New York Life Insurance v. Williamson

184 S.E. 755, 53 Ga. App. 28, 1936 Ga. App. LEXIS 4
CourtCourt of Appeals of Georgia
DecidedMarch 17, 1936
Docket25033
StatusPublished
Cited by36 cases

This text of 184 S.E. 755 (New York Life Insurance v. Williamson) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
New York Life Insurance v. Williamson, 184 S.E. 755, 53 Ga. App. 28, 1936 Ga. App. LEXIS 4 (Ga. Ct. App. 1936).

Opinion

Sutton, J.

This suit is against the New York Life Insurance Company on two policies of life insurance containing total-disability clauses. On August 27, 1918, the company issued to the plaintiff the two policies sued on, one for $2000 and the other for $3000. They were assigned to the First National Bank of Vidalia. The plaintiff paid the annual premiums of $152.50 to and including their anniversary date, August 23, 1930. Each policy contained the following provisions: “And the company agrees to pay to the insured one tenth of the face amount of this policy per annum, during the lifetime of the insured, if the insured becomes wholly and permanently disabled, before age 60, subject to all the terms and conditions contained in section 1 hereof.” Section 1 of the policy provided: “Whenever the company receives due proof, before default in the payment'of premiums, that the insured, before the anniversary of the policy on which the insured’s age at nearest birthday is 60 years and subsequent to the delivery hereof, has become wholly disabled by bodily injury or disease so that he is, and will be presumably [italics ours] thereby permanently and continuously prevented from engaging in any occupation whatsoever for remuneration or profit, and that, such disability has then ex[29]*29isted for not less than sixty days . . then commencing with the anniversary of the policy next succeeding the receipt of such proof, the company will on each anniversary waive payment of the premium for the ensuing insurance year, and in any settlement of the policy the company will not deduct the premiums so waived. . . One year after the anniversary of the policy next succeeding the receipt of such proof, the company will pay the insured a sum equal to one tenth of the face of the policy, and like sum on each anniversary thereafter during the lifetime and continued disability of the insured. . . The company may at any time and from time to time, but no oftener than once a year, demand due proof of such continued disability; and upon failure to furnish such proof, or if it appears that the insured is no longer wholly disabled as aforesaid, no further premiums shall be waived nor income payments made.” It appears that on April 28, 1928, while the policies were in force, the plaintiff was shot with a 45-caliber pistol in the hands of a drunken negro man, two bullets striking his right thigh, shattering the bone and causing his leg and bone to become infected, finally resulting in the shortening of that leg and the stiffening of the knee joint. The plaintiff set up that he made due proof of his disability, and that the insurer refused to pay him, although he was totally and permanently disabled. The plaintiff also set up that he continued to pay premiums until 1931, when he refused to pay any further premiums. He set up that he submitted proper proofs in 1928, 1929, and 1931, as well as 1932, and that after receipt of same and investigation the insurance company each time refused payment on the ground that he was not totally and permanently disabled as provided in the contracts of insurance. He sought recovery of the annual premiums paid by him on August 23, 1928, August 23, 1929, and August 23, 1930, and of disability benefits beginning August 23, 1929; and by amendment, for each policy year thereafter through the year 1934, of the 25 per cent, penalty and reasonable attorney’s fees allowed by law for failure to pay within sixty days after demand, when in bad faith, and accrued interest.

The defendant denied its liability for any sum, setting up that the plaintiff was not “wholly and permanently disabled and permanently and continuously prevented from engaging in any occupation whatever for remuneration or profit,” and that the plain[30]*30tiff failed to “submit due proof of any disability which would entitle the assured to disability benefits within the terms” of the policies. The defendant amended its answer, admitting that the last proof furnished it in 1932 was proper and showed that the plaintiff was disabled at that time within the meaning of the insurance contracts, and that while the plaintiff was entitled, under the policies and from the proof submitted in 1932, only to waiver of premiums beginning on August 23, 1932, and to benefits beginning the next anniversary year, August 23, 1933, the defendant did waive premiums beginning August 23, 1931, and did offer to pay disability benefits beginning August 23, 1932, which offer was rejected by the plaintiff. The defendant set up that it did not continue such offer, but only admitted such liability as is really due, that is, waiver of premiums beginning August 23, 1932, and benefits beginning August 23, 1933. The defendant struck the allegation of its answer that the plaintiff was not totally and permanently disabled, and averred that it acted in good faith in ascertaining the plaintiff’s condition, and that it was not until 1932 that it received such due proof as to show that the plaintiff was so disabled, and that as soon as it received such proof it rated the plaintiff as disabled. The defendant set up that it ascertained about the assignment of the policy made by the plaintiff, and acted with due diligence and in the best of faith, and required the assignee to be made a party, and paid $1000, benefits due for 1933 and 1934 into court for proper distribution,' and prayed for allowance for bringing to light such assignment, as well as other assignments made by the plaintiff. At the trial the plaintiff waived his right to recover any premium paid in 1928, and to recover the benefits for 1929. Both parties introduced evidence. The jury returned a verdict in favor of the plaintiff for $2804.60 principal, $425.96 interest to date of verdict, $451.15 penalty, and $300 attorney’s fees. The verdict was for all items sued for by the plaintiff, except the items waived, and included the penalty and attorney’s fees. The defendant’s motion for new trial was overruled, and it excepted. A fuller and more detailed statement of the essential facts appears in the following opinion.

The verdict is not contrary to the law. Nor is it unsupported by the evidence, in that it does not appear that the insured furnished the company with due proof of disability, as required by [31]*31the provisions of the policies, prior to the proof of disability submitted to it in 1932. . Before the company became liable to pay to the insured or his assignees any total-disability benefits under the policies, it was incumbent on the insured to furnish proof of his disability, in sufficient compliance with the terms of the policies. This was required by the policies themselves, and under our law “Every insurer shall have a right to prescribe regulations as to notice and preliminary proof of loss [disability], which shall be substantially complied with by the assured.” Code of 1933, § 56-831. Proof of disability is primarily intended to secure an adjustment between the insurer and insured, as well as to apprise the insurer of the disability, of its nature and extent, and of the claim of the insured. The insurer is entitled to the information; and in most insurance contracts, as in this case, the submission of such proof within the time and in the manner prescribed are conditions precedent to the right to recover on such a policy or to the accrual of the liability of an insurer. As appears from the evidence in this case, the insured submitted to the insurer proofs of his disability in the year 1928, again in 1929, and again in 1930, as well as in’ 1932. Each time the company denied liability and refused to pay the claim, on the ground that it did not appear that the insured was totally and permanently disabled as provided in the policies.

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Cite This Page — Counsel Stack

Bluebook (online)
184 S.E. 755, 53 Ga. App. 28, 1936 Ga. App. LEXIS 4, Counsel Stack Legal Research, https://law.counselstack.com/opinion/new-york-life-insurance-v-williamson-gactapp-1936.