Julius E. Kern v. Prudential Insurance Company of America, Prudential Insurance Company of America v. Julius E. Kern

293 F.2d 251
CourtCourt of Appeals for the Eighth Circuit
DecidedAugust 9, 1961
Docket16683_1
StatusPublished
Cited by13 cases

This text of 293 F.2d 251 (Julius E. Kern v. Prudential Insurance Company of America, Prudential Insurance Company of America v. Julius E. Kern) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Julius E. Kern v. Prudential Insurance Company of America, Prudential Insurance Company of America v. Julius E. Kern, 293 F.2d 251 (8th Cir. 1961).

Opinion

VAN OOSTERHOUT, Circuit Judge.

This action was brought by plaintiff Kern to determine his rights under two policies of life insurance issued by the defendant — No. 11,335,891, a $10,000 modified whole life policy hereinafter called the whole life policy, and No. 31,000,481, a $49,000 five-year term policy, expiring June 4, 1956, with conversion privilege, hereinafter called the term policy. Both policies contain provisions for waiver of premium for total permanent disability. The issues presented by this appeal are those raised by the plaintiff’s second amendment to complaint and answer thereto. 1

Jurisdiction b'ased upon diversity of citizenship and the requisite amount is established.

Upon the term policy, the court found that the policy by its terms had termi *253 nated and expired; that plaintiff had not exercised the conversion option afforded him by the policy at the time and in the manner required by the policy, and that defendant by its conduct did not repudiate its contractual obligation to convert so as to excuse plaintiff’s compliance with the policy provisions relative to the exercise of the conversion option. The court’s view of the law and the facts is set out in a memorandum opinion reported at 187 F.Supp. 398. Final judgment was entered in favor of defendant on the term policy and plaintiff has appealed from such judgment.

As to the whole life policy, plaintiff after receiving notice on February 16, 1956, that defendant no longer considered him to be totally disabled so as to entitle him to waiver of premiums, paid premiums for the year 1956 and subsequent years under protest. The amount of such premiums so paid is stipulated. The court found plaintiff was disabled within the meaning of the waiver of premium provision of the policy, and awarded plaintiff judgment for recovery of the premiums paid. Defendant has appealed from this portion of the judgment.

We shall first consider defendant’s appeal from the judgment for plaintiff for return of premiums paid on the whole life policy.

The issue raised by this appeal is whether plaintiff in 1956 and thereafter remained totally disabled within the meaning of the policy provisions relating to waiver of premiums for total disability. It is undisputed that plaintiff had suffered a nervous breakdown in 1952 which resulted in hospitalization for a period and considerable medical and psychiatric treatment, which included electric shock and insulin. Plaintiff filed claim for waiver of premiums by reason of total disability and defendant in 1954 recognized that plaintiff was totally disabled since 1952 and waived premiums due on all policies it had issued to the plaintiff for a period subsequent to December 2, 1952, and refunded premiums which plaintiff had paid falling due on or after such date. Recognition of such disability continued until defendant on February 16, 1956, after it had investigated plaintiff’s condition, advised plaintiff by letter that it no longer considered him totally disabled and that the policies were restored to a premium paying basis.

The whole life policy defines total disability as follows:

“The disability must be total in its nature to an extent sufficient to render the Insured incapable of performing any work or engaging in any occupation for remuneration or profit. The benefits of these provisions shall not be allowed or continued if, during any period for which such benefits are claimed, the Insured has applied for or accepted employment for wages or salary or has engaged in any business for profit.”

In the court’s memorandum opinion of May 20, 1959 (not reported), adopted by reference in the opinion reported in 187 F.Supp. 398, 400, the court fully considers and discusses the applicable law and relevant facts, and with reference to the law states:

“The Missouri courts have adopted what is known as the liberal interpretation of the disability provisions in insurance policies. The extent to which the courts go with respect to this matter is governed to some extent by the policy provisions in question, in that the provisions in some policies are like the provisions in the policy before the court, while others fix the liability of the insurer upon the disability of the insured to prosecute his occupation or the occupation stated in the policy. The policy provisions in this case, however, fix liability upon the disability of the insured from performing any work or engaging in any occupation for remuneration or profit. They are quite similar to the provisions of the policies in the Wiener [Wiener v. Mutual Life Ins. Co. of New York, 352 Mo. 673, 179 S.W.2d 39] and Glore [Glore v. Metropolitan Life *254 Ins. Co., Mo.App., 153 S.W.2d 770] cases, supra.
“The Missouri courts have repeatedly held, as was held in the case of Heald v. Aetna Life Insurance Company [340 Mo. 1143], 104 S.W. 2d 379, that the disability clause of a life policy does not mean, as its literal interpretation would require, a state of absolute helplessness, but rather that the disability contemplated means inability to do all the substantial and material acts necessary to the prosecution of the insured’s business, or in many instances, any business or occupation in a customary and usual manner. Under the provisions in the policy before the court, this, of course, would not mean the insured’s business, but rather, would mean any business or occupation.
“In the Wiener case [179 S.W.(2d) 39], at page 42, the court had this to say:
“ ‘ * * * The policy in the instant case covers disability from following any gainful occupation. Therefore, such theory properly applies here and is consistent with the general rule, which the Heald case approves, that a person is totally disabled when his infirmity prevents him from doing “all the substantia] and material acts” of his occupation. The word “all” in the general rule is used in the sense of the whole, meaning the sum total. However, it comprehends only those duties which are material and substantial. Incidental or occasional acts are not included. But a provision in an insurance policy covering disability which prevents the insured from following any gainful occupation must be given a practical interpretation to serve the purpose of such insurance so that it becomes effective when a person is prevented by disability from successfully engaging in an occupation for which he is fitted.
“ ‘Accordingly we hold a person is totally disabled when he cannot perform in the usual manner enough of the substantial and material duties of his occupation to be able successfully to continue his occupation or, in such a case as this, any gainful occupation for which he would be fitted.’
“And so, under the Missouri decisions the question before the court is: Did the plaintiff perform in the usual manner enough of the substantial and material duties of the gainful occupations which he followed during the period in question to determine that he was not totally disabled within the provisions of the policy?”

The insurance contracts before us are Missouri contracts. Thus, Missouri law governs in their interpretation.

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Bluebook (online)
293 F.2d 251, Counsel Stack Legal Research, https://law.counselstack.com/opinion/julius-e-kern-v-prudential-insurance-company-of-america-prudential-ca8-1961.