Philadelphia Life Insurance v. Farnsley's Administrator

171 S.W. 1004, 162 Ky. 27, 1915 Ky. LEXIS 9
Court of Appeals of Kentucky·Decided January 6, 1915·Published·Cited by 5 cases

Opinion

OpinioN op the Court by

William Bogers Clay, Commissioner

Affirming.

On December 4, 1912, the Philadelphia Life Insurance Company issued to Prank B. Parnsley a policy insuring him “against accidental death and dismemberment (suicide, sane or insane, is not covered), disability due to either accident, illness or funeral benefit for death from natural causes as hereinafter respectively defined, limited and specified.” The material provisions of the policy are as follows:

Total Accident Disability.

“ (A) At the rate of Seventy Dollars per month, for a period of not exceeding twenty-four consecutive months, against total loss of time resulting directly and [28] independently of all other canses from bodily injuries effected through, external, violent and accidental means, and which wholly and continuously from date of accident disable and prevent the Assured from performing every duty pertaining to any business or occupation, and require the regular attendance of a physician or surgeon.”

“Specific Total Losses.

“(C) Or, if any one of the following specific total losses shall result solely from the injuries described in paragraph A within ninety days from date of accident, the Company will pay, in lieu of any other indemnity,

“For Loss of

“Life, Seven Hundred Dollars (The Principal sum of this Policy).”

On December 23, 1912, the insured was drowned. The Mechanics Trust & Savings. Bank, as his administrator, brought this action against the insurance company to recover on the policy. To the petition and the petition as amended, defendant interposed a demurrer, which was overruled. Having declined to plead further, judgment was rendered in favor of plaintiff, and defendant appeals.

The sufficiency of the petition as amended is the only question presented. In addition to certain formal aver-ments, which need not be noticed, the petition contains the following allegations:

“Plaintiff says that on the 4th day of December, 1912, the defendant, the Philadelphia Life Insurance Company, a corporation of Philadelphia, Pa., engaged in the life and accident insurance business, issued and delivered to the plaintiff’s decedent its policy of insurance under the terms of which, in consideration of One and 75/100 ($1.75) Dollars, to be paid monthly by the decedent, and which monthly payment for December, 1912, was paid to the defendant by the decedent, the defendant undertook and obligated itself to pay to the defendant’s administrator the sum of Seven Hundred ($700.00) Dollars in. the event of the loss of the decedent’s life, resulting directly and independently of all other causes from bodily injury, effected through external, violent and accidental means. Plaintiff says that on the 23rd day of December, 1912, and during the life of said policy, the decedent did meet an accidental death, effected through external, violent and accidental means.”

[29] The amended petition, is as follows:

“Comes the plaintiff, Mechanics Trust & Savings Bank, administrator of the estate of Frank B. Famsley, deceased, and for amendment to its petition filed herein says, that on the 23rd day of December, 1912, the decedent, Frank B. Farnsley, while crossing a gang plank lying between a barge and steamboat, both vessels lying in the Mississippi Biver near Cairo, Illinois, accidentally slipped from the plank across which he was walking and fell into the Mississippi Biver between the boat and barge and was drowned.”

It is insisted that the petition as amended is fatally defective for two reasons: (1) It fails to negative the suicide of the insured, which is an exception contained in the promissory clause; (2) it fails to allege that the death of the insured resulted directly and independently of all other causes from bodily injuries effected through external, violent and accidental means.

(1) It is true that there is a class of cases which make a distinction between provisos and exceptions in insurance policies, in so far as the question of pleading is -concerned. Provisos are stipulations added to the principal contract to avoid the promise of the insurer by way of defeasance or excuse; and in an action thereon it is incumbent on the insurer to plead them in defense and support them by evidence. Exceptions are clauses taking something out of the general operation of the contract so that the promise is to perform only what remains after the part excepted is taken away; and in actions on policies of insurance containing such clauses, they must not only be negatived by the plaintiff, but he must show by evidence that his case does not fall within the exception. Sohier v. Norwich Fire Ins., Co., 11 Allen, 336. The rule of pleading applicable to such a case is stated as follows:

“If the contract sued on ‘contain in it, first, a general clause, and afterwards a separate and distinct clause which has the effect of taking out of the general clause something that would otherwise be included in it, a party, relying upon the general clause, in pleading, may set out that clause only, without noticing the separate and distinct clause which operates as an exception; but, if' the exception itself be incorporated in the general clause, then the party relying on it must, in pleading, state it together with the exception.’ Com. v. Hart, 11 Cush., 130.”

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Philadelphia Life Insurance v. Farnsley's Administrator, 171 S.W. 1004, 162 Ky. 27, 1915 Ky. LEXIS 9 (Ky. Ct. App. 1915).

171 S.W. 1004 (Philadelphia Life Insurance v. Farnsley's Administrator) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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