New York Life Insurance v. Bradford

189 S.E. 914, 55 Ga. App. 248, 1937 Ga. App. LEXIS 62
Court of Appeals of Georgia·Decided February 13, 1937·No. 25902·Published·Cited by 13 cases

Opinion

Sutton, J.

To paragraph 6 of the petition, alleging that due proof of disability had been furnished, the defendant demurred on the ground that such statement was a mere conclusion without any allegation as to what was contained in the proof or to whom made. The plaintiff then amended by setting out that the defendant had subsequently denied his claim, although by letter to the defendant, dated January 31, 1935, the plaintiff had insisted that he was still totally and permanently disabled, and offered to submit to examination by physicians and furnish any further information that might be required; and also by letter under date of February 13, 1935, again insisting that he was so disabled and unable to work, and offering to submit to any examination or furnish any desired information, but that the defendant persisted in its refusal to pay the disability benefits. The defendant demurred to this paragraph, on the ground that there was no allegation that as to the disability originating on or before January 1, 1935, as alleged by amendment, any due proof had been submitted or that any demand had been made for payments because of such disability caused by rheumatism and neuritis. The plaintiff further amended by setting out copies of the letters referred to. It is apparent that in refusing to continue payments the defendant did not have in mind any disability of the plaintiff other than that originating from a gunshot wound, as the plaintiff had not, according to the exhibits, or from any allegation in the petition, reported any disability from rheumatism or neuritis as was subsequently alleged by amendment to have arisen “on or [255] before January 1, 1935,” and to have existed since. Nevertheless the defendant did know, as shown by the letters from the plaintiff, that the latter was claiming to be still disabled. If he was totally and permanently disabled from the original gunshot wound, or totally and permanently disabled because the disability had continued by reason of aggravation by rheumatism and neuritis, or totally and permanently disabled because of rheumatism and neuritis independently of the gunshot wound, he was so disabled as to be entitled, under the policies, to the monthly payments upon complying with the terms of the policy as to furnishing due proof, or if, upon being notified by the plaintiff that he was totally and permanently disabled within the meaning of the policies, the defendant refused to. make payment, without predicating its refusal upon any failure of the plaintiff to make proof upon demand by the defendant. ’“Every insurer shall have a right to prescribe regulations as to notice and preliminary proof of loss, which shall be substantially complied with by the assured: provided, the same shall be made known at the time of the insurance, and shall not be materially changed during the existence of the contract. An absolute refusal to pay shall waive a compliance with these preliminaries.” Code, § 56-831. Harp v. Fireman’s Fund Insurance Co., 130 Ga. 726, 730 (61 S. E. 704, 14 Ann. Cas. 299); National Life Insurance Co. v. Jackson, 18 Ga. App. 494 (89 S. E. 633); Holmes v. Atlanta Life Insurance Co., 50 Ga. App. 622 (178 S. E. 766); Patrick v. Travelers Insurance Co., 51 Ga. App. 253, 256 (180 S. E. 141). Under the allegations as amended, it was not necessary for the plaintiff to furnish proof of loss before beginning suit, it being shown that the defendant had made a declaration of recovery and had refused to pay the claim, without predicating its refusal on the failure of the plaintiff to furnish proof of his alleged disability. The court did not err in overruling this ground of the demurrer.

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New York Life Insurance v. Bradford, 189 S.E. 914, 55 Ga. App. 248, 1937 Ga. App. LEXIS 62 (Ga. Ct. App. 1937).

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