Court Opinion

ID: 9641759
Source: CourtListenerOpinion
Date Created: 2023-08-22 17:39:51.069266+00
Date Added: 2024-06-11T18:10:39.600354
License: Public Domain

THOMAS, Circuit Judge
(dissenting).
In my opinion the finding and decision of the majority is contrary to the law of the case. The policies in suit are Missouri contracts and their construction is governed by Missouri law. Turner v. New York Life Insurance Co., 8 Cir., 100 F.2d 193; New York Life Ins. Co. v. Levin, 8 Cir., 102 F.2d 403, 405.
The injury resulting in the insured’s disability occurred on June 29, 1931. From that date until September 29, 1933, the insurance company conceded that the disability was “total and presumably permanent” within the meaning of the policies, paid the insured the benefits provided therein and waived payment of premiums.
Since the latter date the policies here in suit have been much litigated. A case involving them has been here before. New York Life Ins. Co. v. Stoner, 8 Cir., 92 F. 2d 845, 848. In that case this court held that under the provisions of the policies “a judgment in favor of the insured for one period of time did not bind the insurance company in an action for disability benefits for a subsequent period.” In addition to that case three different suits have been brought by Stoner in the state courts of Missouri to recover benefits for subsequent -periods. The first suit was brought on the four policies in the Circuit Court of Buchanan County to recover disability benefits ffor-the period from September 29, 1933, to March 29, 1934. That case was tried and appealed to the Kansas City Court of Appeals. Stoner v. New York Life Ins. Co., Mo.App., 90 S.W.2d 784. The second suit was brought in the Circuit Court of Platte County (transferred for trial to Daviess County) on two of the policies to recover for the period from April 29, 1934, to May 29, 1936. This case was tried and appealed to the Kansas City Court of Appeals. Stoner v. New York Life Ins. Co., 232 Mo. App. 1048, 114 S.W.2d 167. The third suit on the two policies not declared on in the suit in Platte County was brought in the Buchanan County Circuit Court to recover for the period from May 29, 1934, to May 29, 1936.
The period. covered by the present suit for a declaratory judgment is from May 29, 1936, to January 7, 1938.
In my view the majority opinion errs in that (1) the issues are not correctly stated, (2) the evidence in reference to the injury sustained by the insured and its effect is minimized, (3) the Missouri law is misinterpreted or ignored, and (4) an undue emphasis is placed on the fact that during the period under inquiry the insured was able successfully to direct his farm operations. This being a minority opinion I shall direct attention to these matters briefly without undertaking to demonstrate them at length.
1. The Issues. — To sustain the burden of proving that the insured was not totally and presumably permanently disabled within the meaning of the policies during the period in issue, the plaintiff introduced in evidence the policies and a transcript of the .testimony taken in the trial in Daviess County and which was before the Kansas City Court of Appeals and considered by that court in the opinion in 232 Mo.App. 1048, 114 S.W.2d 167.
The policies provide that the company agrees to pay monthly benefits and to waive premiums “upon receipt of due proof that the insured is totally and presumably permanently disabled before age sixty, as defined * * *. ” The definition recites: “Disability shall be considered total whenever the insured .is so disabled by bodily injury or disease that he is wholly prevented from performing any work, from following any occupation, or from engaging in any business for remuneration or profit.”
In his applications for the policies the insured stated that he was a farmer, that he owned and operated a grain and stock farm, and that he had had no previous occupation.
*880In its petition for a declaratory judgment the plaintiff, appellant, alleged that “the defendant has been engaged in a recognized work, business and occupation for profit and from which he obtains a livelihood.”
Upon the trial the evidence offered by appellant all related to the operation of the grain and stock farm which the insured was operating at the time the policies were issued. In objection to a question counsel for appellant said “the exact duties are stated in the application for insurance and no other duties are covered by the issues in this case.”
The appellant offered no evidence to prove, and made no claim, that the insured could perform any work, follow any occupation or engage in any business for profit other than in the operation of the farm which he was operating when the policies were issued.
The majority opinion erroneously states that “The appellee contends that the construction [of the policies] should go further and the phrases interpreted as limited to the business or occupation in which insured was engaged when the insurance policies were issued.” The opinion then clouds the issues by holding that the burden is on the appellant but in effect dealing with the problem as if the burden were on appellee. It works out that the majority avoids the application of the. Missouri law by an attempt to distinguish between the policies in suit and “occupational insurance” policies. Such a distinction is not warranted. The appellant having the burden of proof tried this case on the theory that the insured is-engaged in the “occupation” and business of operating a grain and stock farm.
2. The Injury and Its Effects. — The ap-pellee was injured June 29, 1931. The bones in his ankle were broken. The main bone in his leg was broken about four inches above the ankle. The ankle became ankylosed. Infection developed resulting in calcification and the destruction of the ankle joint. The muscles of the lower leg are attached to the bone and do not function. The injured foot and ankle are larger than normal and are painful. There is permanent infection. The blood does not circulate properly in the foot and it is cold.
After the injury insured was in the hospital two months. He was then in bed at home for three.months; then in a wheel chair for a month; then on two crutches for a month; then on one crutch and a cane for a month; and since that time he can get about with one cane. He can walk from one to two blocks in a day, but v/hen he does so, his ankle swells and he can not sleep at night for the pain. He can drive his automobile, but it has the same effect as walking. He can not walk on rough or uneven ground. This condition is permanent, and he can do no physical labor.
3. The Missouri Law. — The latest pronouncement of the Supreme Court of Missouri in a case of this character is found in Heald v. Aetna Life Ins. Co., 340 Mo. 1143, 104 S.W.2d 379, 382. The policy there considered provided for total disability benefits if the injury “wholly and continuously disable the insured from date of accident and prevent him from performing any and every duty pertaining to his occupation.” With reference to the rule of construction the court said: “ * * * that where the language of an insurance policy is plain and unequivocal there is no room for construction and the words employed must be given their usual and natural meaning. State ex rel. Commonwealth Casualty Co. v. Cox, 322 Mo. 38, 14 S.W. (2d) 600, loc. cit. 602, 603. Such is the rule, but to that rule there is an equally well settled exception, viz.: If the language is ambiguous, i. e., open to different interpretations, its meaning is to be determined by judicial construction, and in insurance contracts the construction most favorable to the insured must be adopted. State ex rel. Security Ins. Co. v. Allen ct al., 305 Mo. 607, loc. cit. 614, 267 S.W. 379, 381. The rule prevailing in this state and in most other jurisdictions is to the effect that a provision such as the one before us, with respect of the phrase ‘any and every duty,’ would render the contract utterly useless to, an assured and would be nothing short, practically speaking, of collecting a premium without rendering a consideration in so far as the total disability clause is concerned (James v. United States Casualty Co., 113 Mo.App. [622] loc. cit. 629 [88 S.W. 125]); so said provision in this policy must be construed so as to make the provision effective. The rule prevailing in most jurisdictions is that the ‘total disability contemplated by an accident policy, or the disability clause of a life policy does not mean, as its literal interpretation would require, a state of absolute helplessness; rather, that the disability contemplated means inability to do all the substantial and material acts necessary to the prosecution of the insured’s, or, in many instances, any, business or occupation, in a customary and usual manner.’ Headnotes *881to Annotations in 98 A.L.R. 789. The leading cases cited therein from this state are James v. United States Casualty Co., 113 Mo.App. 622, 88 S.W. 125, 127; Foglesong v. Modern Brotherhood of America, 121 Mo.App. 548, 97 S.W. 240; Bellows v. Travelers’ Ins. Co. (Mo.Sup.) 203 S.W. 978.” (Italics supplied).
The Bellows case, supra, was decided by the Supreme Court of Missouri in 1918. The court therein approved and followed the rule in the James case, 1905, supra, that total disability, as used in an insurance policy, does not mean “that the assured was rendered absolutely and literally unable to perform any part of'his occupation, but that he was disabled from performing substantially the occupation stated in the policy.” [203 S.W. 983.]
The Foglesong case referred to in the opinion in the Heald case, supra, was decided by the Kansas City Court of Appeals in 1906. The contract in that case provided for the payment of disability benefits upon proof “of the permanent and total disability of the said member (plaintiff), which renders him unable to carry on or conduct any vocation or calling.” The insured was a farmer. His right leg was afflicted with a permanent disease which at first confined him to his bed for three months. There was some improvement so that he could walk on crutches and after a while with the aid of a cane. “It was shown that he directed the work to be done on his farm, and that he performed some labor himself”. He drove the wagon in hauling corn and coal, and he directed his sons in carrying on the business of the farm. The court said: “The language of the policy, ‘permanent and total disability of said member, which renders him unable to carry on or conduct any vocation or calling,’ the vocation of the insured not being designated, should be construed as meaning, if anything, the vocation or calling in which he might be following at the time he became disabled.” (citing authorities) The court then approved the rule of the James case, supra, that permanent and total disability means to be “disabled from performing substantially- the occupation stated in the policy.”
Having been approved by the Supreme Court in the Bellows case, the James and Foglesong cases, supra, have long been accepted by the Supreme and Appellate Courts of Missouri as correctly stating and applying Missouri law and as authorities governing the interpretation of all substantially similar forms of disability provisions.1
The evidence introduced by appellant showed that the “substantial and material acts necessary to the prosecution” of carrying on the occupation and business of operating the insured’s 305-acre farm consisted of two parts, one of which was largely physical and the other mental. They were (a) handling horses and livestock, plowing, listing, cultivating corn, sowing, reaping, harvesting crops, walking and husking corn, scooping corn and grain, pitching hay, physical work of all kinds; and (b) directing and supervising hired men, deciding when to plant and harvest, buying and selling livestock and grain. Before the injury the insured was able to do and did all of these duties. Since the injury he has been and always will be unable to do any of the *882physical acts necessary to farming. He can now and ever since the injury occurred has been able to direct the farming operations, but he can not supervise the work. He buys livestock through a broker, but he can not go to the stock yards and inspect-the stock and never can do so.
In the Heald case the court pointed out that the business or occupation of the insured cannot be considered as a “double occupation * * * composed of the separate functions.” The business or occupation must be considered as “a unit, involving interrelated duties, to be normally carried on by the performance of all the substantial duties involved in it.”
On both appeals in the suits on these policies the Kansas City Court of Appeals considered the testimony and reviewed the decisions of the Supreme and Appellate courts of Missouri and held that the question of total and presumably permanent disability was a jury question. In a similar case arising in Kentucky where the law is the same as in Missouri and in which the language of the policy in suit was equivalent to that in these policies and the testimony in reference to the injury very much the same, the Circuit Court of Appeals of the Sixth Circuit held that the question of total disability was for the jury, Equitable Life Assur. Soc. of the United States v. Bomar, 6 Cir., 106 F.2d 640, 643, and that the evidence was sufficient to sustain a verdict against the insurance company.
In the present case Judge Otis of the district court, without reference to the decisions of the Missouri courts, found that the plaintiff did not sustain the burden of proof which it assumed and that Stoner was totally and permanently disabled during the period in issue within the meaning of the policies. I do not think his finding upon this record can be held under the Missouri law to be “clearly erroneous”. Rule 52(a) of the Rules of Civil Procedure, 28 U.S.C. A. following section 723c.
4. The Conclusion. — The majority conclude that because the insured is a healthy man except for the injury to his limb, is able to walk short distances, can drive his car for some distance without undue pain and is able to direct successfully the operations of his farm, the result must necessarily follow that a finding that he is “totally disabled” within the meaning of the policies can not be sustained. They arrive at this conclusion by emphasizing these facts in contravention to the rule that the evidence should be viewed in the light most favorable to the insured on this appeal and by entirely divorcing from consideration that part of the insured’s occupation requiring physical labor. ^ This in my opinion is a substitution of the views of a federal court for the law of Missouri.
Stoner, even if completely paralyzed but still able to be driven about in an ambulance, might well continue to operate his farm as successfully as he now does; and the argument might still be advanced that he was not “wholly prevented from * * * engaging in any business for remuneration or profit.” It is to avoid the harshness of a literal application of the terms of policies of this kind that has led the courts of Missouri and those of other jurisdictions to hold that disability is total when the insured is unable to perform all the substantial and material acts of his business or occupation in a customary and usual manner. To this rule the further qualification is added that the insured’s business must not be viewed as a double occupation made up of separate functions but must be considered as a unit involving interrelated duties.
The majority refuse to apply these principles to the facts in the instant case. I am of the opinion that under the law of Missouri the evidence amply sustains the finding of the district court.
The judgment appealed from should be affirmed.

 Burns v. Ætna Life Ins. Co., Mo. App., 123 S.W.2d 185; Stoner v. New York Life Ins. Co., 232 Mo.App. 1048, 114 S.W.2d 167; Smith v. Metropolitan Life Insurance Co., Mo.App., 108 S.W.2d 995; Pogue v. Metropolitan Life Ins. Co., Mo.App., 107 S.W.2d 144; Barton v. Metropolitan Life Insurance Co., Mo. App., 103 S.W.2d 889; Corcoran v. Metropolitan Life Ins. Co., Mo.App., 93 S.W.2d 1027; Stoner v. New York Life Ins. Co., Mo.App., 90 S.W.2d 784; Heald v. Ætna Life Ins. Co., Mo.App., 90 S.W.2d 797, affirmed in 340 Mo. 1143, 104 S.W.2d 379; Farmer v. Metropolitan Life Ins. Co., 230 Mo.App. 80, 85 S.W. 2d 235; Young v. Metropolitan Life Ins. Co., 229 Mo.App. 823, 84 S.W.2d 1065; Moss v. Metropolitan Life Ins. Co., 230 Mo.App. 70, 84 S.W.2d 395, reviewed on certiorari in State ex rel. Metropolitan Life Ins. Co. v. Hostetter, 338 Mo. 589, 92 S.W.2d 112; Buis v. Prudential Ins. Co. of America, 229 Mo. App. 190, 77 S.W.2d 127; Kane v. Metropolitan Life Ins. Co., 228 Mo.App. 649, 73 S.W.2d 826, reviewed on certiorari in State ex rel. Metropolitan Life Ins. Co. v. Allen, 337 Mo. 525, 85 S.W.2d 469; Rickey v. New York Life Ins. Co., 229 Mo.App. 1226, 71 S.W.2d 88; Hurt v. Equitable Life Assur. Soc., Mo.App., 53 S.W.2d 1101; Katz v. Union Central Life Ins. Co., 226 Mo.App. 618, 44 S.W.2d 250; Frost v. Central Business Men’s Ass’n, Mo.App., 246 S.W. 628; Ramsey v. General Accident, Fire & Life Ins. Co., 160 Mo.App. 236, 142 S.W. 763; Albert v. Metropolitan Life Ins. Co., Mo.App., 95 S.W.2d 343.