Joyce v. United Insurance Co. of America

202 Cal. App. 2d 654, 21 Cal. Rptr. 361, 17 A.L.R. 3d 517, 1962 Cal. App. LEXIS 2529
CourtCalifornia Court of Appeal
DecidedApril 23, 1962
DocketCiv. 19723
StatusPublished
Cited by17 cases

This text of 202 Cal. App. 2d 654 (Joyce v. United Insurance Co. of America) 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
Joyce v. United Insurance Co. of America, 202 Cal. App. 2d 654, 21 Cal. Rptr. 361, 17 A.L.R. 3d 517, 1962 Cal. App. LEXIS 2529 (Cal. Ct. App. 1962).

Opinion

*656 SULLIVAN, J.

In this action brought by a policyholder to recover benefits claimed under two policies of disability insurance, the defendant insurance company, hereafter referred to as United appeals from a judgment, after a nonjury trial, in favor of the plaintiff policyholder in the sum of $4,400.

The two policies, bearing consecutive numbers, are identical in their terms, have the same policy date of November 14, 1957, and provide for a first annual premium of $85. They were issued on separate applications of the plaintiff on printed forms of United, each dated October 30, 1957. So far as pertinent here, United, according to the insuring clause of each policy, insured the plaintiff 11 against loss of . .. time, resulting directly and independently of all other causes from accidental bodily injury received while this policy is in force; .. . ” Each of the subject policies also contains the following provision, found under the caption “Total Disability Accident Benefits for Life”: “The Company will pay at the rate of One Hundred ($100.00) Dollars per month for one day or more from the date of the first medical treatment and so long as the Insured lives and is disabled, if such injury shall within twenty days from date of accident wholly and continuously disable the Insured, cause total loss of time and require regular attendance by a licensed physician, surgeon, osteopath or chiropractor other than the Insured.”

The plaintiff was employed as a mechanical technician or tool maker at the Stanford University Electronics Laboratory. On December 12, 1957, while moving a heavy duty foot shear at his place of employment, he injured his right shoulder. He nevertheless continued working at his customary job. On January 10, 1958, at his same place of employment, the plaintiff injured his right arm while manipulating a heavy duty vise. He left work and finding that his arm continued to bother him over the weekend (the accident occurred on Friday), he secured medical attention on the following Monday, January 13, 1958. From that date until the trial of the case on January 20, 1960, plaintiff did not return to work except for two short periods of time which will be discussed later.

On January 16, 1958, the plaintiff wrote a letter to United, addressed to the latter’s office in San Francisco, referring to his two policies by number, and stating, “I wish to file a claim, due to accidental injury of my right arm which has kept me from work the past week and may continue to do so for a while longer.” No date of the accidental injury was given. United *657 sent him a printed claim form which he filled out and returned. Although dated January 30, 1958, it bore United’s receipt stamp dated February 6, 1958. The printed questions on this form were answered in such a way as to show that the accident occurred on December 12, 1957, and the date he “quit work because of this . . . injury” was January 10, 1958. United replied by letter of March 3, 1958, informing the plaintiff that because of the date of the injury and the termination of the work shown, he was not covered by the policy, since the injury did not cause total and continuous disability within 20 days, as provided by the terms of the policy we have hereinabove set forth. The plaintiff promptly replied by letter of March 4, 1958, complaining of United’s position in the matter, objecting to their statement that he had not been disabled until more than 20 days after the accident, and advising that “[m]y claim is legal and I intend to carry it further. ...” The letter failed to mention anything about the accident having occurred on January 10, 1958. On March 13, 1958, United wrote back, stating that in view of the fact that the reports from plaintiff, his doctor and his employer showed the injury to be on December 12, 1957, United could not approve payment. However, United advised plaintiff that if it had been misinformed, it should be furnished with a corrected statement.

The next communication came from plaintiff’s attorneys who wrote United on August 5, 1958, demanding payment of benefits due from January 13, 1958. No date of accident was mentioned. United replied on August 7, 1958, restating its position. Plaintiff’s attorneys then wrote United on August 19, 1958, advising the company that it was in error, that it was true that plaintiff hurt his right arm on December 12, 1957, “but he did not suffer an injury which disabled him until January 10, 1958, when he suffered a tearing of the. muscle attachment... of the right humerus. ...”

Thus the heart of the controversy between the parties was in the court below, as it is here, the actual date of the disabling injury and the sufficiency and timeliness of the notice of plaintiff’s claim. United’s position was that the injury occurring on December 12, 1957, was the only one suffered by plaintiff and that such injury was not within the coverage of the policy since plaintiff was not wholly and continuously disabled within 20 days of such date, his disability not having commenced until January 10, 1958. The plaintiff’s position was that he sustained a second injury on January 10, 1958, *658 and being thereby immediately disabled, was within the said 20-day period.

At the trial, the plaintiff was the only witness, although both parties introduced documentary evidence. The court found, so far as is pertinent to this appeal, that the plaintiff on January 10, 1958, suffered an accidental injury to his right arm when he pulled at a vise, that such injury proximately caused total disability from the date thereof until the trial, total loss of time and the need for medical care, and that the plaintiff sustained a sprain of the muscle of his shoulder and chest on December 12, 1957, which was a remote cause, if any, of his loss of time and did not cause disability or loss of time. The court concluded that the above injury and disability of January 10th was within the coverage of the policies, and that plaintiff had given timely notice of his claim, and gave judgment accordingly.

United contends before us that (1) the injury sustained by plaintiff does not come within the provisions of the policies; (2) the plaintiff failed to give notice of his claim as required by the policies; (3) there was a termination of disability upon plaintiff’s return to work; and (4) if any coverage existed, it was limited because of the fact that the policies were issued on a budget plan.

Accidental Bodily Injury within Policy Provisions.

United contends that all the evidence shows plaintiff’s injury to have resulted from the accident of December 12, 1957. In short, it attacks the sufficiency of the evidence to support the court’s finding that an accident and resultant injury occurred on January 10, 1958, proximately causing the plaintiff’s disability and loss of time.

The above argument is predicated on two groups of documentary evidence: (a) The above-mentioned correspondence between plaintiff and United in the early part of 1958, including the claim form signed by plaintiff, giving December 12, 1957, as the date of accident; and (b) certain records of proceedings and medical reports before the Industrial Accident Commission.

Plaintiff himself testified that he had an accident and sustained an injury on January 10, 1958.

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Cite This Page — Counsel Stack

Bluebook (online)
202 Cal. App. 2d 654, 21 Cal. Rptr. 361, 17 A.L.R. 3d 517, 1962 Cal. App. LEXIS 2529, Counsel Stack Legal Research, https://law.counselstack.com/opinion/joyce-v-united-insurance-co-of-america-calctapp-1962.