Galindo v. Guarantee Trust Life Insurance

414 N.E.2d 265, 91 Ill. App. 3d 61, 46 Ill. Dec. 543, 1980 Ill. App. LEXIS 3987
CourtAppellate Court of Illinois
DecidedDecember 16, 1980
Docket80-88
StatusPublished
Cited by11 cases

This text of 414 N.E.2d 265 (Galindo v. Guarantee Trust Life Insurance) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Galindo v. Guarantee Trust Life Insurance, 414 N.E.2d 265, 91 Ill. App. 3d 61, 46 Ill. Dec. 543, 1980 Ill. App. LEXIS 3987 (Ill. Ct. App. 1980).

Opinion

Mr. JUSTICE STOUDER

delivered the opinion of the court:

Plaintiff William Galindo, Jr., initiated this action to recover benefits under an accident insurance policy issued by defendant Guarantee Trust Life Insurance Company. After each party moved for summary judgment, the circuit court of Peoria County entered judgment in defendant’s favor. This appeal is from that judgment.

In October 1974, plaintiff sustained a broken neck while playing in a high school football game and as a result of that injury, is a quadriplegic. The high school which plaintiff was attending at the time of his injury was a member of the Illinois High School Association (hereinafter IHSA). That association had an accident insurance policy, issued by defendant, providing various benefits for students injured in interscholastic athletic activities. The first two issues with which we are presented concern the coverage afforded by the policy and its companion information brochure.

Plaintiff’s initial assignments of error invoke the specific loss provision of the policy, which provides:

“Part III Specific Loss Insurance
If the Insured by reason of injury shall sustain any one of the following specific losses within 180 days from the date of accident, the Company will pay for the loss of:
Life..........$ 1,000.00 One Foot and
Both Hands or One Eye.......$5,000.00
Both Arms____ 10,000.00 One Hand or
Both Feet or One Arm...... 5,000.00
Both Legs..... 10,000.00 One Foot or
Both Eyes..... 10,000.00 One Leg....... 5,000.00
One Hand and Either Eye ..... 5,000.00
One Eye...... 5,000.00 Thumb and Index
Finger of
Either Hand.... 2,500.00
Loss shall mean in regard to hand or hands or foot or feet, actual severance through or above wrists or ankle or ankles, and loss of sight of eye or eyes shall mean the irrecoverable loss of the entire sight thereof.”

Plaintiff first contends that this provision provides for the payment of benefits for the loss of arms or legs without the necessity of actual severance. Defendant acknowledges that the provision does not require severance in regard to these members but contends the policy elsewhere provides that dismemberment is a condition for the payment of loss benefits.

The subject policy mentions dismemberment in captions on its front cover and again on the top of its first page:

“This policy provides indemnity for Accidental Death, Dismemberment or Loss of Sight, caused by Accidental Bodily Injury and provides payment for expense incurred for the treatment of Accidental Bodily Injury as herein limited and provided.”

The policy additionally contains a box on its first page, under the caption “Schedule,” which contains the words and figure:

“Maximum Dismembership Benefit $10,000.00.”

A companion brochure, entitled “Catastrophe Accident Insurance Program” prepared by defendant for distribution to principals of IHSA member schools, makes no mention of severance or dismemberment.

An insurance policy in which no ambiguity appears is to be read as any other contract, that is, according to the plain and ordinary meaning of its terms (Dora Township v. Indiana Insurance Co. (1980), 78 Ill. 2d 376, 400 N.E.2d 921) and interpreted from an examination of the complete document and not an isolated part (Weiss v. Bituminous Casualty Corp. (1974), 59 Ill. 2d 165, 319 N.E.2d 491). Where provisions in an insurance policy are clear and unambiguous, courts do not hesitate to enforce those provisions (Kirk v. Financial Security Life Insurance Co. (1978), 75 Ill. 2d 367, 389 N.E.2d 144); however, where language in a policy is subject to different interpretations, such ambiguity is to be construed in favor of the insured and not the insurance company which drafted the contract of insurance. Dora Township v. Indiana Insurance Co.

An examination of the complete subject policy reveals the aforementioned dismemberment captions as well as the specific requirement of actual severance in regard to loss of feet and hands. Plaintiff suggests that the captioned material is “not part of the insuring clause”; however, we believe that headlines or captions may be read into the policy. (See 43 Am. Jur. 2d Insurance §282 (1969).) Plaintiff also suggests that as neither dismemberment nor severance is mentioned in the brochure, the brochure should control. While courts have so held under the theory that group insurance certificates are a part of a total contract under the particular language of the certificate or under a theory of estoppel (see Hofeld v. Nationwide Life Insurance Co. (1975), 59 Ill. 2d 522, 526-27, 322 N.E.2d 454, 457), conflict between a certificate and master policy does not exist when the certificate is silent on a point in controversy (cf. Hofeld v. Nationwide Life Insurance Co.). Without reaching a characterization of the subject policy, we find an examination of the subject brochure similarly reveals no conflict with the subject policy. We therefore do not reach the question of whether the brochure should here control.

It is nonetheless clear from an examination of the specific loss provision and policy captions that an ambiguity here exists. While the captions suggest the policy indemnifies for death, dismemberment, or blindness, no reference is made to dismemberment in the specific loss provision; rather, the reference in that provision is to severance, and that reference is only in regard to hands and feet. The policy does not in any manner define “loss” in regard to arms, legs, or digits in a provision in which it could have easily done so.

In Theorell v. Supreme Court of Honor (1904), 115 Ill. App. 313, a carpenter had fallen from an elevated position and dislocated his neck, as a result of which his lower limbs were paralyzed. Prior to the accident, his insurance membership certificates provided for benefits “ * ° [i]f a member loses both feet, both hands or both eyes, thereby becoming totally disabled * * °’ ” (Theorell v. Supreme Court of Honor (1904), 115 Ill. App. 313, 314); thereafter, the certificate was amended to require “ 9 9 amputation or severance at or above the ankle or wrist 9 9” (Theorell v. Supreme Court of Honor (1904), 115 Ill. App. 313, 315.) As the former provision governed, the court followed Supreme Court of Honor v. Turner (1901), 99 Ill. App. 310, 311, where the court had said:

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Bluebook (online)
414 N.E.2d 265, 91 Ill. App. 3d 61, 46 Ill. Dec. 543, 1980 Ill. App. LEXIS 3987, Counsel Stack Legal Research, https://law.counselstack.com/opinion/galindo-v-guarantee-trust-life-insurance-illappct-1980.