Court Opinion

ID: 9723346
Source: CourtListenerOpinion
Date Created: 2023-08-26 10:12:14.265085+00
Date Added: 2024-06-11T18:24:47.380932
License: Public Domain

Lindemer, J.
(dissenting.) I must dissent because I believe the trial judge was justified in concluding that plaintiff was not suffering from a "confining sickness” as defined in the insurance contract.
In order for this plaintiff to prevail on appeal from the adverse decision of the trial judge, he must be able to establish that the decision below was clearly erroneous. GCR 1963, 810(2). Kevreson v Michigan Consolidated Gas Co, 374 Mich 465; *625132 NW2d 622 (1965). I do not believe the record permits such a finding by an appellate court.
Plaintiff testified that he was advised by his attending physician to engage in "a small amount of exercise, what I felt like I could do — no lifting, no strenuous work, and try to stay out of the terrific heat and excitement and cold”.
Plaintiff admitted that he had engaged in certain activities outside of his "residential premises or yard”. Those activities included accompanying his wife to a department store, exercising the family’s Boston Bull Terrier, and occasionally driving the car in order to pick up his daughter from school or take his mother shopping. Plaintiff also admitted once attending a funeral for a relative and on another occasion attending a hockey game. Plaintiff explained that he found both of these activities too stressful and had resolved not to attend similar functions in the future. Plaintiff admitted that he owned and occasionally operated a self-contained motor home and that he once took it to Hesperia, Michigan for an overnight trip.
In addition to plaintiff’s own testimony, the trial judge had the testimony of two physicians on which to rely. Both physicians agreed that plaintiff is substantially free to come and go as he pleases, subject to avoiding harsh weather conditions and particularly stressful situations. Plaintiff’s own doctor did not believe that Mr. Crowell was suffering from a "confining sickness”. Defendant’s expert witness reached the same conclusion. He testified that there was no apparent reason why plaintiff must necessarily limit himself to activities in his home or yard or other ventures of a strictly therapeutic nature.
It is evident from the record that plaintiff engaged in activities not literally permitted by the *626insurance contract. It is equally evident that plaintiff was encouraged by his physician to engage in these activities. Plaintiff argues, however, that prior case law indicates that his contract must be liberally construed to allow him to occasionally escape the confines of his house or yard for other than the stated exceptions.
In Hoffman v Michigan Home & Hospital Ass’n, 128 Mich 323; 87 NW 265 (1901), the Court found that a strict house confinement clause should be interpreted to allow the insured to "step out of doors now and then, or to occasionally go to the office of his physician”. The Court agreed that "an occasional airing is essential to a speedy recovery” and "[a] rule which would make nugatory a contract having for its special object indemnity on account of sickness, because the insured took an occasional and necessary airing, would be unreasonable”.
The reasons for application of the "substantial confinement doctrine” to situations involving strict confinement clauses which would completely deny recovery are obvious. Defendant does not suggest that the Court must interpret this contract language literally but suggests that a "flexible, reasonable standard should be used * * * giving recognition to the entire benefit structure contained in the policy”. While I agree that the rule of contract interpretation from the Hoffman case is applicable to this case, the facts of the Hoffman case are quite different from the facts of this case. In Hoffman, the contract required defendant to be totally disabled and continuously confined to either his bed or to the house. In the instant case, the plaintiff is permitted to make unlimited use of his yard and necessary visits to health facilities. And unlike the total forfeiture of benefits in the *627Hoffman case, plaintiff in this case was entitled to and did receive benefits for 24 months regardless of the confinement clause.
The majority would deny relief if the excursions were primarily for business or personal reasons, but would grant relief for nonproductive activities that have therapeutic value. The problem with this approach is that most of plaintiffs daily activities outside his home blended the conduct of personal business with therapeutic benefits.
The thrust of the majority opinion is to redraft the definition of the confining sickness clause to allow unlimited nonproductive excursions having some therapeutic value. It is obvious that a person in plaintiffs condition must derive some incidental therapeutic benefit from the activities plaintiff engaged in. However, these incidental benefits cannot justify the otherwise personal nature of the activities outside of his home that plaintiff was able to accomplish on a nearly routine basis.
In rendering his decision the trial judge said:
"The history of the court’s definition of confining illness has been to enlarge its meaning over the years, to allow visits to the doctors’ offices and to the hospital without violating the terms of the confining illness clauses. In effect, in this case the court is asked to enlarge upon those holdings to say that practically anything that has therapeutic value can be allowed without violating the confining illness clauses.
"It is obvious that it is beneficial to the well-being of this plaintiff that he be allowed to take such ventures away from the home and premises as are consistent with the stresses that he can tolerate comfortably. However, the court is of the opinion that I may not enlarge upon the terms of the written agreement between the parties so as to render meaningless the contractual definition placed upon confining illness.”
*628The record establishes that plaintiff was not substantially confined to his premises or yard except for necessary visits to a hospital or doctor’s office for treatment.
I would reverse the Court of Appeals and affirm the decision of the trial court.
Coleman and Ryan, JJ., concurred with Lindemer, J.