OCCIDENTAL LIFE INSURANCE COMPANY OF CAL. v. Nichols

97 So. 2d 879, 266 Ala. 521, 1957 Ala. LEXIS 575
CourtSupreme Court of Alabama
DecidedOctober 31, 1957
Docket6 Div. 772
StatusPublished
Cited by24 cases

This text of 97 So. 2d 879 (OCCIDENTAL LIFE INSURANCE COMPANY OF CAL. v. Nichols) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
OCCIDENTAL LIFE INSURANCE COMPANY OF CAL. v. Nichols, 97 So. 2d 879, 266 Ala. 521, 1957 Ala. LEXIS 575 (Ala. 1957).

Opinion

GOODWYN, Justice.

Appellee, Fred W. Nichols, brought suit against appellant, Occidental Life Insurance Company of California, to recover *525 disability benefits ($350 per month for two months) and return of a premium paid ($1,-213.80) as provided for in a policy of insurance issued to him by the appellant. A jury verdict was rendered in favor of plaintiff and a judgment thereon was duly entered. The defendant’s motion for a new trial being overruled, it brought this appeal.

The policy sued on provides for payment of $35,000 on death of the insured and disability benefits of $350 per month for permanent and total disability. There is a provision in the policy that a disability shall be considered permanent and total after it has continued for four months, with no benefits being allowed for the first four months. The claim in this suit is for two months’ disability following the four months’ waiting period.

The complaint, as last amended, consisted only of Count A, which will be set out in the report of the case. Defendant’s demurrer to the amended complaint being overruled, it entered a plea in short by consent. The primary defenses relied on were the general issue and fraud and misrepresentation on the part of plaintiff in his application for the insurance.

The principal factual issue revolves around the answer to a question in the application. Plaintiff answered “No” to the following question: “Have you ever had any of the following diseases or symptoms? * * * Mental derangement or any nervous disease?” The evidence discloses that he had been confined to a hospital in Birmingham on two separate occasions in 1938. The original diagnosis by his doctor at that time showed that he was suffering from manic depressive psychosis, a mental disease. However, some time thereafter, the doctor changed his diagnosis to “an anxiety reaction,” terming it a “gastric neurosis.” There is a conflict in the evidence as to when this was done and as to whether it was properly made. Apparently, the jury believed the change was made other than for purposes of the trial.

There was conflicting medical testimony as to the symptoms of manic depressive psychosis, how closely these symptoms matched those of plaintiff during his 1938 illness, and as to the probability of recurrence of the disease.

There is no evidence that plaintiff knew, prior to the trial, that he had ever been diagnosed as suffering from manic depressive psychosis. He testified he had been told by his doctor that the 1938 illness was hyperinsulinism.

Subsequent to that illness, plaintiff applied for and received several policies of insurance from other companies, all of which were introduced in evidence in this case. In applications for the earlier of these other policies plaintiff answered questions to the effect that he had had a nervous disorder in 1938. In this connection, it was stipulated by defendant that prior to receipt of plaintiff’s application, it was in possession of coded information furnished it by the Medical Information Bureau on August 18, 1943, that plaintiff had, within “3-4-5 years” prior to that time, suffered an attack of “neurasthenia or nervous prostration”; and that “this information was in the knowledge of the defendant company at the time the defendant’s policy number 2505161 [the policy sued on] was issued.” It was also virtually uncontroverted that plaintiff’s 1952 illness had no relation to that in 1938.

From the summer of 1952, and into the winter of the following year, plaintiff was in several hospitals and received treatment from several doctors. He suffered severe headaches, throat aches, some fever, stomach cramps, loss of appetite, loss of weight, diarrhea and muscle wasting. It appears to be undisputed that he was permanently and totally disabled during this period and that, unless the claimed misrepresentation by him is a bar to recovery, he is due the disability payments sought in this suit.

A doctor for defendant examined plaintiff prior to and in connection with issuance of the policy involved in this case. In *526 filling out the part of the application dealing with plaintiff’s medical history the doctor took information from prior examination records which he had made in connection with his examination of plaintiff for insurance with other companies. Those records did not disclose any prior nervous or mental disease. Plaintiff signed the application but did not read it.

Defendant demurred to the complaint taking the point, among others, that it does not show plaintiff was permanently totally disabled as the result of an accident or disease. The argument is that the policy provides for disability payments during “permanent total disability of the insured” while the complaint alleges only “that plaintiff became so totally disabled on, to-wit, July 4, 1952 so as to be wholly unable to engage in any occupation and perform any work for compensation or profit and the plaintiff was continuously so totally disabled during the months of to-wit, July, August, September, October, November, December of 1952 and the first part of January, 1953.”

It seems to us, from a consideration of all the allegations of Count A, that it sufficiently alleges the insured’s permanent total disability. It first sets out that the insurer agreed to pay a monthly income to the plaintiff “if the plaintiff * * * should become permanently and totally disabled as the result of injury or disease so as to be wholly unable to engage in any occupation or to perform any work for compensation or profit.” It then alleges that the policy provides “that such total disability shall be presumed to be permanent after the plaintiff has been continuously totally disabled for not -less than four (4) months and was during all that period wholly prevented from engaging in any occupation or performing any work for compensation or profit by cause or causes other than death.” It then alleges that “plaintiff became so totally disabled on, to-wit, July 4, 1952 so as to be wholly unable to engage in any occupation and perform any work for compensation or profit and the plaintiff was continuously so totally disabled during the months of to-wit, July, August, September, October, November, December of 1952 and the first part of January 1953.”

There seems to be no question about the right to disability benefits under the policy being dependent upon the insured’s permanent total disability nor that the complaint must show that insured is permanently totally disabled, within the meaning of those terms as used in the policy. It is our view that Count A sufficiently alleges the insured’s permanent total disability. The policy expressly provides that a total disability shall be presumed to be permanent after a continuous total disability for not less than four months. The complaint alleges that plaintiff was “so totally disabled” for more than the prescribed four months, thus effectively alleging, in accordance with the terms of the policy itself, facts showing a permanent total disability. As already noted, the complaint seeks payment for only two months of the period of disability, the first four months being excluded by an express provision of the policy.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Ensor v. WILSON BY AND THROUGH WILSON
519 So. 2d 1244 (Supreme Court of Alabama, 1987)
Aycock v. Martinez
432 So. 2d 1274 (Supreme Court of Alabama, 1983)
Costarides v. Miller
374 So. 2d 1335 (Supreme Court of Alabama, 1979)
McWhorter v. Clark
342 So. 2d 903 (Supreme Court of Alabama, 1977)
Harper v. Baptist Medical Center-Princeton
341 So. 2d 133 (Supreme Court of Alabama, 1976)
Teele v. Gravlee
313 So. 2d 169 (Supreme Court of Alabama, 1975)
Alabama Power Company v. Tatum
306 So. 2d 251 (Supreme Court of Alabama, 1975)
State v. Garris
296 So. 2d 712 (Supreme Court of Alabama, 1974)
Ponderosa Estates, Inc. v. Kuglar Construction Co.
280 So. 2d 755 (Supreme Court of Alabama, 1972)
Central of Georgia Railway Company v. Phillips
240 So. 2d 118 (Supreme Court of Alabama, 1970)
Freeman v. Hall
238 So. 2d 330 (Supreme Court of Alabama, 1970)
Blount County v. Hollingsworth
231 So. 2d 324 (Court of Civil Appeals of Alabama, 1970)
Bradley v. Jones
211 So. 2d 465 (Supreme Court of Alabama, 1968)
Alabama Power Company v. Johnson
201 So. 2d 514 (Supreme Court of Alabama, 1967)
Johnson v. Howard
181 So. 2d 85 (Supreme Court of Alabama, 1965)
South Highlands Infirmary v. Camp
180 So. 2d 904 (Supreme Court of Alabama, 1965)
Cordi v. Dixie Highway Express, Inc.
166 So. 2d 396 (Supreme Court of Alabama, 1964)
State v. Young
157 So. 2d 680 (Supreme Court of Alabama, 1963)
St. Clair County v. Martin
139 So. 2d 617 (Supreme Court of Alabama, 1962)
Roan v. Smith
133 So. 2d 224 (Supreme Court of Alabama, 1961)

Cite This Page — Counsel Stack

Bluebook (online)
97 So. 2d 879, 266 Ala. 521, 1957 Ala. LEXIS 575, Counsel Stack Legal Research, https://law.counselstack.com/opinion/occidental-life-insurance-company-of-cal-v-nichols-ala-1957.