Adkins v. American Casualty Co. of Reading

124 S.E.2d 457, 146 W. Va. 1045, 1962 W. Va. LEXIS 52
West Virginia Supreme Court·Decided March 20, 1962·No. No. 12121·Published·Cited by 2 cases

Opinion

Browning, Judge:

A policy of insurance limited to disability arising by accident was issued by appellant, American Casualty Company of Reading, Pennsylvania, to Aaron Adkins, hereinafter referred to as insured, on June 10, 1957, and the terms of the policy were made effective as of that date. The contract of insurance provided for payment at the rate of Two Hundred Dollars a month. As [1046] the result of an alleged injury on July 8, 1957, the insured made application for benefits and was paid for two months at the rate provided in the policy. Upon appellant’s refusal to make further payments, insured instituted an action in the Circuit Court of Wyoming County, the declaration having been filed on July 7, 1958, to recover the monthly payments allegedly due through that date, and a subsequent action upon the same policy, the declaration therein being filed on August 12,1959, to recover the balance of the payments allegedly due under the contract to that date. Pursuant to the verdict of a jury, upon the trial of the first action, judgment was entered for the plaintiff on April 24, 1959, in the sum of Twenty-two Hundred Twenty Dollars, including interest in the amount of Two Hundred Twenty Dollars. This Court granted a writ of error to that judgment and on June 7,1960, in the case styled Aaron Adkins v. American Casualty Company of Reading, Pennsylvania, a corporation, 145 W. Va. 281, 114 S. E. 2d 556, reversed that judgment, set aside the verdict of the jury and awarded a new trial, stating in the opinion: “It was, we think, reversible error for the trial court to instruct the jury to the effect that they should find for the plaintiff if the disability ‘proximately resulted from an accidental blow on his head’. Defendant’s Instruction No. 4, quoted above, stated the applicable principle of law.” Defendant’s Instruction No. 4, to which reference is made, was in this language: “The Court instructs the jury that plaintiff seeks payment for being disabled from performing his regular occupation by reason of striking his head on July 8, 1957, but before you can find any verdict for him in this case you must believe from the evidence that bumping his head against his automobile on July 8,1957, was the sole and only cause of the disability for which he claims payment.”

Upon remand and retrial, the Circuit Court of Wyoming County, on April 10,1961, after reciting that : “The above captioned actions, heretofore consolidated for a joint trial thereof, came on for trial before the [1047] Court and a Jury, . . . and the issues having been duly tried and the jury on March 31st, 1961, having rendered a verdict for the plaintiff, Aaron v. Adkins, to recover of the defendant damages in the amount of Four Thousand, Four Hundred Dollars ($4,400.00), .... ” entered judgment for the plaintiff in that amount. On May 1,1961, a motion for a new trial was overruled and the judgment confirmed, to which action this Court granted a writ of error on June 26, 1961.

In a pre-trial order entered August 25, 1960, it is recited that a pre-trial conference was held on August 22, 1960, the parties being represented by counsel, and that certain facts were agreed upon. The order states that the defendant ‘ ‘ does not question the fact that the plaintiff did sustain a blow on his head by striking it on his car on the above mentioned date and that since that date and for a period of twelve months thereafter, the plantiff has been disabled to the extent that he could not perform any of the duties of his usual occupation, but the defendant denies liability under the said accident insurance policy” upon the grounds, (a) the injury was not the sole cause of the disablement of the defendant, (b) “That the policy of accident insurance in issue is avoided by reason of the plaintiff’s misrepresentation of material facts in his written application for the policy sued on” and (c) “That the policy of accident insurance in issue is avoided by reason of verbal false statements” or ‘ ‘ concealments ’ ’ of material facts made by the insured with regard to the previous condition of his health and other material matters at the time he applied for the policy of insurance.

The pertinent provisions of the policy involved insure only against loss resulting from accidental bodily injury, and specifically define the word “Injury” as used in the policy to mean “accidental bodily injury which is the sole cause of the loss and is sustained while this Policy is in force”. Accident benefits accruing under the policy were to be paid only “If injury shall within thirty days after the date of the accident [1048] wholly and continuously disable and prevent the Insured from performing any and every duty pertaining to his occupation”. The single syllabus point in Adkins v. American Casualty Company of Reading, Pennsylvania, 145 W. Va. 281, 114 S. E. 2d 556, decided by this Court on June 7, 1960, states: “The insured in an accident policy providing for payment of benefits for loss ‘resulting from accidental bodily injury’, limiting the meaning of the word ‘injury’ to the ‘sole cause of the loss’, and providing that benefits would be payable only in the event the ‘accident wholly and continuously’ disabled the insured, is not entitled to recover benefits for total disability on a showing that an accident merely activated a pre-existing diseased condition, which resulted in the disability. ’ ’ This determination, of course, constitutes the law of the case. “The general rule is that when a question has been definitely determined by this Court its decision is conclusive on parties, privies and courts, including this Court, upon a second appeal or writ of error and it is regarded as the law of the case.” Pt. 1, Syllabus, Mullins v. Green, 145 W. Va. 469, 115 S. E. 2d 320.

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Adkins v. American Casualty Co. of Reading, 124 S.E.2d 457, 146 W. Va. 1045, 1962 W. Va. LEXIS 52 (W. Va. 1962).

124 S.E.2d 457 (Adkins v. American Casualty Co. of Reading) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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