Commercial Travelers Life & Accident Insurance Co. v. Bruce

405 S.W.2d 634, 1966 Tex. App. LEXIS 2205
CourtCourt of Appeals of Texas
DecidedJanuary 27, 1966
Docket180
StatusPublished
Cited by3 cases

This text of 405 S.W.2d 634 (Commercial Travelers Life & Accident Insurance Co. v. Bruce) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Commercial Travelers Life & Accident Insurance Co. v. Bruce, 405 S.W.2d 634, 1966 Tex. App. LEXIS 2205 (Tex. Ct. App. 1966).

Opinions

[635]*635OPINION

SHARPE, Justice.

This is an appeal from a judgment rendered after jury trial in favor of Roy L. Bruce, appellee, plaintiff below, against Commercial Travelers Life and Accident Insurance Co., appellant, defendant below. The suit is on an insurance policy providing indemnities for loss of time due to disability and hospital confinement. The jury found in answer to special issues numbered as indicated that (1) plaintiff had loss of time due to sickness after January 7, 1964; (2) that during such loss of time plaintiff had total disability; (3) that he was totally disabled from January 7, 1964, to March 24, 1964, a period of 77 days; (4) that his loss or disability was not caused or contributed to by a hernia; (S) unanswered (to be discussed hereinafter); and (6) that $500.00 was a reasonable plaintiff’s attorney fee. The trial court rendered judgment for $960.00 benefits, penalties in the amount of 12%, or $115.20, and attorney’s fees of $500.00, aggregating $1575.20.

Appellant urges six points of error in substance as follows: By point one, that the trial court should have rendered judgment for appellant because the evidence conclusively established that the loss and disability claimed by appellee was caused by or contributed to by hernia, either directly or indirectly, such loss and disability being excluded by the terms of the policy sued upon; by points two and three, that the evidence was factually insufficient to prove that the loss and disability was not caused by or contributed to by hernia, directly or indirectly, and to support the answer to special issue 4; by point four, that the trial court erred in failing to include the words “either directly or indirectly” in special issue 4, since said wording is a part of the exclusion rider in the policy; by points five and six, that the evidence is legally and factually insufficient to support the answer to special issue six on the question of attorney’s fees.

In reply to appellant’s first three points, appellee contends by counterpoint one that his disability arose from a sickness covered by the policy and such disability was not caused by or contributed to, directly or indirectly, by hernia. The insurance policy sued upon is dated December 8, 1960. It provides for indemnities in the amounts specified therein, including benefits for loss of time beginning with the first day of continuous total confining disability at the rate of $300.00 per month, with an additional $300.00 per month indemnity for time confined in the hospital. Attached to and made a part of the policy is an exclusion rider reading as follows:

“It is hereby agreed and understood that in consideration of the issuance of the above described policy, the insured agrees to waive any claim for indemnity provided by the policy on account of any loss or disability hereafter sustained which shall be caused by or contributed to by hernia, either directly or indirectly; and, the insured further agrees that this rider shall continue to be and remain a part of said policy as long as it shall be maintained in force and effect, any provisions to the contrary notwithstanding.”

Appellant expressly pleaded the policy exclusion above-mentioned and appellee had the burden of establishing the non-application of it. Rule 94, Texas Rules of Civil Procedure; Shaver v. National Title & Abstract Co., 361 S.W.2d 867 (Tex.1962). Ap-pellee concedes that he had such burden but says it was discharged by evidence legally and factually sufficient to support the jury findings which established that he was totally disabled, the period of time for which disabled, and that such disability was neither contributed to nor caused by a hernia.

The evidence consists of the testimony of appellee, his admissions pursuant to requests under Rule 169, T.R.C.P., and the hospital records. Appellee had his first day of disability and loss of time on January 7, 1964, when he was admitted to the hospital where he remained until January [636]*63616, 1964, a period of ten days. He was readmitted to the hospital from January 22, 1964, to January 25, 1964, a period of four days. He was again admitted to the hospital on January 28, 1964, where he remained until February 1,1964, a period of five days. The total hospital confinement was, therefore, nineteen days. On April 24, 1964, ap-pellee returned to partial work and thus terminated the period for which he could claim benefits under the policy. The record shows that on January 8, 1964, three operations were performed on appellee, one for hernia, one for hemorrhoids and one for a nodule in the right epididymis. The two subsequent readmissions to the hospital were for hemorrhage resulting from reopening of the incision made during the hemorrhoid operation. Appellee testified that he entered the hospital originally in order to have the hemorrhoids removed; that prior thereto he had the hernia for more than a year; that it was no worse than it had been for a long time; that it did not particularly bother him; and that he would not have entered the hospital if his sole complaint had been the hernia. Appellant countered this evidence by offering the hospital records showing the three operations in the order above-mentioned and, particularly, the hernia as the number one reason for admission, along with other references and notations concerning it.

The evidence is legally and factually sufficient to support the jury findings that plaintiff had loss of time and total disability for seventy-seven days during the period from January 7 to March 24, 1964, due to sickness within the meaning of the policy. There is no question that loss of time and disability resulting from the hemorrhoids and the operation and treatment thereof as well as for the nodule were covered by the policy. The question is not whether appel-lee had a hernia or an operation thereon. Instead, the issue is whether appellee would have suffered the loss of time and disability on account of the covered sickness regardless of the hernia and the treatment thereof. If so, he is entitled to recover. If not, i. e., if the hernia contributed to cause appellee's loss and disability, then, to the extent that it so contributed, he is not entitled to recover.

There is no serious fact question concerning appellee’s second and third hospital confinements. The evidence supports the view that they were due to the hemorrhoid condition and operation. With reference to ap-pellee’s first hospital confinement the evidence is sufficient, legally and factually to support a finding that appellee went to the hospital primarily for treatment of the hemorrhoid condition and the repair of the hernia was incidental; further, that appellee would not have gone into the hospital on account of the hernia condition alone; and, further, the hemorrhoid and nodule conditions were sufficient to cause the loss of time and disability without reference to the hernia. In addition to the jury findings hereinbefore mentioned, the trial court also submitted special issue 5 which was to be answered only if in answer to special issue 4 the jury found that appellee’s loss or disability had been caused or contributed to by a hernia. Special issue 5 reads as follows : “How many months or days do you find from a preponderance of the evidence that plaintiff’s total disability and loss of time, if any, was caused or contributed to by hernia?” Since the jury answered special issue 4 to the effect that appellee’s loss or disability was not caused or contributed to by a hernia, special issue 5 was not answered.

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Related

Group Hospitalization, Inc. v. Foley
255 A.2d 499 (District of Columbia Court of Appeals, 1969)
Commercial Travelers Life & Accident Insurance Co. v. Bruce
405 S.W.2d 634 (Court of Appeals of Texas, 1966)

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Bluebook (online)
405 S.W.2d 634, 1966 Tex. App. LEXIS 2205, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commercial-travelers-life-accident-insurance-co-v-bruce-texapp-1966.