relies for reversal of the judgment on the proposition that it was error for the trial court to instruct the jury that the clause in the life insurance policy above quoted meant that plaintiff was entitled to disability benefits thereunder if he was unable to perform the substantial and material acts of “his” business, and that in place of such instruction the jury should have been instructed that such clause meant that plaintiff was entitled to disability benefits only when his disability was such that he would be unable to perform the substantial and material acts connected with “any” business.
This proposition is tenable. It is to be noted that:
(1) The policy which is the basis of the present suit is a total disability policy as distinguished from an occupational policy. By an occupational policy the insured may recover upon a showing that he is substantially unable to perform the acts required by his business or profession, while under a total disability policy he must prove his disability is such as to prevent him from engaging in any occupation or performing work for compensation of financial value. Most of the cases cited by plaintiff arise under provisions of occupational policies and are, therefore, inapplicable to the facts of the instant ease.
*84(2) Defendants concede that a liberal construction is to be placed upon clauses of an insurance policy (Wright v. Prudential Ins. Co., etc., 27 Cal. App. (2d) 195, 205 [80 Pac. (2d) 752] ; Hill v. New York Life Ins. Co., 38 Cal. App. (2d) 627, 632 [101 Pac. (2d) 752]). In the instant ease the trial court instructed the jury at plaintiff’s request as follows:
“Plaintiff’s Instruction No. 8.
“The words in the policy of insurance in evidence in this case which deal with the right of the assured to receive disability benefits if he is totally and permanently disabled read as follows:
‘If the insured shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such an extent that he (or she) is rendered wholly, continuously and permanently unable to engage in any occupation or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime . . . ,’
“I charge you that the law is and the disability clause which I have quoted to you means that the insured is entitled to the disability benefits when his disability is such that he is unable to perform the substantial and material acts of his business or occupation in the usual customary way and when such disability is presumably permanent.
“The expressions in the policy ‘any occupation’ and ‘any work’ mean the ordinary employment of the insured or such other employment, if any, approximately (sic) the same livelihood, as the insured might fairly be expected to follow, in view of his station, circumstances, and the physical and mental capabilities. If the insured is so incapacitated that substantially all of the material activities of any such employment are reasonably closed to him, he is totally disabled within the meaning of the policy.”
“Plaintiff’s Instruction No. 5.
“I instruct you that the provisions of the insurance contract in this case, relating to the disability benefits, do not require that the disease or diseases from which the plaintiff may be suffering, shall render him absolutely helpless, but such provisions are construed in law as meaning such a disability as renders him unable to perform the substantial
*85and material acts of his business or occupation in the usual and customary way. The fact that the insured may have done some work or engaged in some activities of pleasure, or transacted some business duties during the time for which he claims payment for total disability, is not conclusive evidence that his disability is not total and permanent within the meaning of the policy. The test of disability is not what the plaintiff has actually done in an effort to perform the duties of his occupation, but what in the exercise of due prudence he was reasonably able to do. This is a question of fact which you should determine under all the evidence in the case and under all of the instructions of the Court on the law of the ease, and if you find from a preponderance of the evidence and under these instructions that the plaintiff has been so totally and permanently disabled, your verdict will be for the plaintiff and against the defendant.”
“Plaintiff’s Instruction No. 6.
“The defendant in this case admits that the plaintiff is, and for many years has been, suffering from the disease known as chronic asthma but claims that this does not prevent the plaintiff from following some sedentary occupation, and therefore, that under the terms and provisions of the contract of insurance he is not totally and permanently disabled. I instruct you that it is for you to determine as a fact under all the evidence in the case and the instructions of the Court, whether or not the plaintiff is totally and permanently disabled. In that connection I charge and instruct you that if the plaintiff’s condition, as a result of the disease, is such that common care and prudence required that he desist from the transacting of business or working, and his condition is presumably permanent and continuous, he is permanently and totally disabled, within the meaning of the contract, though he may not be physically disabled to perform occasional acts of pleasure or acts connected with his business, profession or occupation.”
It is the law that under a clause in an insurance policy such as that involved in the present ease, defendant is not liable unless plaintiff be wholly disabled from engaging in “any” occupation of employment for profit. It is not sufficient that the evidence disclose that he is disabled from engaging in “Ms” occupation. In referring to a clause similar *86to the one here involved, the Supreme Court of New York, Appellate Division (Garms v. Travelers’ Ins. Co., 242 App. Div. 230 [273 N. Y. Supp. 39]), speaking through Mr. Justice Martin thus accurately states the rule:
“ . . . The Insurance Company is not liable unless there be proof that the insured had been wholly disabled by bodily injuries or disease and will be continuously and wholly prevented thereby for life from engaging in any occupation or employment for wage or profit. The trial court sent this question to the jury, and a verdict was rendered for the plaintiff. To prove the second cause of action it was necessary for plaintiff to show that he had sustained bodily injury as a result of which he would thereafter be prevented for life, from engaging in any occupation or employment for wage or profit.”
In accord with this rule are the following cases: Metropolitan Life Ins. Co. v. Guinn, 199 Ark. 994 [136 S. W. (2d) 681, 684] ; Cooper v. Metropolitan Life Ins. Co., 217 Pa. 405 [177 Atl. 43, 44] ; Thigpen v. Jefferson Standard Life Ins. Co., 204 N. C. 551 [168 S. E. 845, 847] ; Jones v. Connecticut General Life Ins. Co., 114 W. Va. 651 [173 S. E. 259, 262]; Wyckoff v. Metropolitan Life Ins. Co., 302 Ill. App. 241 [23 N. E. (2d) 802, 804]; Kaneb v. Equitable Life Assur. Soc., 304 Mass. 309 [23 N. E. (2d) 889, 890] ; Shabotzky v. Equitable Life Assur. Soc., 257 App. Div. 257 [12 N. Y. Supp. (2d) 848, 852] ; Hill v. New York Life Ins. Co., 38 Cal. App. (2d) 627, 636 [101 Pac. (2d) 752].
Applying the foregoing rule to the present case, it is apparent that the instructions given by the trial court were erroneous in stating that defendant was liable to plaintiff if the jury should find that plaintiff was disabled from following “his” occupation, nor was this error cured by the fact that the trial court gave other instructions which correctly stated the law. Such instructions simply were contradictory of the instructions stated above and thus tended to confuse the jury (Starr v. Los Angeles Ry. Corp., 187 Cal. 270, 280 [201 Pac. 599]). Incorrect instructions on a material issue will not be cured by a correct statement of the law in another instruction, for it is impossible to determine which instruction the jury has followed (Gaster v. Hinkley, 85 Cal. App. 55, 62 [258 Pac. 988]). Article VI, section 4½ of the Constitution of the State of California is inapplicable to the facts *87of the instant case, for the reason that it is not possible to determine whether the 'jury would have returned the same verdict had they been correctly instructed, since the record in the present case discloses that plaintiff had the equivalent of a high school education, had studied accounting and bookkeeping, and had engaged in business as a salesman over a long period of years. In the opinion of a number of the doctors, who testified at the trial, plaintiff at the time of the trial was able to engage in some gainful occupation.
For the foregoing reasons the judgment in my opinion should be reversed.
A petition for a rehearing was denied June 23, 1941. Me-Comb, J., voted for a rehearing.
Appellant’s petition for a hearing by the Supreme Court was denied July 24, 1941.