Fritz v. Metropolitan Life Insurance

123 P.2d 622, 50 Cal. App. 2d 570, 1942 Cal. App. LEXIS 973
CourtCalifornia Court of Appeal
DecidedMarch 19, 1942
DocketCiv. 12858
StatusPublished
Cited by6 cases

This text of 123 P.2d 622 (Fritz v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fritz v. Metropolitan Life Insurance, 123 P.2d 622, 50 Cal. App. 2d 570, 1942 Cal. App. LEXIS 973 (Cal. Ct. App. 1942).

Opinion

HANSON, J. pro tem.

This is an action brought to recover disability benefits under a group policy of insurance issued in Missouri by respondent in July, 1926, to The Long-Bell Lumber Company of Kansas City, Missouri, as the employer, for the benefit of its employees, of whom plaintiff was one. Respondent’s risk under the policy ended at midnight February 28, 1933, leaving the insurer without liability except as to such obligations as had then accrued under the terms of the policy. At the hour just mentioned a new group policy of insurance issued by Business Men’s Assurance Company took effect. This policy, like that of respondent’s, was procured by the employer for the benefit of its employees, of whom plaintiff was one. On the trial below plaintiff contended (1) that in 1932 he became totally and permanently disabled within the purview of the policy issued by respondent and while it was in full force and effect, and (2) that he submitted to respondent due proof of such disability in June, 1934. The court expressly found that plaintiff was not totally and permanently disabled prior to midnight February 28, 1933. Notwithstanding this finding the trial court *573 also found that at the time of the trial, in December, 1939, plaintiff was totally disabled as a result of psyehoneurosis, and that the condition was presumably permanent and had existed for some time. On these findings judgment went for defendant and the case is here on plaintiff’s appeal.

The questions presented are: (1) whether the policy by its terms requires the insured, where he becomes totally and permanently disabled while the policy is in effect, to submit due proof thereof to the New York office of the insurer while the policy is in full force; (2) if the terms of the policy so require, has the requirement been waived by the insurer in the trial below; and, if so, (3) is the admissible evidence sufficient to sustain the finding that plaintiff was not totally and permanently disabled during the period of respondent’s risk under the policy.

First: Respondent argues that under the terms of the policy its obligation rests not alone upon the existence of insured’s disability but is expressly conditioned upon (1) the receipt by it of proof of disability and (2) the receipt of such proof while the employee is insured under the policy and while it is in force. In support of its position it points first to the language in the first paragraph of the policy and secondly to the language of the second paragraph, both set forth in the margin. 1 However, the second paragraph deals with the computation of the company’s liability and not with the time within which proof is to be given. Accordingly, before discussing it we turn to a consideration of the first paragraph, which alone bears directly on the subject.

In his written argument counsel for respondent not only rests heavily on the language of paragraph two, but he quotes *574 in connection therewith paragraph one and italicizes therein the words “while insured.” From this we apprehend that he implies that the pertinent sentence from paragraph one should be deemed to read: “Upon receipt, at the Home Office ... of due proof [while insured] that any Employee, while insured hereunder, and prior to his sixtieth birthday, has become totally and permanently disabled . . .” But the phrase “while insured hereunder,” as a matter of grammatical construction, modifies the word “Employee” and does not refer to the matter of due proof. More persuasive than mere grammatical construction, perhaps, is the support given by the fact that with the phrase “while insured hereunder” is grouped the further phrase, “and prior to his sixtieth birthday.” The latter phrase could have no intelligent bearing on the time when due proof should be made, but does appear as a proper, if arbitrary, limit on the time within which disability must occur. Both phrases clearly have reference to the same event, and the second phrase clearly concerns the matter of time of disability and not time of proof. The clear meaning of the words “while insured hereunder and prior to his sixtieth birthday” is that the disability, and not due proof of disability, must occur while the insurance is in force in favor of the insured. This is buttressed by the more explicit language which is found in the certificate 2 which the insurer issued to the plaintiff.

*575 While one would assume, as the first paragraph of the group policy deals with the question of “due proof,” that all provisions in respect thereto would be found in that paragraph only, we are told by counsel for respondent that this is not so. To sustain his view he points to the language in the second paragraph, reading: “The amount of each monthly instalment shall be such as the amount in force on the life of said Employee at the date of receipt of proof of such disability will purchase ...” Because of this language he contends that it follows that “due proof” must be made while the insurance is in force, and that it is a condition precedent to recovery. For this view he cites Metropolitan Life Ins. Co. v. Phillips, 236 Ala. 259 [182 So. 35]. In that case the language of the policy and the certificate was substantially the same as is here involved. The court there said: “The furnishing of proofs was not merely the event upon which payments should begin, but proof while the policy was in force is, by this policy, a condition precedent to liability for benefits.” We agree that by the language used in the policy and certificate there involved, as in the instant case, the obligation is to pay in monthly instalments such an amount “as the amount of insurance in force on the life of the employee at the date of receipt of proof of disability will purchase as of the due date of the first instalment [three months hence], on the basis of 3y2 per centum per annum, compound interest,” and that this language, read literally, prohibits a recovery where the proof was not made while the policy was in effect. However, we do not agree with the Alabama court if its opinion implies that it is a condition precedent to recovery that the insured allege and prove that due proof was made while the policy was in force. Bather, the provision deals with the amount that will be paid, and that amount is nothing if the policy is not in force on the date the due proof is received. But this is not the same thing as saying that due proof while the policy is in effect is a condition precedent. In other words, the failure to make due proof while the policy is in effect is a matter of defense and not an element of the insured’s cause of action.

In viewing the clause in question we think it is quite plain that the insurer had in mind, not that due proof of disability should be given while the insurance was in effect, but that the amount it should pay was to be predicated on the amount *576 of insurance in effect at the date of due proof rather than that which might have been in effect at the date insured became totally and permanently disabled.

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

Related

Exstrum v. Union Casualty and Life Insurance Co.
91 N.W.2d 632 (Nebraska Supreme Court, 1958)
Wallace v. World Fire & Marine Ins. Co. of Hartford, Conn.
70 F. Supp. 193 (S.D. California, 1947)
Edmonds v. State
201 Ga. 108 (Supreme Court of Georgia, 1946)
Fohl v. Metropolitan Life Insurance
129 P.2d 24 (California Court of Appeal, 1942)

Cite This Page — Counsel Stack

Bluebook (online)
123 P.2d 622, 50 Cal. App. 2d 570, 1942 Cal. App. LEXIS 973, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fritz-v-metropolitan-life-insurance-calctapp-1942.