Mataya v. Delta Life Ins.

58 So. 2d 564, 1952 La. App. LEXIS 584
CourtLouisiana Court of Appeal
DecidedApril 28, 1952
DocketNo. 19573
StatusPublished
Cited by3 cases

This text of 58 So. 2d 564 (Mataya v. Delta Life Ins.) 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
Mataya v. Delta Life Ins., 58 So. 2d 564, 1952 La. App. LEXIS 584 (La. Ct. App. 1952).

Opinion

McBRIDE, Judge.

This- suit was brought on a policy of insurance for $500 on the life of plaintiff’s wife, he being the beneficiary. The insured died on October 8, 1949. The company defended the action on the ground that in her written application for the policy of insurance, the insured intentionally deceived the company by concealing information regarding the state of her health and physical condition. The district court dismissed the suit, and plaintiff has appealed.

[566]*566It is of the utmost importance to first determine whether the policy is one of industrial life insurance. On May 30', 1949, when the policy was issued, Act No. 195 of 1948, Louisiana Insurance Code, LSA-R.S. 22:1 et seq., was in force, and its provisions are to be controlling in this case. The act regulated insurers and the insurance business, and revised and codified the insurance laws of the state. Provisions concerning the business of industrial life insurance and the issuance of industrial life insurance policies are quite different from those provisions of the act regulating the general life insurance business and the issuance of life insurance on the ordinary plan.

In the policy before us, the Delta Life Insurance Company, in consideration of a weekly premium of seventy-one cents, obligated itself to pay plaintiff, as beneficiary, upon the due proof of the death of his wife, Lorenzo A. Mataya, while the policy is in force and effect, the sum of $500. Besides the life insurance feature of the policy, certain additional benefits were stipulated for, as follows:

“Additional Benefit In Event of Death By Accidental Means. — Upon receipt of due proof that the death of the Insured resulted independently of all other causes from 'bodily injuries caused solely by external, violent or accidental means, provided such death occurs within sixty (60) days from the date of such injury, the Company will pay the ‘Amount of Insurance’ shown in the Schedule.
“Additional Benefits In Event of Disability By Specific Loss. — Upon receipt of due proof that the Insured, solely as the result of disease or injury contracted or sustained after the date of this Policy, has suffered the loss by severance of 'both hands above the wrists, or of both feet above the ankle, or of one hand above the wrist and one foot above the ankle, or has suffered irrecoverably the loss of the entire sight of both, eyes, total and permanent disability will be deemed to exist and the Company will pay to the Insured, if living, the ‘Amount of Insurance’ stated in the Schedule, or upon receipt of due proof that the Insured has suffered the loss by severance of one hand above the wrist, or of one foot above the ankle, the Company will pay to the Insured, if living, one-half the ‘Amount of Insurance’ stated in the Schedule; * * * ”,

The first statutory definition of industrial life insurance in this state is to be found in Act 65 of 1906, which was amended by Act 240 of 1916. The definition appears thus:

“That Industrial Life Insurance is hereby defined to be that Insurance for which stipulated premiums, advanced assessments or dues are regularly payable and collectible every four weeks, tri-weekly, bi-weekly, weekly, semiweekly or at any other stated terms not exceeding one calendar month apart, and the policies or benefit certificates for which are for sums of Five Hundred Dollars or less on a single life on which policies or benefit certificates provide a weekly cash benefit for disability, caused by sickness or accident, of Twenty Dollars per week or less, or which provide for the attendance of a physician or supplying of drugs, or furnishing a funeral.” (Italics ours.)

The preposition “on” in the above act, which we have italicized, was erroneously used, and should have read “or” in order to make the language used comprehensible. See Dominique v. Washington National Life Ins. Co., La.App., 166 So. 628.

In Act 148 of 1936, as amended by Act 340 erf 1942, the Legislature defined industrial life insurance as:

“ * * * that insurance for which stipulated premiums advanced assessments, or dues, are regularly payable and collectible annually, semi-annually, quarterly, monthly, tri-weekly, bi-weekly, weekly, or semi-weekly, and the policies or benefit certificates for which (a) do not exceed in the aggregate the sum of Twenty-five Hundred Dollars on a single life, (b) provide a weekly cash benefit for disability, caused by sickness or accident, of [567]*567Forty Dollars per week or less, (c) provide for the attendance of a physician and the payment of hospitalization and surgical costs, (d) provide for the supplying of drugs, or (e) provide for the furnishing of a funeral, as hereinafter limited and provided.”

Act 195 of 1948, the Insurance Code, in Chap. 7, § 7.01, LSA-R.S. 22:251, sets forth the following definition:

“1. Industrial life insurance is hereby defined to be that insurance for which premiums are regularly payable and collectible and the policies or benefit certificates for which:
“(a) Do not exceed twelve hundred and fifty dollars on a single life,
“(b) Provide a weekly cash benefit for disability, caused by sickness or accident, or forty dollars per week-or less,
“(c) Provide for the payment for or furnishing of hospitalization, drugs, attending physician and surgical costs,
“(d) Provide for the payment for or furnishing of a funeral, all as herein limited and provided.”

Plaintiff takes the position that to come within the definition laid down for an industrial life insurance policy, the contract must contain all four of the elements recited in § 7.01. On the other hand, the defendant contends that an industrial life insurance policy need not provide for each and every type of benefit mentioned in the section. It is argued that the policy should be deemed a contract for industrial life insurance because it contains an accidental death benefit and includes disability provisions. It is also stressed by counsel that the policy contains the requisite mandatory provisions required of industrial life insurance policies as prescribed in § 7.09 of the act, LSA-R.S. 22:259.

The bare fact that the policy does contain the mandatory provisions appearing in § 7.09 does not of itself place the policy in the category of one of industrial life insurance. To be an industrial life insurance policy the contract must come within the orbit of the definition set forth in § 7.01, and our opinion is that the contract does not conform thereto. In prior legislation, the disjunctive word “or” appears, and it was not necessary for the contract to provide for each and every type of benefit set forth in the definition of industrial life insurance. In § 7.01 of Act 195 of 1948, the disjunctive “or” is not present, and a reading of the section formulates the thought that there must be a concurrence of all four of the essentials in the contract before it can be classified as industrial life insurance. Usually, industrial life insurance embraces small policies of accident, health, or life insurance issued in consideration of weekly payments or payments to be made at short regular intervals, in contradistinction to the ordinary plan of insurance, where premiums are payable annually, semiannually, or quarterly. See 44 C.J.S., Insurance, § 20, p. 480.

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Related

Kelmell v. Atlas Life Insurance
107 So. 2d 818 (Louisiana Court of Appeal, 1958)
Mataya v. Delta Life Ins. Co.
71 So. 2d 139 (Louisiana Court of Appeal, 1954)
Mataya v. Delta Life Ins. Co.
62 So. 2d 817 (Supreme Court of Louisiana, 1953)

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Bluebook (online)
58 So. 2d 564, 1952 La. App. LEXIS 584, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mataya-v-delta-life-ins-lactapp-1952.