Dezsi v. Mutual Benefit Health & Accident Ass'n

125 N.W.2d 219, 255 Iowa 1027, 1963 Iowa Sup. LEXIS 803
CourtSupreme Court of Iowa
DecidedDecember 10, 1963
Docket51107
StatusPublished
Cited by15 cases

This text of 125 N.W.2d 219 (Dezsi v. Mutual Benefit Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dezsi v. Mutual Benefit Health & Accident Ass'n, 125 N.W.2d 219, 255 Iowa 1027, 1963 Iowa Sup. LEXIS 803 (iowa 1963).

Opinion

Snell, J.

This is an action at law seeking recovery under a hospital insurance policy. On March 10, 1961, Zoltán Dezsi signed an application for insurance with defendant, Mutual Benefit Health & Accident Association, generally called Mutual of Omaha, providing for benefits in the event of hospitalization. The policy was issued covering applicant as the principal in *1030 sured and also bis wife and minor child. Mr. Dezsi was hospitalized June 30, 1961, and incurred medical and surgical expense thereafter. He died in surgery on July 15, 1961, of heart failure, called cardiac arrest. The cause of deátli was unrelated to the condition for which he was hospitalized or for which the surgery was performed.

Mrs. Dezsi, the beneficiary under the insurance policy, sought payment of the scheduled benefits. Defendant denied liability.

As affirmative defenses defendant alleged that the application signed by decedent contained statements false and known to be false; that decedent was ill from a sickness contracted less than thirty days after the policy date or long prior thereto; that there was no valid policy of insurance upon which plaintiff could recover.

The issues were submitted to a jury. The jury returned a verdict for plaintiff.

I. Complete review herein of all the evidence is unnecessary. Our review is not de novo. This is a law action. We need only determine if there was sufficient evidence to support the verdict. The jury verdict if supported by substantial evidence is binding on us. Defendant pleaded and relied on affirmative defenses. The burden of proof in connection therewith is clearly upon defendant. Ordinarily the burden follows the pleading and one who pleads and relies upon an affirmative issue must carry the burden of proving it. This rule is followed in insurance cases. Service Life Insurance Co. v. McCullough, 234 Iowa 817, 830, 13 N.W.2d 440, 153 A. L. R. 697. Further citation of authority is unnecessary. See rule 344(f), paragraphs 1 and 5, Rules of Civil Procedure.

II. Mr. and Mrs. Dezsi were Hungarian and German immigrants. They came to the United States in 1951 through the Church World Service Refugee Program. Thereafter they were employed as domestics in the home of a Cedar Rapids family. Mr. Dezsi was well educated in his own country. He spoke several languages. He could read and understand English but because of his accent was very hard to understand when he spoke English. In the Cedar Rapids home Mr. Dezsi was the cook. *1031 He enjoyed and ate highly seasoned, greasy food in generous quantities. He teased an Austrian friend with whom he frequently ate who “couldn’t eat so good anymore.” Mr. Dezsi said “I can eat what I want and so much I want.” At times he would overeat. He occasionally suffered some abdominal distress.

As conditions precedent to entry into the United States Mr. and Mrs. Dezsi passed physical examinations in Germany. Defendant objected to this testimony but in view of defendant’s defense of antecedent ailments the testimony did not relate to matters so remote as to make its acceptance reversible error. “The question of whether such evidence is too remote depends upon the causal connection in each particular case, and its acceptance rests largely in the sound discretion of the trial court.” Brower v. Quick, 249 Iowa 569, 581, 88 N.W.2d 120.

In June 1952 Mr. and Mrs. Dezsi took out an accident and health insurance policy with Continental Casualty Company. This policy was carried until its expiration date after the effective date of the policy with defendant herein.

Some time prior to March 10, 1961, in response to advertisements of defendant Mrs. Dezsi wrote for information. An agent of defendant called. He extolled the advantages of a Mutual of Omaha policy and obtained an application for insurance. The application blank was filled out by the agent and signed by Mr. Dezsi. It contained negative answers to the following questions:

“Have you or any Dependents ever had, or been told you had, or received advice or treatment for: (circle conditions answered ‘yes’ and give details below) (a) High blood pressure, heart, vein or artery trouble, rheumatic fever?
“(b) Lung or other respiratory trouble; stomach, gall bladder, intestinal or rectal trouble; rupture; diabetes ?
“(c) Any form of tuberculosis; kidney or bladder trouble, prostate trouble, female trouble, venerea] disease?
“(d) Mental or nervous trouble, epilepsy, brain disorder ; arthritis, rheumatism, back or spinal trouble ?
“(e) Cancer, tumor or any form of growth; any de *1032 formity; loss of bearing; loss of, or loss of use of, eye or limb? Have you or any Dependents ever had, or been told you had, or received advice or treatment for:
(a) any physical conditions or injuries not mentioned above, or (b) any symptoms of ill health?”

Dr. Carl Aschoff, a physician in general practice, -was the Dezsi family doctor. He knew Mr. Dezsi from 1956 until his death. Mr. Dezsi had the usual run of minor illnesses but in the opinion of the doctor none of major consequence until June 1961.

In June 1961 Mr. Dezsi was having severe abdominal pain. The cause was obscure. To aid in diagnosis the patient was referred to Dr. John Huston, a radiologist. Fluoroscopic and X-ray examinations followed. Generally normal conditions were found except for an irregularity in outline near the apex of the duodenum. No ulcer crater was seen. The radiologist could not be sure but he thought the patient “probably had an ulcer.”

The irregularity or scarring noted by the radiologist had nothing to do with where an ulcer was ultimately found.

Mr. Dezsi was hospitalized and extensive examination, including X-ray and laboratory tests, followed. Normal conditions were found. No one knew what was wrong with Mr. Dezsi.

From July I, 1961, on, at the request of Doctor Aschoff, the patient was also examined and treated by Dr. E. Lindley, a specialist in internal medicine and diagnosis. After a week of study, examination and testing Doctor Lindley could give no positive diagnosis and did not know what was wrong.

About July 8 or 9 symptoms of intestinal bleeding were noted. Multiple transfusions and extensive medication produced no cure. Surgery followed. On July 15 Mr. Dezsi died during surgery as a result of heart failure. The cause of death had nothing to do with the condition for which the surgery was performed. During surgery a duodenal ulcer in the second portion of the duodenum was found.

The doctors could not say how long the condition had existed. It could have existed for some time or have begun but a short time before.

Four doctors, Doctor Aschoff, the family physician, *1033 Doctor Lindley, the internist, Doctor Huston, the radiologist, and Dr. Daniel Toungblade, an intern at the hospital, testified.

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Bluebook (online)
125 N.W.2d 219, 255 Iowa 1027, 1963 Iowa Sup. LEXIS 803, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dezsi-v-mutual-benefit-health-accident-assn-iowa-1963.