Pilgrim Health & Life Insurance v. Gomley

148 S.E. 666, 40 Ga. App. 30, 1929 Ga. App. LEXIS 12
CourtCourt of Appeals of Georgia
DecidedJune 17, 1929
Docket19240
StatusPublished
Cited by8 cases

This text of 148 S.E. 666 (Pilgrim Health & Life Insurance v. Gomley) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pilgrim Health & Life Insurance v. Gomley, 148 S.E. 666, 40 Ga. App. 30, 1929 Ga. App. LEXIS 12 (Ga. Ct. App. 1929).

Opinion

Bell, J.

The defendant, for the purpose of reducing the liability under the policy, pleaded that the insured died of Bright’s disease within twelve months from the date of the policy, and that this was a constitutional disease within the meaning of the quoted provision. The plaintiff- admitted that the insured died of Bright’s disease, but took issue with the defendant as to the nature and character of such disease, and the verdict was against the contention of the defendant, being for $150 as principal, and for additional amounts as attorney’s fees and damages. This was to [32]*32allow the plaintiff: only half the face amount, because the death occurred within twelve months, but to deny a further reduction as for death by an excepted disease.

A physician introduced as a witness by the defendant testified that in his opinion Bright’s disease should be classed as a constitutional disease, while another physician introduced by the plaintiff: testified to the contrary. The testimony of this witness was objected to by the defendant on the ground that the question was not one of fact to be decided by the jury, but involved a construction. of the contract, and was therefore one for determination by the court. The overruling of this objection is complained of in one of the grounds of the motion for a new trial. The defendant further contends that, even in the face of evidence to the contrary, this court, on the basis of judicial notice, should hold that Bright’s disease is a constitutional disease within the meaning of the policy, and thus should set aside the verdict, on the general grounds of the motion.

Each of the witnesses referred to spoke of medical definitions of the term “constitutional disease,” one of them having quoted certain medical works defining such a disease as, “one affecting the entire constitution — the whole constitution of the body, — not local but pertaining to the constitution,” or as “intrinsic, organic, or structural defects in body mechanism, affecting the entire system or constitution.” While the medical dictionaries may be helpful, they should not be controlling in determining the question at issue. In deciding whether the particular disease of which the insured died was a constitutional disease within the meaning of the policy, the descriptive words must be understood in their ordinary signification, and should not be interpreted in the technical sense in which they might be used by the medical profession. Insurance companies do business chiefly with the common people, whose thinking is not technical, and, therefore, the expressions contained in a policy should, in the absence of a contrary import, be defined according to the usual understanding, and be construed strictly against the insurer, where otherwise they would tend to limit the range and force of the obligation. Civil Code (1910), § 4268 (1); Meyer v. Fidelity & Casualty Co., 96 Iowa, 378 (65 N. W. 328, 59 Am. St. R. 374); Beile v. Travelers’ Protective Association, 155 Mo. App. 629 (135 S. W. 497); Richards v. Stand[33]*33ard Accident Ins. Co., 58 Utah, 622 (200 Pac. 1017, 17 A. L. R. 1183); 32 C. J. 1147. Certainty here the diseases intended to be excepted were described in common, everyday verbiage, such as would be used by the average man, and with absolutely no effort to speak in terms of medical or scientific knowledge. For instance: “consumption” is the lay expression for tuberculosis; “rheumatism” is a name more applicable to symptoms- than to a specified ailment; the word “paralysis” is not technical; nor is “child birth,” or “womb disease.” In fact, practically every word in the stipulation is a mere loose expression to designate an illness by the name given to it by the masses. Hence, we think that the language “constitutional disease” should be construed in like manner. Standard Oil Co. v. Swanson, 121 Ga. 412 (49 S. E. 262); Weatherly v. Mayor &c. of Athens, 18 Ga. App. 734 (2) (90 S. E. 494).

While the people generally may have no definite concept as'to the meaning of the phrase, “constitutional disease,” they do occasionally speak of such diseases, and each of the two words composing this phrase has a very common usage, in view of which the instant policy should be studied. The word “constitution,” as applied to natural persons, is defined in Webster’s International Dictionary as, “the aggregate of the physical and vital powers of an individual; physique or physical nature,” and in the same work we find the word “constitutional” defined as follows: “Belonging to or inherent in the constitution or structure of body or mind; as, a constitutional infirmity.” The Century Dictionary adds: “Springing from or due to the constitution or composition.” Another definition which might be given from the books is, “relating to or affecting the constitution.” However, if the word is susceptible of more than one meaning, the court, in construing the contract should adopt the one most favorable to the insured. Columbia Casualty Co. v. Rogers, 157 Ga. 158 (121 S. E. 224). The meaning of a general term may be limited where it is favorable to the insured to do so, and where such a construction appears to be fair and reasonable upon a consideration of the entire contract. Hence, the last definition suggested above will be discarded, as will any others except the one most favorable to the insured, the purpose being to exclude all diseases which do not clearly fall within the terms of the policy. “Affecting” might suffice in [34]*34part if by it we mean directly affecting, and if other necessary qualities are expressed in the definition.

The word “disease,” as a general term, may be defined as any alteration in the state of the body or of some of its organs, interrupting or disturbing the performance of the vital functions (Webster’s Dictionary; 18 C. J. 1139), and in this broad sense a portion of the body -might be said to be diseased when it ceases to perform its proper functions, although the disorder therein may be the mere result of some affection or malady which in its primary operation is restricted to a different area. However, in the instant policy the word “disease” does not stand alone, but is limited by another term, which must be given due and important consideration in arriving at the intended sense of the words under construction. “Belonging to” and “inherent in,” as contained in Webster’s definition of “constitutional,” each connotes the idea of permanency, if not also of original attribute; but we do not think that a constitutional disease as commonly understood would necessarily and in every case include hereditary or even natal quality.

In Metropolitan Life Ins. Co. v. Bergen, 64 Ill. App. 685, the insurer contended that pneumonia was a pulmonary disease within the meaning of a certain provision limiting liability in event of death within one year from such a disease. The court said: “In common acceptation, a pulmonary disease is one which arises from an inherent or organic defect or affection of the lungs, and it is our opinion this provision of the policy was not intended to include, and should not be construed to include pneumonia, which is but a temporary inflammation of those organs.” It would seem that the language for interpretation in that case was less restrictive than that with which we are concerned in the case at bar.

We can not say that the term “constitutional disease” is so general or indefinite as to be entirely ignored in the construction of the contract.

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Bluebook (online)
148 S.E. 666, 40 Ga. App. 30, 1929 Ga. App. LEXIS 12, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pilgrim-health-life-insurance-v-gomley-gactapp-1929.