Pennsylvania Life Ins. Co. v. Mattingly

464 S.W.2d 632, 1970 Ky. LEXIS 103
CourtCourt of Appeals of Kentucky
DecidedDecember 11, 1970
StatusPublished
Cited by1 cases

This text of 464 S.W.2d 632 (Pennsylvania Life Ins. Co. v. Mattingly) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pennsylvania Life Ins. Co. v. Mattingly, 464 S.W.2d 632, 1970 Ky. LEXIS 103 (Ky. Ct. App. 1970).

Opinion

DAVIS, Commissioner.

Harold Mattingly obtained verdict and judgment against Pennsylvania Life Insurance Company based on his claim of total disability as the result of an accident, within the provisions of a nonoccupational policy Pennsylvania issued to him. A summary of the facts will be given before discussion of the numerous grounds of error asserted by Pennsylvania.

Mattingly fell from a combine on October 15, 1966. He experienced pain in his low back region as a result of the fall, for which he sought medical treatment two days later when he called on his family physician, Dr. Atherton. The doctor prescribed “easing medicine” and directed Mattingly to rest in bed. However, Mat-tingly obtained the services of a masseur and did not revisit Dr. Atherton until January 6, 1967. Dr. Atherton referred Mattingly to Dr. Woodward, an orthopedic surgeon, who performed a partial laminectomy and dissectomy on February 13. Mattingly remained in the hospital until March 1 following the surgery. The medical testimony and Mattingly’s own evidence indicate that he has not been able to perform manual labor since the accident.

Dr. Woodward deposed that Mattingly has had satisfactory recovery from the surgical procedures, but now suffers from osteoarthritis and trochanteric bursitis. Dr. Woodward explained that the bursitis was occasioned by Mattingly’s being required to lie on his side after the surgery, resulting in irritation of the bursa in his thigh. The doctor also gave it as his opinion that the arthritic condition had been quiescent until the accident, but the symptoms of arthritis were brought on by the fall from the combine.

There was evidence that Mattingly now suffers from an intestinal ulcer, although there was no showing of how much, if any, of his disability is ascribable to that fact.

So far as appears of record, Mattingly gave Pennsylvania no notice of his accident nor proof of any claim until February 8, 1967. The report of disability which he furnished on that date was stamped as received by the company on February 16. Mrs. Mattingly had completed the form, inadvertently relating November 15 as the date of accident rather than October 15. The form was subscribed by “Dr. D. Vincent” as attending physician, although “Doctor” Vincent had crossed out the printed initials “M.D.” following his signature.

Subsequently, other reports were furnished reflecting a claim for “non-confining illness” and indicating Mattingly’s back operation as the nature of his “sickness or injury.” The company paid Mattingly $2010 and contends this sum is all that is due. These payments were based on the policy provisions relating to hospital and sickness benefits. By letter dated April 18, 1967, the company advised Mattingly that it could not accept liability under the accident provisions of the policy since his condition “did not require the regular and personal care of a licensed physician within twenty days from the date of the accident.” At that time, Mattingly had not disclosed to the company that he had consulted Dr. Atherton two days after the accident.

Citing United Insurance Company of America v. Brown, Ky., 432 S.W.2d 428; New York Life Ins. Co. v. Saunders, 314 Ky. 577, 236 S.W.2d 692; and Continental Casualty Co. v. Johnson, 314 Ky. 53, 234 S.W.2d 190, the appellant asserts that Mattingly has not suffered continuous total disability and continuous loss of time within the meaning of the policy. The principal basis for this argument is the fact that Mattingly’s actual farm income increased somewhat in 1967 and 1968, despite his asserted disability. Another key facet of this contention is that Mat-tingly rented a farm (which he placed in certain federal “soil-bank” programs) for 1967 and 1968. It is urged that Mattingly managed and supervised an extensive farming operation; hence, he was not totally [635]*635disabled, nor did he sustain continuous loss of time. It must be conceded that some of the language in United Insurance Company of America v. Brown, Ky., 432 S.W.2d 428, seems to lend support to appellant’s position. If the language in Brown means that evidence of income reported in income tax returns is conclusive of the issue of the existence of disability, it should not be considered authoritative. There was no evidence indicating that Mattingly performed any of the physical duties incident to farming, and it is not claimed that he earned income from any other occupation. The supervision attributable to his efforts was no more than that shown in Rudder v. Ohio State Life Insurance Company, Ky., 389 S.W.2d 448. The increase in income was explained as not being attributable to work by Mattingly. The increase alone is not sufficient to demonstrate as a matter of law that Mat-tingly failed to prove disability, nor did the court mean to be so understood in United Insurance Company of America v. Brown, Ky., 432 S.W.2d 428. The issue of Mattingly’s disability was appropriately submitted to the jury.

Next, appellant points to the evidence of Mattingly’s osteoarthritis and bursitis in support of its claim that Mat-tingly’s alleged disability did not result directly and independently of all other causes from the accident. A number of decisions are cited of which New York Life Insurance Company v. Rees, Ky., 341 S.W.2d 246, is representative.

Appellant’s position would be well taken if the evidence showed that Mattingly’s disability, or any part of it, arose from a source unconnected with the accident. But, the medical proof for Mattingly was to the effect that both the arthritis and bursitis were proximately caused by the accident and the effects of the accident. In these circumstances, the jury had the right to find that Mattingly’s disability stemmed directly and solely from the accident. Cf. Prudential Insurance Company of America v. Grant, 226 Ky. 372, 10 S.W.2d 1073.

Appellant defended on its claim that Mattingly gave false information on his application for insurance, material to the risk. On the application for insurance, a negative answer was given respecting an inquiry relating to previous injury or disease to the spine. Mattingly testified that he told the insurance agent about having consulted a doctor concerning a muscle strain in his back some years prior to the application, but the agent inserted the negative answer. The doctor whom Mattingly consulted on that occasion testified and related that the incident was not regarded by him as significant. It would appear that the rationale of Pennsylvania Life Insurance Company v. McReynolds, Ky., 440 S.W.2d 275, governs here. The record supports the drawing of an inference that Mattingly fully disclosed the back episode to the agent and that the latter regarded it as too inconsequential to report.

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Cite This Page — Counsel Stack

Bluebook (online)
464 S.W.2d 632, 1970 Ky. LEXIS 103, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pennsylvania-life-ins-co-v-mattingly-kyctapp-1970.