Court Opinion

ID: 9445090
Source: CourtListenerOpinion
Date Created: 2023-08-03 21:19:16.660972+00
Date Added: 2024-06-11T17:30:07.176300
License: Public Domain

MILLER, Circuit Judge
(dissenting).
It may well be that the judgment herein reviewed- should eventually be affirmed. But, in my opinion, the record in its present shape does not furnish a satisfactory basis for doing so, and the ease should be remanded for amplified or additional findings of fact.
The majority opinion well portrays the strong humanitarian appeal present in this case. The review of the evidence therein does not, however, reject or contradict the basic fundamental fact that on January 26, 1948, when, the insured died, the policy herein sued on was not in force or effect, having lapsed, for nonpayment of premiums, on January 23, 1946, approximately two years prior thereto. During that time no application was made for waiver of premiums'.
This Court has held in two recent decisions that 100% physical disability in and of itself is not sufficient to constitute “circumstances beyond his control” which under the statute would excuse the insured’s failure to apply for waiver of premiums. United States v. Cooper, 6 Cir., 200 F.2d 954; Gossage v. United States, 6 Cir., 229 F.2d 166. See also: McIntosh v. United States, D.C.E.D.Ky., 114 F.Supp. 241. The’facts in the present case are in many respects- analogous to the facts in those cases. The insured, although totally physically disabled, was not confined to his home. He made occasional trips to the center of'town. I dó not read the evidence as saying that he did not at any time go alone. '- On "one occasion he macle a trip by himself from his home in Louisville, Kentucky, to Lexington, Kentucky, and return. He received letters from the Veterans Administration and transacted necessary business with the Administration. It was .stipulated by the parties that from October 1,1947 to November 5,194.7 he was employed by the American Radiator and Standard Sanitary Corporation at Louisville, Kentucky, “during which period of time he worked 40 hours per week, resigning because of illness.”
In both the Cooper and Gossage cases, as well as in this case, there was 100% physical disability. In the Cooper case the insured had a severe heart lesion. The insured died from coronary thrombosis due to hypertension and arteriosclerosis. In the Gossage case, the insured was constantly under the care of physicians and spent considerable time in several different hospitals. He had a skin ailment known as “jungle rot”; his voice was constantly hoarse and he was short of breath. He often had fever, and it was also thought that he had a goiter. His trouble was later diagnosed as chest cancer, with death inevitable, which fact he knew several weeks before his death. In each of those cases this Court held that the failure of the insured to apply for waiver of premiums was not due to circumstances beyond his control. Unless the present case involves some additional material fact, it is necessarily controlled by our previous decisions in the Cooper and Gossage cases, although it is recognized that the cases cited in the majority opinion may have .established a contrary rule in some of the other circuits. The rule in those circuits, however, is also in conflict with the rulings in Aylor v. United States, 5 Cir., 194 F.2d 968, and Horton v. United States, 5 Cir., 207 F.2d 91, certiorari denied 346 U.S. 903, 74 S.Ct. 233, 98 L.Ed. 403. See also Novak v. United States, D.C.W.D.Pa., 107 F.Supp. 151.
The additional fact upon which the .ruling of the District Judge is based is contained in his finding that the insured “was mentally incapable of -knowing or realizing his condition.” This is the Court’s finding from a consideration of ■the evidence reviewed in the majority opinion. The review of the evidence in .the majority opinion, together with any conclusions there drawn by the Court, ■can not be used on this appeal as findings, since findings are to be made by the trial court, not by this Court on re*405view. Paramount Pest Control Service v. Brewer, 9 Cir., 170 F.2d 553; Campbell v. Campbell, 83 U.S.App.D.C. 237, 170 F.2d 809, 810. I am of the opinion that, in view of other factors hereinafter referred to, the finding of the District Judge is not definite enough to advise us of the exact factual situation presented and to afford us a satisfactory basis for a review.
If the finding is to be construed as meaning that the insured was mentally incompetent, it would furnish the neces.sary factual basis for the Court’s ruling. But such a finding would be contrary to Paragraph 11 of the Stipulation between ihe parties that “at no time subsequent to the insured’s discharge from the United States Navy on September 26, 1945 was the insured mentally incompetent,” and would have to be set aside. If it be •construed as meaning a certain limited mental disability, there is a serious question if such a finding is not also in conflict with the Stipulation.
If the finding be construed as meaning that the insured, although mentally competent, did not know that “his condition” was one of total disability, it, together with other facts, might bring the case within the rule stated in Landsman v. United States, 92 U.S.App.D.C. 276, 205 F.2d 18. As pointed out in Gossage v. United States, supra, the rule to be applied in such a situation is still an open question in this Circuit. But such a finding would present a serious question as to whether it was clearly erroneous in view of another finding of the District Judge that on September 26, 1945 the veteran received an honorable medical discharge because of total physical disability and drew disability benefits for one hundred percent disability until some time in August 1947 when his rate of disability was cut to 30%. There is also the uncontradicted evidence that when he was notified by the Veterans Administration on August 20, 1947 of the reduction, he attempted to have the 100% rating restored. Although the insured may not have known the exact cause of his trouble, I find no evidence directly supporting a finding that the insured did not know of his 100% disability rating.
If the finding be construed as meaning that the insured, although knowing that he was rated 100% disability, did not know or realize that “his condition” was Ewing’s Sarcoma, a most malignant cancer-type growth, or that his disease was incurable, a question of law is presented which is not covered by the previous ruling of this Court or by the ruling in Landsman v. United States, supra. The majority opinion apparently relies in part upon the assumed fact that the physicians who examined the insured were ignorant of the fact that he had Ewing’s Sarcoma. There is no finding to that effect. On the contrary, Paragraph 8 of the Stipulation between the parties reads as follows: “The insured was given an honorable discharge from the United States Navy on September 26, 1945, after having received treatment at the Navy Hospital, Yosemite, California, on August 9, 1945, wherein his illness was diagnosed as ‘Sarcoma, Ewing’s, Ninth Left Rib;’ this condition having been first discovered by X-ray at Pearl Harbor on June 15, 1945, the operation having taken place at Oakland, California, on July 7, 1945, wherein the anterior portion of the ninth rib was removed with borders of the adjacent rib and a tumor mass.” I also think reliance is erroneously placed upon the ruling of the Veterans Administration which changed the insured’s disability rating from 100% to 30%. This occurred on August 20, 1947, which was subsequent to the time (August 1, 1947) when any application for waiver of premiums was barred by the statute. Obviously, his failure to apply for the waiver by August 1, 1947 was not induced by this ruling of August 20, 1947.
There is no finding that the Veterans Administration or the doctors who examined and treated the insured prior to the August 20, 1947 ruling, acted fraudulently, negligently, or improperly in the handling of this case. We can not make such a finding here.
*406In view of the different rulings throughout the Circuits, as shown by the cases cited in Gossage v. United States, supra, and in order for this Court to have before it the exact question it is called upon to decide, I would remand this case to the District Court for amplification of its findings with respect to the factual questions referred to herein. Winnick v. Commissioner, 6 Cir., 199 F.2d 374; Maher v. Hendrickson, 7 Cir., 188 F.2d 700, 702; Polaroid Corp. v. Markham, 80 U.S.App.D.C. 225, 151 F.2d 89, 90; Compare: Kelley v. Everglades Drainage District, 319 U.S. 415, 422, 63 S.Ct. 1141, 87 L.Ed. 1485.