Lewis v. Liberty Industrial Life Ins. Co.

166 So. 143
CourtLouisiana Court of Appeal
DecidedFebruary 24, 1936
DocketNo. 16216.
StatusPublished
Cited by1 cases

This text of 166 So. 143 (Lewis v. Liberty Industrial Life Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lewis v. Liberty Industrial Life Ins. Co., 166 So. 143 (La. Ct. App. 1936).

Opinions

McCALEB, Judge.

On July 3, 1922, the defendant, Liberty Industrial Life Insurance Company, insured one. Lillian Fisher against disability from sickness or accident, subject to certain conditions expressed in the policy contract.

During the year 1931, while the insurance policy was in force and effect, Lillian Fisher became insane. On May 27, 1931, she was committed to the East Louisiana hospital at Jackson, La., at which institution she has been continuously confined as a patient therein.

In the proceedings entitled. “Interdiction of Lillian Fisher,” No. 206,079 of the civil district court, the insured was interdicted and the plaintiff herein, Alma-Lewis, was appointed and qualified as curatrix.

Plaintiff, in her representative capacity, filed this suit against the insurer, claiming health benefits under the policy for the years 1931, 1932, 1933, and 1934, together with double indemnity and attorney’s fees.

*144 The insurer, among other things, based its chief defense upon two premises:

Primarily, that insanity is a disability of the mind and not of the body, and therefore such affliction, although causing permanent, total disability, was neither contemplated by the parties nor covered by the terms of the policy.

Secondarily, that Lillian Fisher, though insane, was not ill physically, and that the policy only covers illness in case the insured is “necessarily confined to bed.”

The district judge found for the defendant insurer, being of the opinion that the policy “was never intended to cover a permanent disability of the mind, causing insured to become insane, without physical disability.”

The facts are not in dispute. The medical evidence shows that the insured is suffering from dementia prsecox, hyper-phrenic type. This is described to be a mental disturbance subjecting the afflicted person to hallucinations. Because of the malady affecting her mind, the insured is unable to engage in pursuits of any sort and is totally incapacitated. There are no pathological changes in the brain in persons suffering- with this type of insanity.

Notwithstanding the insured’s mental derangement, she is physically in good health- and has never been confined to bed by reason of her apathy.

The policy in this case insures “against disability from sickness and accident.” Insanity is not excluded.

Bouvier’s law dictionary defines sickness as follows: “By sickness is understood any affection of the body which deprives it temporarily of the power to fulfil its usual functions. It has been held to include insanity. L.R. [1872-3] .8 Q.B. 295.”

■ Ballentine’s law dictionary says: “Insanity has always been considered a disease and comes strictly.within the meaning of the word sickness” — citing Robillard v. Societe St. Jean Baptiste de Centreville, 21 R.I. 348, 43 A. 635, 45 L.R.A. 559, 79 Am.St.Rep. 806.

Ruling Case Law, vol. 14, p. 1249, reads: “Insanity is 'sickness or other disability’ within a health policy, * * * ” — citing McCullough v. Expressman’s Mut. Ben. Ass’n, 133 Pa. 142, 19 A. 355, 7 L.R.A. 210.

We hold that insanity is a “sickness” included in that term as used in the policy contract now before us. See Donlen v. Fidelity & Casualty Co., 117 Misc. 414, 192 N.Y.S. 513; American Nat. Ins. Co. v. Denman (Tex.Civ.App.) 260 S.W. 226.

Having found that the disease suffered by the insured is a sickness within the terms of the policy, does the fact that the insured is not confined to bed bar her recovery ?

The policy provides “weekly benefits for sickness will only be paid for each period of 7 consecutive days that the insured is, by reason of illness, necessarily confined to bed and that he shall remain under the professional care of a duly licensed and practicing physician.” (Italics ours.)

The above-quoted provision is clear and unambiguous. It can mean only just what it says. The insured may, under this condition, suffer many known ailments, but liability of the insurer will only attach in the event the insured is necessarily confined to bed.

Counsel for plaintiff asserts that our Supreme Court has held, in the case of Newton v. National Life Ins. Co., 161 La. 357, 108 So. 769, 770, that the test of liability in health policies is disability from sickness rather than actual confinement to bed.

Prior to a discussion of the Newton Case, supra, it is helpful to briefly review some of the holdings by other courts in respect to the causes and extent of the liability of the insurer in health insurance contracts.

Corpus Juris, vol. 29, p. 280, informs: “With reference to sickness indemnity policies, there may be said to be three degrees of sickness, namely: (1) Where the patient is confined to his bed. (2) Where he is not confined to his bed, but is confined to his house. (3) Where he is too sick to work, but is not confined to his house.”

Hence the parties to the contract may stipulate for protection against any one or all of the three kinds of sickness. It follows that a contract for payment of benefits in case of sickness disability from work would broadly cover all known sicknesses preventing one from engaging in his usual business. Again, the policy may also be narrow in its terms, protecting only for illness which is house-confining. And, again, the contract may be of a more limited scope, as here; where liability ensues only in case the sickness is necessarily bed confining.

*145 These three classes of health policies have been given a liberal, rather than a literal, interpretation by a vast majority of the courts.

The cases are numerous, particularly so with reference to policies which provide for coverage only in the event the sickness is such that it confines the insured continuously within the house. The great weight of authority in actions falling under this class is that the words “continuously confined to the house” mean that the insured must be substantially confined, and the fact that he makes occasional visits to his physician’s office, or takes a trip for his health, or is taken out in the air, all on his physician’s advice, will not defeat recovery. See Garvin v. Union Mut. Cas. Co., 207 Iowa, 977, 222 N.W. 25, 61 A.L.R. 633; Interstate Business Men’s Acc. Ass’n v. Sanderson, 144 Ark. 271, 222 S.W. 51; Great Eastern Cas. Co. v. Robins, 111 Ark. 607, 164 S.W. 750; Jennings v. Brotherhood Accident Co., 44 Colo. 68, 96 P. 982, 18 L.R.A.(N.S.) 109, 130 Am.St.Rep. 109; Metropolitan Plate Glass & Cas. Ins. Co. v. Hawes’ Ex’x, 150 Ky. 52, 149 S.W. 1110, 42 L.R.A.(N.S.) 700; Columbian Relief Fund Ass’n v. Gross, 25 Ind.App. 215, 57 N.E. 145; Van Dusen v. Interstate Business Men’s Ass’n, 237 Mich. 294, 211 N.W. 991; Jentz v. National Casualty Co., 52 N.D. 688, 204 N.W. 344; Mutual Benefit Ass’n v. Nancarrow, 18 Colo.App. 274, 71 P. 423; Ramsey v. General Accident, Fire & Life Ins. Co., 160 Mo.App. 236, 142 S.W. 763; American Life & Accident Ins. Co. v. Nirdlinger, 113 Miss. 74, 73 So. 875, 4 A.L.R. 871; Breil v. Claus Groth Plattoutschen Vereen, 84 Neb. 155, 120 N.W. 905, 23 L.R.A.(N.S.) 359, 18 Ann.Cas. 1110; Olinger v. Massachusetts Protective Ass’n, 221 Mo.App. 405, 278 S.W. 86; Musser v. Great Northern Life Ins. Co., 218 Mo.App. 640, 266 S.W.

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Related

Lewis v. Liberty Industrial Life Ins. Co.
170 So. 4 (Supreme Court of Louisiana, 1936)

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