Court Opinion

ID: 9626159
Source: CourtListenerOpinion
Date Created: 2023-08-22 08:04:07.158319+00
Date Added: 2024-06-11T14:57:30.946941
License: Public Domain

Fatzer, J.,
concurring: I concur in the reversal of this case for the reason stated in paragraph 2 of the Syllabus, but feel compelled to note briefly my objection to the district court’s construction of the policy and its application of I (2) (b) to the evidence.
In my judgment, the provisions of I (2) (b) have no application to the evidence presented. The evidence clearly established that plaintiff suffered an accidental injury when he fell on the porch of his home on February 5, 1962. That occurrence contained all the elements of an accident recognized by this court—it was “undesigned, sudden, and unexpected event, usually of an afflictive or unfortunate character, and often (but not necessarily) accompanied by a manifestation of force.” (Gilliland v. Cement Co., 104 Kan. 771, 180 Pac. 793; Pinkston v. Rice Motor Co., 180 Kan. 295, 303 P. 2d 197.)
Section I (2) (a) of the policy defines “such injury” which determines when monthly accident benefits under F (1) occur, as follows: “‘Such injury’ as the term is used in this policy, is defined as bodily injury brought about by an accidental cause and not other-wiser The definition continues and clearly determines by its own language when the accident benefits of the policy shall apply and when the sickness benefits of.the policy shall apply, and states: “Bodily injury, fatal or non-fatal, not resulting from accidental cause shall be considered only under the sickness provisions of this policy.”
The only exception with respect to when bodily injury brought about by accidental cause is not payable under the accident benefit section of the policy is a loss defined in 2 (a) (c) as hernia of any type, heatstroke or sunstroke which shall be classified as sickness. This provision of the policy is not here involved. Total disability which the plaintiff seeks, is payable under F, monthly accident benefit when “such injury,” i. e., when bodily injury is brought about by accidental cause (I [2] [a]), which, independently of any and all other causes, totally and continuously disables the insured.
*585As established by the evidence, the plaintiff’s fall produced his bodily injury, and the fact that it “triggered” the dormant osteoarthritic condition in his knees, which had not previously prevented his working, is virtually of no significance. Under no circumstances can it be said that his condition became one which might be considered under I (2) (b) of the policy. In Silverstein v. Metropolitan Life Ins. Co., 254 N. Y. 81, 171 N. E. 914, the insured was lifting a milk can into an icebox and slipped and fell, the can striking him in the abdomen causing great pain and an operation revealed that he had a duodenal ulcer which had been previously unknown, the blow to the ulcer resulting in peritonitis which caused the injured’s death. In the opinion Mr. Justice Cardozo said:
“We think the evidence sustains a finding that the ulcer was not a disease or an infirmity within the meaning of the policy ... A policy of insurance is not accepted with the thought that its coverage is to be restricted to-an Apollo or a Hercules.” (p. 84.)
In Thibodeaux v. Pacific Mutual Life Insurance Co., 237 La. 722, 112 So. 2d 423, the insured had a congenital back defect and like the plaintiff, lived with the defect and performed heavy manual labor up to the day of his accident; the congenital defect making, the injury more serious than it might have been. In the opinion it was said:
“A review of authorities convinces us that where an insured has a dormant condition and such condition is awakened by accident, the condition is not deemed the cause of the disability or loss which the insured suffers. (Cases cited.)” (p. 735.)
Plaintiff’s bodily injury was brought about by accidental cause, independently of any and all other causes, and the fact that the accident also served to aggravate or accelerate an existing condition or intensify the affliction does not change its occurrence as being, brought about by accidental cause.
It is well established in this jurisdiction that no standard of health, is prescribed for workmen, and the district court should look to the-injury and not to the preexisting infirmities to determine the plaintiff’s benefits under the policy.