Manuel v. American Income Life Insurance

223 So. 2d 817, 254 La. 316, 1969 La. LEXIS 2854
CourtSupreme Court of Louisiana
DecidedJune 9, 1969
DocketNo. 49474
StatusPublished
Cited by5 cases

This text of 223 So. 2d 817 (Manuel v. American Income Life Insurance) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Manuel v. American Income Life Insurance, 223 So. 2d 817, 254 La. 316, 1969 La. LEXIS 2854 (La. 1969).

Opinion

HAMITER, Justice.

In this suit Saluce Manuel seeks to enforce payments for total disability, through confinement to his home, under a policy of insurance issued to him in September, 1965 by the American Income Life Insurance Company, the defendant herein.

The trial court rendered judgment in plaintiff’s favor ordering defendant to pay him the sum of $200 per month until plaintiff’s disability ends, together with payments then due and unpaid.

The judgment was affirmed on appeal. 212 So.2d 169.

The casé is before us on a writ of certiorari issued at the instance of the defendant. 252 La. 942, 215 So.2d 122.

[319]*319Following the issuance of the policy the plaintiff, who was employed as a school bus -driver and who also farmed a tract of land owned by him, regularly paid premiums until April 9, 1967, at which time he suffered a severe myocardial infarction which required hospitalization for approximately three weeks. From then he has been totally disabled to carry on his former occupations of bus driving and farming.

He made application to the defendant insurer for benefits under the policy. Initially the defendant refused to make any payments whatsoever, it asserting that plaintiff had intentionally failed to disclose a preexisting ailment which would have made him uninsurable; and this was the principal defense when the instant suit was filed to compel compliance with the contract. But it was rejected by both the district court and the Court of Appeal.

The defendant later abandoned such defense, and in its application here it relied on its alternative one which was that the plaintiff’s concededly total disability was non-confining, and for it payments were due for only four months under Part 11 of the policy — not (as held by the district court and Court of Appeal) for the duration of the disability under Part 10.

The contract in question is designated as one for “Personal Compensation Disability”, and it insures the plaintiff-against loss of life, limb or sight from accidental bodily injuries or against loss of time caused by such injuries or by sickness.

Part 10 provides that if the sickness causes continuous, total disability and total loss of time, and requires continuous confinement within doors and the regular attendance of a licensed physician, the company will pay the stated monthly benefit ($200) for as long as the insured is so disabled and confined. The phrase “continuous confinement within doors” is defined to mean that “such sickness shall necessitate whole, total and continuous confinement by the insured within doors, provided that the insured’s going to the office of a licensed physician during the disability and confining sickness shall not be considered as an interruption of the confinement.”

Part 11 states that if the sickness results in total disability and loss of time, but does not require continuous confinement within doors, the company will pay the recited monthly benefits while the insured is disabled, not, however, exceeding four months for any one illness.

The defendant contends that because of the presence of the two clauses in the contract, both relating to and requiring total disability, the “confinement indoors” provision of Part 10 cannot be considered as having been inserted for evidentiary purposes to determine the extent of disability, as had been the interpretation given by this court when only one such clause was con[321]*321tained in the policy. In this manner the defendant seeks to distinguish our earlier decisions which gave the term “house confinement” or “confinement indoors” a liberal construction. See Newton v. National Life Insurance Company, 161 La. 357, 108 So. 769 and Lewis v. Liberty Industrial Life Insurance Company, Inc., 185 La. 589, 170 So. 4, 107 A.L.R. 286. And the defendant argues that, consequently, the phrase as used in the instant case in Part 10 means virtually absolute, uninterrupted, confinement indoors (other than for the excepted visits to the doctor), and that any permissive or occasional excursion out of the house would render the insured’s sickness a non-confining one governed by Part 11. Clesi v. National Life and Accident Insurance Company, Inc., 195 La. 736, 197 So. 413 is cited in support of this argument.

The question posed by this defense requires that we determine whether a strict and literal interpretation should be given to the “house confinement” clause, as urged by defendant, or whether it should be accorded a liberal one which would render effective the benefit provisions of Part 10 of the policy, even though the disabled insured does not remain strictly and uninterruptedly within the four walls of his home.

An extensive annotation in 29 A.L.R.2d 1411 et seq. treats of the cases dealing with the problem involved. It encompasses “all forms and types of the provision” (the “house confinement” clause), particularly those cases dealing with policies of the “two-clause” variety. Therein the author of the note states: “While there is considerable authority supporting the view that the ‘house confinement’ clauses are to be literally construed, so as to preclude recovery where the insured for any reason, with the possible exception of emergencies beyond his control, leaves the house, the great majority of cases support the so-called liberal construction view.” Those listed as falling within such interpretation indicate whether they are of the “one-clause” or “two-clause” variety. Most of them deal with the latter type.

The annotation points out that the courts in imposing the liberal interpretation arrive at such conclusion by a variety of reasoning. Thus, some cases state that “substantial confinement is a sufficient compliance with ‘house confinement’ clauses, or, conversely, that there must be substantial confinement as a condition of recovery by the insured”; some hold that “ ‘house confinement’ clauses are intended to describe the required extent of the insured’s illness or other disability, rather than to impose a strict limitation upon his conduct”; while others declare that “ ‘confinement’ is equivalent to ‘inability to work’ ”, and that “house confinement is merely an evidentiary requirement, designed to show with certainty the insured’s total disability.” It is further pointed out that in many cases the various theories have been treated as not [323]*323mutually exclusive, with two or more being cited with approval in the same decision.

The mentioned note includes the following observations: “Two quite generally accepted doctrines, with reference to the insured’s right to recover under a specific factual situation, emerge from the cases.

“The first of these is the doctrine that ‘house confinement’ clauses are not violated where the insured occasionally departs from within the four walls of the house for the purpose of getting fresh air and exercise, in a bona fide attempt to improve his health, particularly where such departures are undertaken by the direction of a physician, or where he visits his physician’s office or a hospital for examination and treatment.

“On the other hand, where the insured is able to, and does, leave his house for primarily business or other non-therapeutic records, he can no longer be considered within the scope of a ‘house confinement’ clause.”

The discussed annotation was prepared in connection with a case decided in 1951.

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Bluebook (online)
223 So. 2d 817, 254 La. 316, 1969 La. LEXIS 2854, Counsel Stack Legal Research, https://law.counselstack.com/opinion/manuel-v-american-income-life-insurance-la-1969.