Court Opinion

ID: 9577058
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:31:19.122171+00
Date Added: 2024-06-11T13:19:53.341333
License: Public Domain

CARTER, J.,
Dissenting. — I dissent. I concur in that portion of the majority opinion which holds that plaintiff is totally and permanently disabled and therefore entitled to disability payments under the policy, but I dissent from that portion of said opinion determining that the insured was not entitled to disability payments after the insured’s *405refusal of the insurer’s demand that he submit to a medical examination. As set forth in the opinion, the clause in the policy on that subject reads: ‘ ‘ The company may from time to time demand due proof of such continued disability, and any medical adviser of the Company shall be allowed to examine the person of the Insured in respect to any alleged permanent total disability, in the manner and as such times as the medical adviser may require but not oftener than once a year after such disability has continued for two full years. Upon failure to furnish such proof, or if it appears that the Insured is no longer wholly disabled as aforesaid, no further premiums shall be waived nor income payments made.”
There are several reasons why that clause should not debar plaintiff from obtaining payments during the period following his refusal to submit to a medical examination by the insurer’s physician. In the first place, it will be noted that the clause provides for two things the insurer may do with respect to demanding evidence of disability, to-wit: (1) The company may demand due proof of continued disability; (2) Have the insured examined by the insurer’s medical adviser. These two things are separate and distinct. They are divided by a comma, and are not the same. “Due proof” might well consist of a medical report by the insured’s own physician. While the second provision is for a specific kind of proof, that is, examination by the insurer’s physician. Turning then to the latter part of the provision here in question which specifies what the penalty is for a violation thereof, we find it states that upon failure to furnish such proof, no further payments shall be made. The word “such,” manifestly refers to “due proof” rather than an examination by the insurer’s physician. This is apparent when we consider that the penalty arises for failure to “furnish” the proof. It could hardly be said that the insured was furnishing the proof by submitting to an examination. Here the insured did furnish proofs consisting of his physician’s report. The payments could not therefore be stopped for any failure in that respect. There is no clause authorizing the discontinuance of payments for failure to submit to a medical examination, therefore the insurer had no authority to discontinue the payments. This interpretation of the clause in the policy is entirely appropriate when we give heed to two fundamental rules, namely, that a policy of insurance is to *406be construed most strongly against the insurer and in favor of the insured and that an interpretation which will avoid a forfeiture is to be adopted when possible.
Secondly, the insurer had breached the contract at the time of the refusal to submit to an examination. Under those circumstances the insurer should not be permitted to assert nonliability for the failure to so submit. Its right to insist upon an examination should be confined to those instances where it is performing the contract, making the payments. The case is not dissimilar from a clause in fire insurance policies which provides that the insured must submit to an examination under oath before he may recover for a loss. It is held that that provision is waived by the insurer when he denies all liability under the policy. (State v. Becker, 336 Mo. 59 [77 S. W. (2d) 100].)
Third, it should be remembered that the insurer was not prejudiced or injured in any way by the failure of the insured to submit to the examination. He was examined by the insurer prior to the trial and therefore the insurer was not prevented from obtaining evidence with respect to the insured’s physical condition. Even after the insurer obtained a report from its own physician as to insured’s physical condition, it still denied liability. The trial court found against the insurer on this point and this court has sustained the finding of the trial court on the issue of total disability. Therefore, even if the insured had submitted to the insurer’s request for an examination by the latter’s physician, the insurer would still have refused disability payments as it still contends that insured is not totally disabled.
In my opinion the judgment should be affirmed.