Ercole v. Metropolitan Life Insurance

39 A.2d 293, 155 Pa. Super. 549, 1944 Pa. Super. LEXIS 535
CourtSuperior Court of Pennsylvania
DecidedApril 21, 1944
DocketAppeal, 130
StatusPublished
Cited by14 cases

This text of 39 A.2d 293 (Ercole v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ercole v. Metropolitan Life Insurance, 39 A.2d 293, 155 Pa. Super. 549, 1944 Pa. Super. LEXIS 535 (Pa. Ct. App. 1944).

Opinion

Opinion by

Baldrige, J.,

The plaintiff, an employe of Jones and Laughlin Steel Corporation, insured under a group life insurance policy issued by the Metropolitan Life Insurance Company, brought this action to recover benefits alleging he has been totally and permanently disabled since May 17, 1938. Hé was employed by the company from September 28, 1929, to May 17, 1938, when he was laid off due to a lack of work. It is not disputed that his name remained on the roll of Jones and Laughlin’s employes and that he was insured until November 26, 1938, when his employment was terminated. There appeared on his employment card the notation as of that date “Dismissed — No work — bad heart.” The first notice the company received of any claim for total and permanent disability was contained in a letter written by plaintiff’s counsel on January 26, 1942. The company made an investigation and wrote several letters to plaintiff’s attorney to which reference will be made later.

Binding instructions were given at the trial on the ground that under the provisions of the master policy and the law applicable thereto, the plaintiff was barred from maintaining the suit as no notice or proof of disability was given the company until the expiration of three years and eight months and suit was not brought until October 5, 1942, four years and five months from the time the alleged disability commenced. Following the refusal of motions filed by the pliantiff for judgment n. o. v. and for a new trial, judgment was entered for the defendant.

*551 The master policy contains no definite limitation respecting the time for filing notice and proof of claim in cases of “total and permanent disability.” Section M requires immediate notice of “sickness” or “injury” be given to the company and proof of such “sickness” or “injury” to be furnished within thirty days after such notice; that no action at law shall be brought for the recovery of benefits for permanent disability “unless brought" within two (2) years from the expiration of the time within which such proof is required to be filed.”

Appellant asserts that the immediate notice and the proof of sickness or injury to be furnished within thirty days refers to claims for temporary disability only. We do not give that interpretation to those words. In our judgment they include claims for total, as well as temporary, disability. Total and permanent disability is the result of either sickness or injury. If appellant is correct there is no express provision in the policy limiting the time for filing notice and furnishing proofs of disability. Such a situation was never contemplated by the parties. Those preliminary steps or conditions precedent are uniformly required before a claim for benefits is recognized as valid: Perlman v. N. T. Life Ins. Co., 105 Pa. Superior Ct. 413, 416, 161 A. 752; Lyford v. New England Mutual Life Ins. Co., 122 Pa. Superior Ct. 16, 22, 184 A. 469; Buntz v. General American Life Ins. Co., 136 Pa. Superior Ct. 284, 290, 7 A. 2d 93.

Limitations within which the bringing of an action on a policy of insurance have been sustained as valid and reasonable though they shorten the statutory period otherwise applicable: O’Connor v. Allemannia Fire Ins. Co., 128 Pa. Superior Ct. 336, 342, 194 A. 217 (fire insurance); Ferguson v. Manufacturers’ Casualty Ins. Co. of Phila., 129 Pa. Superior Ct. 276, 281, 195 A. 661 (automobile casualty insurance): Tellip et al. v. Home *552 Life Ins. Co., 152 Pa. Superior Ct., 147, 81 A. 2d 364 (life insurance, two year limitation); In Bahas v. Equitable Life Assurance Society, 128 Pa. Superior Ct. 167, 171, 193 A. 344 (affirmed in 331 Pa. 164, 200 A. 91) tlie group policy and the certificate specifically required proof of total and permanent disability ‘‘before, the expiration of one year, from the, date of its commencement.” No such proof was given until eighteen months after the disability began. ,We held the period of one year was a reasonable and valid limitation, and a recovery was denied.

The appellant asserts, that he is not bound by- the limitation, of two years set forth in the master policy, since ;neither the certificate nor the pamphlet given him when insurance, was. obtained, made, mention of any such limitation. The-policy , contract undoubtedly includes not only the group, or master policy but. the certificate of insurance issued to the .employe as it alone names the beneficiary and -the amount of his insurance

(Ozanich v. Metropolitan Life Ins. Co., 119 Pa. Superior Ct. 52, 56, 180 A. 67), but the group policy is the principal contract: Couch, Cyclopedia of Ins. Law, Yol. 1, §164, supplement. . .

The plaintiff in his statement of claim avers that he bases his right of recovery not-only 'oh the certificate 'but' on the group policy. The certificate states it is issued “under and subject to the terms and conditions of the group policy.” The insured was thus notified that his certificate does not include all the covenants of the- contract. If he had desired further knowledge of the .provisions of the master policy he could.have readily acquired it by making inquiry: Lewis v. Connecticut Gen. Life Ins. Co., (Texas) 94 S. W. 2d 499, 502. The position of an owner of a- certificate .-issued under a group policy is. similar to that of-a holder of a bond, which-recites , that it and other bonds are issued pnder a mortgage and.refer to it. for the terms *553 and conditions upon which the bond is issued: Cf. Rittenhouse Lukens Steel Co., 116 Pa. Superior Ct. 303, 176 A. 543. It is apparent that the’plaintiff was in fact familiar .with the terms of his contract-as admittedly on four-previous-occasions he had made claims for temporary disability; filed proofs and had been paid benefits. No sound reason has'been advanced to warrant a conclusion that , the limitation in a master policy as to the bringing of suit, although not set out in the certificate, is not binding.

' Our decision in this case, however, need not rest on the point we have just been considering. If we assume appellant is correct in his cbntention that the insurance contract is silent respecting notice' and proof of claim for total and permanent disability benefits' then under a well recognized rulé applicable to group life policies notice and proofs of claim must be furnished in a reasonable time: Springfield Fire & Marine Ins. Co. v. Brown, 128 Pa. 392, 395, 18 A. 396; Curran v. Natl. Life Ins. Co. of U. S. A., 251 Pa. 420, 431, 96 A. 1041; Unvergzagt v. Prestera et al., 339 Pa. 141, 144, 13 A. 2d 46; Gerber v. Fletcher et al., 108 Pa. Superior Ct. 226, 229, 164 A. 135. Where no time is’fixed, and there are no disputed facts, the question of reasonable time'is one of law for the' court:' Milam v. Equitable Life Assur. Soc. of U. S., (W. Va.) 183 S. E. 865 ; Metropolitan Life Ins. Co. v. Johnson, (Ind.) 12 N. E. 2d 755, 757 (delay of three years held unreasonable); Metropolitan Life Ins. Co. v. Henry, (Ind.) 24 N. E. 2d 918, 920) (delay of six and one-half years); Lewis v. Connecticut General Life Ins. Co., supra, p.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Sebastian v. Provident Life & Accident Insurance
73 F. Supp. 2d 521 (D. Maryland, 1999)
Public School Bldg. Auth. v. Quandel
585 A.2d 1136 (Commonwealth Court of Pennsylvania, 1991)
Petraglia v. American Motorists Insurance
424 A.2d 1360 (Superior Court of Pennsylvania, 1981)
Brooks v. St. Paul Insurance
399 A.2d 714 (Superior Court of Pennsylvania, 1979)
Commonwealth v. Transamerica Insurance
341 A.2d 74 (Supreme Court of Pennsylvania, 1975)
Starego v. Reliance Insurance
70 Pa. D. & C.2d 680 (Luzerne County Court of Common Pleas, 1975)
Commonwealth v. Transamerica Insurance
316 A.2d 85 (Commonwealth Court of Pennsylvania, 1974)
Frankel v. Reliance Mutual Life Insurance
184 A.2d 305 (Superior Court of Pennsylvania, 1962)
Terpeluk v. Insurance Co. of North America
150 A.2d 558 (Superior Court of Pennsylvania, 1959)
Aetna Life Insurance Company v. Messier
173 F. Supp. 90 (M.D. Pennsylvania, 1959)
Peyton v. Equitable Life Assurance Society
48 A.2d 145 (Superior Court of Pennsylvania, 1946)
Selden v. Metropolitan Life Insurance
47 A.2d 687 (Supreme Court of Pennsylvania, 1946)
First National Bank v. Metropolitan Life Insurance
43 A.2d 334 (Superior Court of Pennsylvania, 1945)

Cite This Page — Counsel Stack

Bluebook (online)
39 A.2d 293, 155 Pa. Super. 549, 1944 Pa. Super. LEXIS 535, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ercole-v-metropolitan-life-insurance-pasuperct-1944.