Bashans v. Metro Mutual Insurance

119 N.W.2d 622, 369 Mich. 141, 1963 Mich. LEXIS 448
CourtMichigan Supreme Court
DecidedFebruary 6, 1963
DocketCalendar 95, Docket 49,763
StatusPublished
Cited by13 cases

This text of 119 N.W.2d 622 (Bashans v. Metro Mutual Insurance) is published on Counsel Stack Legal Research, covering Michigan Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bashans v. Metro Mutual Insurance, 119 N.W.2d 622, 369 Mich. 141, 1963 Mich. LEXIS 448 (Mich. 1963).

Opinion

Carr, C. J.

In April 1955, defendant insurance company executed and delivered to plaintiff its policies of insurance providing payments of expenses incurred by way of medical and hospital charges resulting from accidental injury or illness. Provision was also made for the payment of benefits, for loss of time suffered by the insured, caused by accident or illness.

Claiming that he had sustained a physical injury on December 27, 1955, resulting in a herniated disc, plaintiff made claim under his policies for the benefits provided therein. It is admitted that written notice was given defendant and that payment was refused. A suit to recover on the policies was instituted on February 10, 1959, plaintiff alleging in his declaration the issuance of the policies to him, his subsequent injury, the demand for the payment of benefits under the policies, and defendant’s denial of liability. To said declaration defendant filed answer admitting the execution of the policies but denying liability thereunder. By way of affirmative defense it was alleged that plaintiff had made certain fraudulent representations in his application for the insurance, that the physical condition constituting the basis of the claim for the right to recover judgment in fact antedated the issuance of said policies, and that under the specific terms of said contracts plaintiff’s suit was not seasonably instituted. Plaintiff’s reply to the answer denied the sufficiency of the affirmative defenses raised. Subsequently plaintiff was granted permission to amend his reply by incorporating therein allegations that defendant had by its conduct waived the time limitation of the *143 policies and was estopped to assert said provision. Defendant by further pleading controverted the averments of the plaintiff’s amended reply to the answer. Defendant’s motion to dismiss the suit was denied, and the case proceeded to trial before the circuit judge without a jury.

After listening to the proofs and arguments of the parties, the trial court disposed of the controversy in the following language:

“The court, having read the pleadings in said cause and having heard testimony in open court, is of the opinion that the defendant has failed to sustain the burden of proof on the question of fraud.

“On the question of the 2-year limitation period on said policies in which an action at law or equity must be brought, the court is of the opinion that the defendant’s waiver is supported by the testimony and evidence in the case.”

In accordance with the óonclusions indicated judgment was entered for the plaintiff in the sum of $1,340. Defendant has appealed.

Each of the policies in question contained the following express provision:

“No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after proof of loss has been filed in accordance with the requirements of this policy, nor shall such action be brought at all unless brought within 2 years from the expiration of the time within which proof of loss is required by the policy.”

This Court in prior decisions has recognized the binding force of a policy provision of the kind quoted, limiting the period within which suit may be brought. In Hall v. Metropolitan Life Ins. Co., 274 Mich 196, defendant affirmatively pleaded that plaintiff’s suit to recover could not be maintained because the policy in question required such action *144 to be brought within 2 years from the expiration of the time within which proof of loss was required to be filed. On behalf of plaintiff it was argued that a request for blanks upon which to make a report had not been honored, and that such action amounted to a waiver of proof of disability. It was held that the 2-year clause in the policy was effective and that defendant’s motion for a directed verdict in the trial court should have been granted. See, also, Lombardi v. Metropolitan Life Ins. Co., 271 Mich 265.

In Barza v. Metropolitan Life Ins. Co., 281 Mich 532 (112 ALR 1283), the plaintiff, an employee of the Fisher Body Corporation, was covered by a group insurance policy providing for the payment of total and permanent disability benefits under proper circumstances. Said policy contained a provision imposing a 2-year time limit on suits for recovery of such benefits. Plaintiff claimed permanent disability. Defendant company was notified by plaintiff’s son but apparently no reply was received to his communication. A telephone call resulted in the son being told to take the matter up with the Fisher Body Corporation. This was done, but apparently without results. In upholding the action of the trial judge in granting defendant’s motion for a directed verdict, it was held by this Court that plaintiff was bound by the 2-year limitation in the group policy and that the evidence in the case did not establish facts or circumstances barring the application of the 2-year provision on the ground of waiver or estoppel.

In the case at bar plaintiff’s claim that defendant by its conduct waived the right to interpose the policy clause in question as a defense to the suit rested in the trial court on the basis of proofs that were partially in dispute. It appears that defendant denied liability on its part in a letter sent by it to *145 plaintiff under date of July 18, 1956. Thereafter plaintiff retained counsel who on February 11, 1957, addressed the following letter to defendant, attention of its claim manager:

“Please be advised that Mr. Phillip Bashans, of 1925 Mack road, Saginaw, Michigan, has turned over to us for handling his claim for hospitalization, medical expenses and loss of' earnings under a policy issued by you, as above set forth.

“We are giving you this opportunity to have your adjuster discuss with us possible settlement of the claim; on the other hand, if you feel that you have sufficiently determined the true facts and believe there is no liability under the policy, please so inform us by return mail so that we may institute suit to have his claim determined in a court of law.”

The secretary of defendant company, on February 15, 1957, acknowledged receipt of counsel’s letter as follows:

“This will acknowledge receipt of your letter under date of February 11, 1957, and- we wish to inform you that we will have a representative call at your office within the next week to 10 days.”

Defendant’s secretary was a witness on the trial of the case in circuit court and téstified that on March 20, 1957, he was in Saginaw, that he called at the office of counsel for plaintiff for approximately 10 to 15 minutes, that he told counsel that he was there in regard to counsel’s letter relating to the Bashans claim, and that the purpose of his call was to reaffirm the denial by the company of liability. He further testified that plaintiff’s counsel then advised him that suit would be started. The testimony of defendant’s witness was disputed, plaintiff’s counsel taking the stand and stating that his office records did not indicate that he had an appointment on March 20,1957, with defendant’s secretary, and that he had *146

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Cite This Page — Counsel Stack

Bluebook (online)
119 N.W.2d 622, 369 Mich. 141, 1963 Mich. LEXIS 448, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bashans-v-metro-mutual-insurance-mich-1963.