McGrail v. Equitable Life Assurance Society of the United States

263 A.D. 439, 33 N.Y.S.2d 742, 1942 N.Y. App. Div. LEXIS 6910
CourtAppellate Division of the Supreme Court of the State of New York
DecidedMarch 4, 1942
StatusPublished
Cited by3 cases

This text of 263 A.D. 439 (McGrail v. Equitable Life Assurance Society of the United States) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McGrail v. Equitable Life Assurance Society of the United States, 263 A.D. 439, 33 N.Y.S.2d 742, 1942 N.Y. App. Div. LEXIS 6910 (N.Y. Ct. App. 1942).

Opinion

Crapser, J.

The defendant issued to the plaintiff, a physician and surgeon, a combined accident and health policy which was in full force and effect at the time of the accident insuring him against loss resulting directly and independently of all other causes, from bodily injuries effected during the term of this policy solely through external, violent and accidental means, and against disability from disease.”

Parts I and II are concerned with payment of indemnity for death or disability caused by accident while part III is concerned with indemnity for disability caused by disease. Part I, providing for indemnity for accidental death, is not here involved. Part II provides for the payment of weekly indemnity for total disability in paragraph A and for partial disability in paragraph B.

Paragraph A of part II provides for the payment of weekly indemnity of fifty dollars for not exceeding 200 consecutive weeks “ if such injuries shall wholly and continuously disable the insured from date of accident and prevent him from performing any and every duty pertaining to his occupation,” and for the payment of the same weekly indemnity for 200 weeks so long as he shall be wholly and continuously disabled from engaging in any occupation or employment for wage or profit. It is under paragraph A that recovery here has been had.

Paragraph B provided for payment for partial disability “ if such injuries shall continuously disable the insured from date of accident and prevent him from performing one or more important daily duties pertaining to his occupation, or for like continuous disability following total disability.”

Part III contains provision for the payment of indemnity for disability caused by disease, the weekly amount being fifty dollars for periods of house confinement and twenty-five dollars for periods of non-house confinement. It was under part III that the second cause of action was based, which cause of action has been discontinued and is not involved.

The policy further provides that the insurance under parts I and II shall not cover accident, injury, disability, death or other loss caused directly or indirectly, wholly or partly by bodily or mental infirmity or by any other kind of disease.

The complaint contains two causes of action, the first to recover payment of fifty dollars per week from April 1, 1940, as the result of an accident on February 9, 1940, which it is alleged caused a dislocated shoulder, coronary thrombosis and traumatic neuritis, and that solely by reason of said coronary thrombosis, traumatic neuritis and dislocated shoulder the plaintiff has been wholly and continuously since the accident totally disabled; and the second to [441]*441recover fifty dollars per week from April 1, 1940, for periods of house confinement and twenty-five dollars per week for periods of non-house confinement resulting from the total disability by reason of the disease of coronary thrombosis and neuritis which had its inception and onset in 1940 prior to April second.

At the trial of the action the plaintiff elected at the close of his case to stand upon his first cause of action and discontinued the second.

The defendant moved for a dismissal of the first cause of action at the close of the plaintiff’s case and again at the close of the entire case and the motion was denied.

The defendant does not dispute that the plaintiff had been totally disabled since April 1, 1940, or that he was entitled to disability payment under the health provisions of the policy but contended that he was not entitled to the accident provisions because (1) the accident was not the sole cause of the disability, and (2) plaintiff was not totally disabled continuously since February 9, 1940, the date of the accident.

On February 9, 1940, the plaintiff, a physician and surgeon, fifty-five years of age, who lived at 637 New Scotland avenue and who had an office at 35 Clinton avenue in the city of Albany and ninety per cent of whose work was surgical and ten per cent general medicine, in the evening while walking from his garage to his house, a distance of about forty or fifty feet, carrying two medical bags in his right hand, slipped upon the ice and fell backwards and struck the back of his chest and head and sustained a dislocation of his right shoulder. He was not rendered unconscious but felt pain in his right shoulder, right arm, breast and chest. His wife assisted him to arise, pulled his right arm which he thought was dislocated and he felt it go back into place. He went into the house feeling very bad and sat down for about a half hour near the door and then went to bed.

While sitting by the door he complained of severe pains in his right shoulder and in his breast and chest. His wife helped him upstairs to his room and into bed and about two o’clock in the morning he was in pain and his wife came into his room and gave him some brandy which he instructed her to do and some nitroglycerine. He was having difficulty in breathing and he felt severe pain radiating down his left arm. He stayed in bed the next day until noon when he arose from bed. The pain again became severe in the left arm and breast and he went back to bed and got up again about three-thirty and rested in a chair and felt a little better and decided to go and have an X-ray taken for the purpose of determining whether there was any fracture in his right shoulder or [442]*442sternum. He went to Dr. Prentice on State street who took an X-ray at seven o’clock and no fracture was found.

He did not consult a doctor again until the twenty-sixth of February when he went to Dr. Prentice again for an X-ray because he was having pain in the chest. The X-ray taken then was negative and Dr. Prentice suggested that he have an electrocardiogram.

On February tenth, after the accident, he went to see a man who lived above his office, on whom he had operated the night of the accident. He saw Mrs. Dunn on Colonie street for whom he had reduced a fracture of an arm on the morning of the day he had the accident; this was on the tenth, about half-past five. He also saw another patient on the tenth on whom he had formerly operated. Altogether he saw three patients on February tenth.

Between the tenth of February and the twenty-third of February he saw a patient on Lenox avenue at her home and he saw a Mr. Hess sometime in March on Main avenue; the call to come and see him was by telephone.

After the twenty-third of February he went to his office for six days during which time he gave reports to attorneys and insurance men about cases that he had had. He made out one death certificate right after the twenty-third of February. On the twenty-third he saw three patients at his office. Between the twenty-third of February and the first of April he went to his office on about six occasions for business and he performed part of his duties after the tenth day of February. After the twenty-third of February the plaintiff went to his office in the evening.

On February twenty-fifth, while returning to his home from his office, he was taken with an attack and stopped at a tavern for a drink of brandy and he took some nitro-glycerine which on occasions is administered for heart attacks. The next day he went back to Dr. Prentice who X-rayed his chest and who sent him to Dr. Hoffman on the following day for an electrocardiogram of his heart. He consulted no doctor from the time he had the X-ray taken of his shoulder on February tenth until he went back for another X-ray on February twenty-sixth.

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Bluebook (online)
263 A.D. 439, 33 N.Y.S.2d 742, 1942 N.Y. App. Div. LEXIS 6910, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcgrail-v-equitable-life-assurance-society-of-the-united-states-nyappdiv-1942.