Court Opinion

ID: 9716205
Source: CourtListenerOpinion
Date Created: 2023-08-26 06:30:49.945611+00
Date Added: 2024-06-11T09:58:55.288229
License: Public Domain

JUSTICE LINDBERG, specially concurring: I respectfully dissent from the majority reasoning that the disability provision is so ambiguous as to be interpreted against the insurance company. (Bessler v. John Hancock Mutual Life Insurance Co. (1981), 99 Ill. App. 3d 230, 233, 425 N.E.2d 508.) While acknowledging that the policy must be read as a whole, the majority, nonetheless, does not cite the proof-of-loss and time-of-payment-of-claims provisions which are also found in the policy. Therefore, I conclude that when the policy is addressed in its entirety, the disability provision is not ambiguous and the burden of proof is upon plaintiff to prove his continuing disability. At the outset a distinction should be kept in mind. While plaintiff, at least initially, was considered totally disabled he was never determined to be permanently disabled. Plaintiff maintains that, although initially an insured has the burden of proving he is totally disabled, if an insurer makes a disability payment it has the burden of proving the insured is no longer totally disabled. Based upon this allocation of the burden of proof, plaintiff further maintains that “defendant did not sustain its burden.” This last contention need not be addressed because I believe the trial court properly placed the burden of proving total disability on plaintiff. Neither party has cited, and my research has not disclosed, an Illinois case deciding this issue. Authorities from other jurisdictions are divided on the question of whether the making of a payment for disability shifts the burden to the insurer to prove disability has ceased. (See, e.g., Aetna Life Insurance Co. v. Fruchter (Fla. 1973), 282 So. 2d 36; Forman v. Prudential Insurance Co. of America (1944), 310 Mich. 145, 16 N.W.2d 696; 46 C.J.S. Insurance sec. 1319 (1946).) Although these authorities appear to have established rules generally applicable in all cases in which an insurer has started and then discontinued disability payments, I believe that the issue raised can only be resolved by applying general principles of Illinois law to the specific insurance policy at issue. Generally, a plaintiff has the burden of proving his cause of action by a preponderance of the evidence while a defendant has that burden with respect to any affirmative defense raised. (See Noyes v. Gold (1941), 310 Ill. App. 1, 34 N.E.2d 1.) In an action on an insurance policy, an insured has the burden of proving that the loss claimed comes within the terms of the policy. (Sell v. Country Mutual Insurance Co. (1960), 23 Ill. App. 2d 497, 163 N.E.2d 547.) It has long been the law that a plaintiff-insured will not be entitled to recover in an action on an insurance policy if he has not pleaded and proved the occurrence of any conditions precedent in the policy. (Continental Life Insurance Co. v. Rogers (1887), 119 Ill. 474, 486, 10 N.E. 242, 248.) On the other hand, the burden of pleading and proving the occurrence of a condition subsequent rests with a defendant-insurer. Scott v. Freeport Motor Casualty Co. (1945), 392 Ill. 332, 341-42, 64 N.E.2d 542, 547. The parties disagree on the operation of the total disability provisions of the policy, defendant maintaining that continuation of total disability is a condition precedent and plaintiff maintaining that cessation of total disability is a condition subsequent. A condition precedent is one which must occur before a contract becomes effective or which must occur before one party to an existing contract is obligated to the other party, while a condition subsequent is one which divests liability that has already attached upon the occurrence or nonoccurrence of the condition. (Black’s Law Dictionary 266 (5th ed. 1979); In re Estate of Rice (1985), 130 Ill. App. 3d 416, 428, 473 N.E.2d 1382, 1390; Wysocki v. Bedrosian (1984), 124 Ill. App. 3d 158, 163, 463 N.E.2d 1339, 1344.) Whether a provision of a contract creates a condition of either type is a question of construction depending on the intent of the parties, which is ascertained from the words employed by reading and interpreting all provisions of the contract together. 17A C.J.S. Contracts secs. 338, 339 (1963). The one provision of the policy at issue provided: “[T]he Company will continue the payment of weekly indemnity at the same rate thereafter so long as the Insured shall be wholly and continuously disabled by such injuries from engaging in any substantially gainful occupation or employment for wage or profit for which he is qualified or may become qualified.” This language is most reasonably interpreted as making defendant’s liability to pay total disability benefits for a particular period contingent upon plaintiff’s being “wholly and continuously disabled” during that period. In other words, total disability during a period is a condition precedent to defendant’s obligation to pay total disability benefits for the period. Support for this interpretation may be found in other provisions of the policy, which state: “Proofs of Loss: Written proof of loss must be furnished to the Company at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after termination of the period for which the Company is liable***. Time of Payment of Claims: *** Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid at the expiration of each four weeks during the continuance of the period for which the Company is liable, and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.” (See substantially similar language in statutes establishing minimum requirements for these provisions at Ill. Rev. Stat. 1983, ch. 73, par. 969.1, 969.8, 969.9.) Thus, defendant was not obligated to pay benefits for a period until “due written proof of loss” for that period was furnished by plaintiff. (See also Ill. Rev. Stat. 1983, ch. 73, par. 969.9a.) Such a provision is consistent with a construction of the policy making total disability during a period a condition precedent to defendant’s obligation to pay total disability benefits for the period, as it permits the insurer to determine whether the condition has occurred before paying the benefits. A similar scheme has been adopted statutorily in Illinois regarding the disability pensions of firefighters. (Ill. Rev. Stat. 1985, ch. IO8V2, par. 4 — 112.) Section 4 — 112 provides “[mjedical examination of a firefighter receiving a disability pension shall be made at least once each year prior to attainment of age 50 in order to verify continuance of disability.” Thus, it does not appear unreasonable or against public policy to place the burden of proof on a claimant either statutorily or by insurance contract particularly where no permanency has been established. Plaintiff’s continuing to be totally disabled was therefore a condition precedent, from a reading of the entire policy of insurance, to defendant’s obligation to pay further total disability benefits. The trial court did not err when it interpreted the contract of insurance and placed the burden of proving total disability on plaintiff. Finally, I do not believe that this case can be affirmed if, as the majority argues, the burden of proof was defendant’s. From the trial judge’s letter informing counsel of his decision, it is apparent that the trial court believed it was up to plaintiff to show he was “wholly and continuously disabled” and that plaintiff failed to make this showing. The court thus placed the burden of proof of disability on plaintiff, where the majority holds it does not belong. The majority does not reverse, however, because it believes defendant satisfied its burden of proof. If the question were simply whether the trial court’s decision for defendant was against the manifest weight of the evidence, I would agree. I would agree that the evidence was sufficient to sustain the court’s decision regardless of who had the burden of proof on the issue, so long as the trial court correctly understood who had that burden. In the case at bar, though, the majority’s analysis would lead to the conclusion that the trial court improperly allocated the burden of proof to plaintiff rather than defendant. The evidence on the issue, recited by the majority, was not so strong that a decision for plaintiff would have been against the manifest weight of the evidence, particularly when the burden of proof is placed on defendant. On this state of the evidence, I would not find an error in allocating the burden of proof to plaintiff nonprejudicial. Therefore, I believe that the majority’s holding with respect to the burden of proof should result in reversal and a remand for a new trial.