Phifer v. Mutual Ben. Health & Accident Ass'n

148 S.W.2d 17, 24 Tenn. App. 600, 1940 Tenn. App. LEXIS 69
CourtCourt of Appeals of Tennessee
DecidedJuly 27, 1940
StatusPublished
Cited by7 cases

This text of 148 S.W.2d 17 (Phifer v. Mutual Ben. Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phifer v. Mutual Ben. Health & Accident Ass'n, 148 S.W.2d 17, 24 Tenn. App. 600, 1940 Tenn. App. LEXIS 69 (Tenn. Ct. App. 1940).

Opinion

JOSEPH HIGGINS, S. J.

We shall refer to the parties as complainant and defendant just as they appeared in the lower Court. '

This was a bill filed by complainant to recover some installments claimed by him to be due from defendant upon a health benefit certificate issued by defendant to him on the 25th day of May, 1937— this bill being filed on the 26th day of May, 1938.

Complainant alleged the payment of premiums and reproduced the obligatory provision of the policy with respect to the payment of monthly benefits, and alleged that on the 9th of August, 1937, *603 he had become disabled on account of sickness and took his bed on August 22, 1937, and had been confined to his bed ever since; that he had been examined by reputable physicians who pronounced him suffering’ from liver and gall bladder trouble.

Complainant further averred that he had given defendant notice of his illness and had reported his illness to the defendant on blanks furnished by it; that in response to this notice and presentation of his claim defendant denied liability and undertook to refund premiums, and declared its intention of cancelling the policy. That notwithstanding this effort at cancellation, complainant continued to pay his premiums, which had been received by defendant, and that defendant had repeatedly refused to consider his application and has repeatedly made an effort to cancel the policy and return the premiums to complainant.

Complainant filed his original policjr as an exhibit A and alleged that it was a valid and enforceable contract, and that he had complied with its provisions and that he was entitled to go into Court and require defendant to comply with its provisions.

Complainant further alleged that it seemed apparent that his disability was or probably would become permanent; that he had been advised that he was entitled to a judgment for the benefits provided in the policy — being for $20 for the first fifteen days of his illness, and at the rate of $80 per month since that time, and that he was entitled to keep the policy in force by the payment of his quarterly premiums.

He prayed that at the hearing the policy held by him be declared to be a valid and binding contract and enforceable under the laws of Tennessee; and he prayed for judgment for the sum of $20 and for $80 per month after and since the expiration of the first fifteen days after his illness began.

There was a demand for a jury.

The pertinent paragraph of the policy quoted by complainant is in this language: "The Association will pay for one day or more at the rate of $40 per month for the first fifteen days, and at the rate of $80 per month thereafter, for disability resulting from disease the cause of which originates more than thirty days after the effective date of this policy, and which confines the insured continuously within doors, and requires regular visits therein by legally qualified physicians; provided said disease necessitates total disability and total loss of time.”

Defendant admitted issuing the policy and that the exhibit filed with the bill was the original, but defendant denied that the premiums had been paid as alleged.

Defendant denied the allegations in the second paragraph of the bill wherein complainant had alleged that he had become sick and had been attended by two physicians, and that lie had had the com *604 plaint therein alleged, and that he had been confined to his bed continuously since the date given.

Defendant denied that complainant had become disabled within the provisions of the policy, for the reason that any disability from which complainant was suffering had originated before the effective date of the policy, and that defendant was not liable.

Defendant admitted the complainant had written for forms and that a proof of claim had been received by defendant, but denied that complainant was entitled to relief thereon.

There was a denial of sections four and five of the bill wherein complainant had alleged that his contract was a valid and binding one, and that he had become disabled and was entitled to the benefits, and that defendant was indebted to him in any amount because of disability.

Defendant, proceeding further, alleged that complainant in making application in writing for the policy which was attached as Exhibit A had answered certain questions; that the policy had been issued in reliance upon the answers inserted in said application; that in said application inquiry was made as to whether complainant was in good health and he answered the question, “yes.” He was further asked if he had ever had other named diseases, which he denied.

Defendant alleged that complainant was not in good health at the time of the making of the application — that he was at that time suffering from a liver disease, and possibly cancer and stomach trouble, and that he had suffered from bronchitis, dysentery and fever. And defendant further alleged that complainant had warranted that he did not use intoxicating liquors to excess, and that this was not true; and that said representations of complainant were material and affected the risk, and were made with intent to deceive; and defendant repeated its contention of non-liability, and defendant repeated its averment that the policy was not effective unless complainant was in good health.

It was further alleged that complainant made application for disability pajonents to the Lincoln National Life Insurance Company on the day of the delivery of the policy here sued on.

It appears in the bill of exceptions that before the Chancellor entered upon the hearing of the cause, the following stipulation was entered into: “It is stipulated and agreed that the jury in this case be waived, and it is agreed that said case be tried before the Chancellor sitting as a jury.” The Chancellor did try the case upon oral and documentary evidence as shown by his decree — which decree embraces this recital, “A jury having been demanded in the pleadings but by consent of the' parties the jury was waived and the cause was tried before the Chancellor sitting as a jury. ’ ’

The Chancellor decreed in substance that the allegations of complainant’s bill had been sustained by the proof, and that complain *605 ant was entitled to the relief sought. He further decreed that the policy was a binding and subsisting contract of insurance; that at the time of the filing of the original bill defendant was indebted to complainant in the sum of $779.50, and that since that time there had accrued under said policy an additional indebtedness of $1,360 and interest, for which a decree for the $2,220 was entered.

The concluding part of the decree is in this language, “For the present this case is retained in court for the disposition of any matters arising out of the obligations assumed under the terms of the insurance policy made the basis of this suit.”

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Cite This Page — Counsel Stack

Bluebook (online)
148 S.W.2d 17, 24 Tenn. App. 600, 1940 Tenn. App. LEXIS 69, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phifer-v-mutual-ben-health-accident-assn-tennctapp-1940.