Brandt v. Mutual Ben. Health & Acc. Ass'n

202 S.W.2d 827, 30 Tenn. App. 14
CourtCourt of Appeals of Tennessee
DecidedMarch 1, 1947
StatusPublished

This text of 202 S.W.2d 827 (Brandt v. Mutual Ben. Health & Acc. Ass'n) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brandt v. Mutual Ben. Health & Acc. Ass'n, 202 S.W.2d 827, 30 Tenn. App. 14 (Tenn. Ct. App. 1947).

Opinion

FELTS, J.

Complainant brought this suit to recover the indemnity for “confining illness” under a health and [16]*16accident policy issued to liim by defendant. Tbe canse was tried before tbe Chancellor and a jury. Complainant’s proof consisted of bis testimony and tbe deposition of bis physician. Defendant offered no proof. Tbe Chancellor discharged the jury and decreed complainant a recovery of $150, tbe maximum provided by tbe policy for ‘ ‘ nonconfining illness. ’ ’

Complainant appealed in error and insists that tbe Chancellor should have allowed him a recovery at tbe rate of $100 per month for “confining illness” from tbe date bis illness began, October 14, 1944, on so long as it continues, not to exceed 24 months, as stipulated in tbe policy.

Both parties treat the facts as undisputed and, we understand, both agree that there was no issue for tbe jury and it was proper for the Chancellor to decide tbe case upon tbe undisputed facts and tbe applicable law, and that tbe only question before us is whether such facts bring tbe case within tbe provisions of part “K” or within those of part “L” of tbe policy.

Part “K” provides an indemnity at tbe rate of $100 per month, not to exceed 24 months, for disability from disease which “confines tbe Insured continuously within doors and requires regular visits therein by a legally qualified physician,” “provided said disease causes total disability and necessitates total loss of time.” Part “L” provides an indemnity at tbe rate of $50 per month, not to exceed three months, for disability from disease which “does not confine the Insured continuously within doors, but requires regular medical attention,” “provided said disease necessitates continuous and total disability and total loss of time.”

Complainant is afflicted with coronary thrombosis, a serious disease of the heart. He was stricken in the eve[17]*17ning of October 14, 1944, was taken next morning to tbe clinic of Dr. 0. N. Bryan, and from then on till tbe trial be was under continuous treatment by Dr. Bryan, wbo was stipulated to be an expert. For tbe first three or four weeks part of tbe treatment was absolute rest in bed except for bis visits to tbe doctor’s office. Thereafter part of tbe treatment was to have him take short walks for tbe fresh air and sunshine and to prevent deterioration of tbe heart muscles from continuous lying in bed.

During this period complainant was unable to do any work. In bis application for tbe policy be bad stated bis occupation was a grocer. Dr. Bryan described bis condition and expressed tbe opinion that be was totally and permanently disabled to perform tbe duties of that occupation or to do any work requiring physical exertion. In its brief defendant concedes be is totally disabled.

Its defense is that be was not confined continuously within doors and regularly visited therein by bis physician, as required by tbe policy to entitle him to tbe indemnity be claims. At first be went to bis doctor’s office every three or four days and later about once a week. In good weather be took short walks on bis doctor’s advice. After defendant denied liability be came on tbe bus to town a number of times — once or twice to defendant’s office, once to tbe Insurance Commissioner’s office, several times to bis lawyer’s office, and once to testify in court.

So tbe question is whether, bis total disability being conceded, bis claim should be denied because, instead of staying continuously within doors and being there treated, be went out to tbe extent stated for his treatment and in connection with bis claim.

Similar provisions requiring tbe insured to be “confined continuously within doors,” or “confined to bis room,” or “necessarily confined to bed” have often been [18]*18before the courts; and while none of them construes or applies such provisions literally, their decisions are by no means harmonious.

Some courts apply such provisions quite strictly, and deny recovery where the insured visits his physician, goes out for fresh air or sunshine or exercise, or leaves his house for any purpose except for an exigency compelling his removal by reason of fire, an order of the board of health, or the like. Sheets v. Farmers’ & Merchants’ Mut. Life & Cas. Ass’n, 116 Kan. 356, 225 P. 929; Rocci v. Massachusetts Accident Co., 222 Mass. 336, 110 N. E. 972, Ann. Cas. 1918C, 529, second appeal, Id., 226 Mass. 545, 116 N. E. 477, and cases cited in Note 18 Ann. Cas. 1112, 1113.

But the majority of courts construe and apply such provisions liberally in favor of the insured, and hold that his right to recover is not defeated by the fact that he visits his physician for treatment, or goes out on the physician’s advice for fresh air or sunshine or exercise, or goes to a hospital or to a different climate for his treatment, or goes out occasionally for other purposes, provided he is entirely incapacitated for work or business on account of his illness. Jennings v. Brotherhood Acc. Co., 44 Colo. 68, 96 P. 982, 18 L. R. A., N. S., 109, 130 Am. St. Rep. 109; Home Protective Ass’n v. Williams, 151 Ky. 146, 151 S. W. 361, Ann. Cas. 1915A, 260; Breil v. Claus Groth Plattsdutschen Vereen, 84 Neb. 155, 120 N. W. 905, 23 L. R. A., N. S., 359, 18 Ann. Cas. 1110; Stewart v. Continental Cas. Co., 141 Wash. 213, 250 P. 1084, 49 A. L. R. 960; Lewis v. Liberty Industrial L. Ins. Co., 185 La. 589, 170 So. 4, 107 A. L. R. 286; Annotations, 49 A. L. R. 965, 107 A. L. R. 289; 7 Couch Cyclopedia of Law of Insurance, Secs. 1678, 1681; 1 Appleman on Insurance, Secs. 652, 653, 654; 29 Am. Jur. Insurance, Secs. 1171, 1172.

[19]*19Decisions in this State are in line with this liberal view, and this Court is committed to the rule of a liberal construction of such provisions in favor of the insured. National Life & Accident Ins. Co. v. Armstrong, 21 Tenn. App. 92, 105 S. W. (2d) 520; Interstate Life & Accident Co. v. Spurlock, 16 Tenn. App. 250, 64 S. W. (2d) 75; Wilkes v. National Life & Accident Ins. Co., 7 Tenn. App. 36; National Life & Accident Ins. Co. v. Bradley, 6 Tenn. Civ. App. 566.

In the Bradley case, supra, the insured, a laborer, became totally disabled by blindness. But, attended by his wife, he went out “at intervals for the purpose of obtaining medical aid and to attend to necessary business matters or to obtain exercise.” Nonetheless he was held to have been “necessarily confined to his room and there visited by a duly licensed physician,” under the liberal construction that should be given this provision.

In the Wilkes case, supra, the provision was “necessarily confined to bed” — a stricter requirement, as noted by Judge Senter, than “confined to his room.” The insured was totally disabled by paralysis of his legs. He was otherwise in perfect health. He could use crutches and, with the aid of an attendant, could go wherever he chose. In these circumstances the court held he was not “necessarily confined to bed,”'but indicated he was substantially “confined to his house.” The court approved the decision in the Bradley case, supra, and quoted approvingly from the Breil case, supra (84 Neb. 155, 120 N. W. 905, 23 L. R. A., N. S., 359, 18 Ann. Cas, 1110): “ ‘Within the meaning of an insurance contract for sick benefit, it cannot be said that an assured is not confined ‘ ‘ constantly to the house ’ ’ during an illness characterized by recurring periods of severity, although at intervals he may occasionally step into his yard, or make visits to his [20]

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Bluebook (online)
202 S.W.2d 827, 30 Tenn. App. 14, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brandt-v-mutual-ben-health-acc-assn-tennctapp-1947.