Crowell v. Federal Life & Casualty Co.

247 N.W.2d 503, 397 Mich. 614, 1976 Mich. LEXIS 320
CourtMichigan Supreme Court
DecidedNovember 23, 1976
DocketDocket 57196
StatusPublished
Cited by20 cases

This text of 247 N.W.2d 503 (Crowell v. Federal Life & Casualty Co.) 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
Crowell v. Federal Life & Casualty Co., 247 N.W.2d 503, 397 Mich. 614, 1976 Mich. LEXIS 320 (Mich. 1976).

Opinions

Fitzgerald, J.

The issue on appeal is whether plaintiff suffers from a "confining sickness,” as defined by a policy of health and accident insurance issued to him by defendant Federal Life and Casualty Company. The policy was issued to plaintiff in September of 1966 for an annual premium of $201.50. The controversy concerns § 3D of the policy which provides the following coverage:

'Policy section 3
"D. Total Disability — Sickness
(1) Non-confining or confining sickness
Monthly indemnity $200
24 Months for any one Sickness
(2) Confining Sickness and continued Disability after (Dl)
Monthly Indemnity $200
Lifetime for any one Sickness
" 'Confining Sickness’, means that as a result of Sickness the Insured is confined to his residential premises or yard, except for necessary visits to a hospital or doctor’s office for treatment.
" 'Total Disability’, means that as a result of Injury or Sickness, the Insured is under the regular care and attendance of a duly licensed doctor of medicine or [618]*618osteopathy, other than himself, is completely unable to perform each and every duty pertaining to his occupation and is not gainfully employed in any other occupation, except that if a monthly indemnity has been paid for 12 months during any period of continuous total disability, then for the balance of the period of such continuous total disability, the term total disability in addition shall mean the complete inability of the Insured to engage in any gainful occupation for which he is reasonably qualified by education, training or experience.”

In March of 1969, at the age of 47, plaintiff suffered a severe myocardial infarction. As a result of that attack and of the subsequently diagnosed chronic heart disease, plaintiff became disabled from engaging in any gainful employment. Prior to his attack, he had been employed by the Continental Motors Corporation and had, in addition, operated a used-car lot in Muskegon.

He has been diagnosed as suffering from chronic coronary ischemia, which is an insufficiency of the blood supply nourishing the heart. For this reason, he is incapable of more than mild physical activity. He has been told by his treating physician, Dr. Claude VanAndel, D. O., to avoid physical and mental strain, lifting, exposure to inclement weather, and crowds. He was told that mild exercise short of that which produces chest pain or shortness of breath is of therapeutic value.

The evidence indicates that apart from initial and subsequent periods of hospitalization, plaintiff’s time is spent around home. His principal exercise and pastime is walking, which he can do for stretches of three or four blocks without pain or shortness of breath. He has been characterized by his physician as an extremely nervous individual, a typical coronary type, one for whom another acute attack is merely a question of time. It ap[619]*619pears that plaintiffs walking exercise has been his main transition from active employment to the life of a semi-invalid which he now leads. He walks about his yard or the neighborhood when the weather is good. During inclement weather, he will walk inside his house, from one room to another or out into a connecting garage. Once or twice a week he will accompany his wife or mother to the grocery store or to a shopping center where he can walk about for a change of scenery. His walking, which is done in stretches of three or four blocks, may total as much as two miles on some days. He also drives on occasion, although this has been curtailed by his physician because of the arm motion involved. He estimated that he might do approximately ten percent of the family driving around town. For instance, he testified that he may on occasion pick up his seven-year-old daughter from the neighborhood school or that he occasionally drives his mother to the store.

Except for monthly visits to his doctor and occasional visits to neighbors, the above constitutes the extent of plaintiffs activities outside the home. During the course of his day, plaintiff takes the following medication prescribed by his physician: digitalis, Nitrobid, Coumadin, Bentyl, and Nitrostat (which is an improved form of nitroglycerin and which plaintiff takes in times of distress).

Following the onset of plaintiffs disability in March 1969, defendant paid plaintiff the $200 monthly indemnity for two years pursuant to § 3D(1) of the policy. Defendant’s refusal to pay continued benefits pursuant to § 3D(2) of the policy resulted in plaintiffs complaint on October 27, 1971, in Muskegon Circuit Court. It was the opinion of plaintiffs physician that the rigors of trial might precipitate another coronary. For that rea[620]*620son, and on the stipulation of counsel, a bench trial was had at which the depositions of plaintiff, his treating physician, and defendant’s medical expert, Dr. David A. Amos, M. D., were admitted into evidence. The trial court entered judgment for the defendant on the ground that, although plaintiff had been totally and continuously disabled within the terms of the policy at issue, he was disqualified by reason of the confinement clause for further benefits. The Court of Appeals reversed at 61 Mich App 377; 232 NW2d 710 (1975), in a scholarly opinion whose analysis and whose result we affirm.

Perhaps the best discussion regarding the development of case law pertaining to house confinement clauses is found in Anno, When is one conñned to house within meaning of health or accident insurance policy, 29 ALR2d 1408, 1412-1413, wherein it is stated in summary:

"While there is considerable authority supporting the view that 'house confinement’ clauses are to be literally construed, so as to preclude recovery where the insured for any reason, with the possible exception of emergencies beyond his control, leaves the house, the great majority of cases support the so-called liberal construction view.
"Two quite generally accepted doctrines, with reference to the insured’s right to recover under a specific factual situation, emerge from the cases.
"The first of these is the doctrine that 'house confinement’ clauses are not violated where the insured occasionally departs from within the four walls of the house for the purpose of getting fresh air and exercise, in a bona fide attempt to improve his health, particularly where such departures are undertaken by the direction of a physician, or where he visits his physician’s office or a hospital for examination and treatment.
[621]*621"On the other hand, where the insured is able to, and does, leave his house for primarily business or other non-therapeutic records [sic] , he can no longer be considered within the scope of a 'house confinement’ clause.”

A review of recent decisions compiled in the Later Case Service of this collection reveals that most if not all jurisdictions which have recently confronted the issue follow the liberal rule.

In 1A Appleman, Insurance Law and Practice, §§652-653 (1976 Pocket Part, pp 134-135), it is stated:

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Crowell v. Federal Life & Casualty Co.
247 N.W.2d 503 (Michigan Supreme Court, 1976)

Cite This Page — Counsel Stack

Bluebook (online)
247 N.W.2d 503, 397 Mich. 614, 1976 Mich. LEXIS 320, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crowell-v-federal-life-casualty-co-mich-1976.