General American Life Insurance v. Rios

164 S.W.2d 521, 139 Tex. 554, 1942 Tex. LEXIS 268
CourtTexas Supreme Court
DecidedJuly 1, 1942
DocketNo. 7919.
StatusPublished
Cited by7 cases

This text of 164 S.W.2d 521 (General American Life Insurance v. Rios) is published on Counsel Stack Legal Research, covering Texas Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
General American Life Insurance v. Rios, 164 S.W.2d 521, 139 Tex. 554, 1942 Tex. LEXIS 268 (Tex. 1942).

Opinion

Mr. Judge Taylor

delivered the opinion of the Commission of Appeals, Section B.

The insured, Joe Rios, filed this suit to recover from General American Life Insurance Company for total and permanent disability as provided by a certificate of insurance issued to him under a group insurance policy issued by the company to the employer of Rios. The trial court awarded judgment in favor of Rios. The El Paso Court of Civil Appeals affirmed the judgment. 154 S. W. (2d) 191. See the opinion for a more detailed statement of the case.

The coverage provision provided by the insurer for total and permanent disability, as set out in the policy and certificate, is as follows:

“If an employee insured under this policy shall furnish the company with due proof that before having attained the age of 60 years, he or she has become totally and permanently disabled by bodily injury or disease, and that he or she is then, and will be at all times thereafter, wholly prevented thereby from engaging in any gainful occupation, and that he or she has been so permanently and totally disabled for a period of six months, the company will immediately pay to such insured in full settlement of all obligations hereunder as to such insured’s life, the amount of insurance in force hereunder on such insured at the time of the approval by the company of the proofs as aforesaid. This amount will be paid either in one sum or in installments as hereinafter provided. For each $1,000.00 of insurance hereunder the amount of each installment shall be in accordance with the following table: (Here follows a statement of the optional methods of installment payment) .”

*556 The provision obligating the company to pay the compensation provided for total and permanent disability may be more tersely stated, for present purposes and without variance of language, as follows: “If the employee shall furnish the company with due proof that * * * he has become totally ami permanently disabled * * *, and that he * * * has been so * * * disabled for a period of six months, the company will immediately pay to the employee * * *, the amount of insurance in force * * * at the time of the approval by the company of the proofs as aforesaid.”

The provision governing the payment of premiums reads:

“All premiums are payable in advance at the home office of the company, but may be paid to an authorized agent of the company upon delivery of a receipt signed by the president or vice-president, and countersigned by said agent. If any premium shall not be paid when due, this policy shall terminate except as hereinafter provided.”

(The exception has reference to certain conversion privileges accorded employees, and to other matters not pertinent here.)

Rios sustained total and permanent disability May 10, 1937. His premiums were paid to July 26, 1937, and none was paid after that date. On November, 1937, Rios’ attorney wrote the company that Rios had become “totally and permanently disabled as a result of injuries received” (May 10, 1937) and that he had at the time the letter was written, “became permanently and totally disabled for a period of six months.” It will be assumed for present purposes (without deciding) that the letter was sufficient, along with other facts, to constitute due proof of total and permanent disability for a period of six months. No provision of the policy contract is pointed to (and we find none) excusing the failure to continue payment of the monthly premiums after July. There are no facts indicating an impossibility of performance of any of the contract requirements incumbent upon the assured.

In this case, as in General American Life Insurance Company v. Johnson et al, 88 S. W. (2d) 535, opinion by the Beaumont Court, (same coverage provisions and same provisions for payment of premiums) the company asserted substantially that by virtue of the stipulations of the coverage and premium paying provisions of the contract it was necessary for Rios, in order to establish liability on the part of the company, to make *557 due proof that total and permanent disability had existed for a period of six months; and asserted further in this connection that during such period, and until due proof of such disability was furnished the company, the certificate must have been kept in force by the payment of premiums as provided by the contract.

The Court of Civil Appeals in affirming the trial court’s judgment stated there is a division of authority upon the question of the necessity on the part of the insured to keep the policy in force by continuing the payment of premiums until the furnishing of due proof of total and permanent disability; and further states that it was with extreme reluctance the Court declined to follow the Beaumont Court in General American Life Insurance Company v. Johnson above referred to, the correctness of the judgment in which this Court recognized by dismissing the application filed therein for writ of error, noting in so doing that the judgment was correct. Writ of error was granted in the present case on its conflict with the Johnson case referred to.

The view of the El Paso Court in sustaining the judgment below in favor of Rios, briefly stated, as expressed in its opinion, is that the company’s obligation to pay should be held to be existent, though in an unmatured state, throughout the period from the beginning of disability and until the making of “due proof” on November, 1937, notwithstanding the insured’s failure to pay any of the premiums after the month of July, 1937, following his injury in May of that year.

The reason for concluding the obligation was existent throughout the time referred to is not to be found in the policy contract. The coverage clause of the contract quoted above clearly obligated the company to pay the sum stipulated “immediately” upon being furnished proof that the insured was totally and permanently disabled, and, that such a state of disability has existed “for a period of six months.” As stated in Missouri State Life Insurance Company v. Nidiffer, 168 Tenn. 584, 79 S. W. (2d) 1024, “Before there can be anything due under the policy for total and permanent disability, such disability must have lasted for six months.” The period of permanent disability covered has a definite time of beginning. It is not from the time disability in fact begins, but from the time the insured furnishes the company due proof that total *558 and permanent disability has been existent for a period of six months. It is only after expiration of that period and the furnishing of proof thereof that the liability of the company to pay the disability compensation accrues. There is no room for indulging in possible constructions of the language of the coverage contracted for. It is clear and unambiguous, and no other language of the policy has the effect of rendering it ambiguous. The following statement in Bergholm v. Peoria Life Insurance Company, 284 U. S. 489, 52 Sup. Ct., 230, 76 L. ed. 416, (a case in which the disability provisions were sufficiently similar to those of the present case to invoke the same principal with respect to liability) is in point:

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Bluebook (online)
164 S.W.2d 521, 139 Tex. 554, 1942 Tex. LEXIS 268, Counsel Stack Legal Research, https://law.counselstack.com/opinion/general-american-life-insurance-v-rios-tex-1942.