Pacific Mut. Life Ins. Co. of California v. Coley

1917 OK 77, 162 P. 713, 62 Okla. 161, 1917 Okla. LEXIS 270
CourtSupreme Court of Oklahoma
DecidedJanuary 9, 1917
Docket7786
StatusPublished
Cited by6 cases

This text of 1917 OK 77 (Pacific Mut. Life Ins. Co. of California v. Coley) is published on Counsel Stack Legal Research, covering Supreme Court of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pacific Mut. Life Ins. Co. of California v. Coley, 1917 OK 77, 162 P. 713, 62 Okla. 161, 1917 Okla. LEXIS 270 (Okla. 1917).

Opinion

Opinion by

HOOKER, C.

This action was commenced in the district court of Muskogee county by the defendant in error against the plaintiff in error, to recover the benefits alleged to be due the plaintiff below by virtue of a policy of accident insurance had by him in the company of the plaintiff in error, and it was claimed by the defendant in error that on January 5, 1913, while engaged in his usual business, he slipped and fell striking his back and hips against the reverse lever Quadrant on the engine in which he was employed, and against the edge of the floor, as a result of which an injury was caused to him by external, violent, and accidental means, producing at times visible and external marks upon his body, by virtue of which he was prevented from performing the duties of his occupation, and as a result thereof there was due to him benefits accruing under said policy at the rate of $75 per month for the time of such total disability, not to exceed six months.

The answer of the company herein denied the allegations of the petition, although admitting the execution of the policy, denied that the injury alleged to have been suffered by the defendant in error was covered or embraced in the policy of accident insurance held by the defendant in error with the company so as to make the company liable for said injury, and it further claimed that the defendant in error had submitted his claim to the company, claiming $75 per month for a number of months by reason of said accident, but that it had denied liability, and that it had made a complete settlement with him for any damages or sum due by virtue of said policy, for the reason that it had paid to said defendant in error the sum of $75, and at the time thereof the said defendant in error executed and delivered to it a receipt in words and figures as follows:

“Receipt and Indorsement.
“Received the above balance, being in full satisfaction and final settlement of all claims accruing or to accrue against the Pacific Mutual Life Insurance Company of California on account of any accident already sustained and any disease or illness heretofore contracted.
“S. B. Coley.”

It appears from the evidence that the company contended that there was no liability on its part to the defendant in error by virtue of said accident, for the reason that the policy provides that the said Samuel B. Coley was insured “against the results hereinafter set forth, of and caused solely by external, violent, and accidental means (excluding suicide, sane or insane, or any attempt thereat, sane or insane) at once producing visible and external mark upon the body, such means so producing such mark being hereinafter called accident, such accident happening during the term of and while this' policy is in full force and effect,” and that the injury suffered by the insured did not come within this provision of the policy, for, the reason that it did not produce visible and external marks upon the body. The illness benefit of the policy was as follows:

“Illness Benefits.
“Article 5. Illness benefits at the rate of seventy-five dollars per month for such time, not exceeding six months that said insured is necessarily and continuously confined inside the house and regularly visited in the house by a legally qualified physician by reason of disease that is contracted and begins after this policy has been maintained in force continuously for thirty days.
“Or, if the insured by reason of such disease shall be totally disabled and prevented continuously from performing any and all duties pertaining to the insured’s occupation, though not confined inside the house, and regularly treated by a legally qualified physician, the company will pay said illness benefits for such time, not exceeding one month, provided the total amount of benefits payable under this article 5 shall not exceed the amount payable for six months of such house confinement.”

Proof of claim of the insured was filed by him with the company, and about April 17, 1913, the company declined payment under the accident provision of this policy, and addressed to him the following communication :

“Mr. Samuel B. Coley, Muskogee, Oklahoma. Dear Sir: Acknowledging receipt of yours of the 12th inst., would say that reports at hand from you do not establish that your disability is the result solely of bodily injury caused through external, violent and accidental means which at once produced external mark upon the body. In fact reports establish contrariwise that there was an external mark on your body that immediately disabled you as a result of accidental bodily injury. Therefore your claim if anything would come within the illness clause of your policy, as you hold a general disability contract. You will note that under the illness clause the limit of the company’s liability is one month’s benefit for nonhouse *163 confinement and we, without acknowledging liability even in that amount, are disposed to give you the benefit thereof and inclosing check herewith -of $75.00 to cover. As to your request for deducting April premium this will serve to advise you that we wish to take advantage of article 18 of the policy. Yours respectfully, Pacific Mutual Life Insurance Company. [Signed] J. W. Rhodes, Supervisor.”

The physician’s certificate, accompanying the statement of the claim, was to the effect that no objective signs of injury were to be found on the body, but that there was tenderness of the lumbar vertebrae. And in answer to the specific question propounded in the certificate:

“What if any external appearance did the injury show at first examination? Answer. Objective symptoms negative.”

The doctor further certifies that he examined Coley on the date of the injury, January 5, 1913, and the examination disclosed as stated above.

One of the defenses of the company here, as stated, upon which it relies, was an accord and satisfaction of any liability to the plaintiff for injuries under said policy, by reason of the facts above stated.

The plaintiff below sought to avoid the settlement made by him upon the ground that, at the time of signing his name to said receipt, he was ill from the effects of the injuries received, and was suffering, by reason of said injury and illness, great bodily pain, and that by reason thereof, when he signed said receipt and indorsement, he did not know, nor was his attention called to the fact, that the statement on the back of the check was anything other than a receipt for the $75 and an indorsement on said check, and that at the time he signed said receipt and indorsement there was due to him more than the sum of $75, and that he never intended to accept the same in full satisfaction of the demand due him by the company, nor would he have ever signed said receipt and indorsement, but from that fact that he was suffering physical pain, and on account thereof was mentally incapable of understanding or comprehending the meaning of such receipt, supposing that he was Simply indorsing a check.

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

Related

Shoenfelt v. Donna Belle Loan & Inv. Co.
1935 OK 579 (Supreme Court of Oklahoma, 1935)
Williams v. New Brunswick Fire Insurance
1935 OK 520 (Supreme Court of Oklahoma, 1935)
Green v. Cox MacHinery Co.
1926 OK 43 (Supreme Court of Oklahoma, 1926)
Payne v. Smith
1924 OK 874 (Supreme Court of Oklahoma, 1924)
Pacific Mut. Life Ins. Co. of California v. Coley
1920 OK 352 (Supreme Court of Oklahoma, 1920)

Cite This Page — Counsel Stack

Bluebook (online)
1917 OK 77, 162 P. 713, 62 Okla. 161, 1917 Okla. LEXIS 270, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pacific-mut-life-ins-co-of-california-v-coley-okla-1917.