Provident Life & Accident Insurance v. Nicholson

160 S.E. 5, 157 Va. 345, 1931 Va. LEXIS 325
CourtSupreme Court of Virginia
DecidedSeptember 17, 1931
StatusPublished
Cited by6 cases

This text of 160 S.E. 5 (Provident Life & Accident Insurance v. Nicholson) is published on Counsel Stack Legal Research, covering Supreme Court of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Provident Life & Accident Insurance v. Nicholson, 160 S.E. 5, 157 Va. 345, 1931 Va. LEXIS 325 (Va. 1931).

Opinion

Epes, J.,

delivered the opinion of the court.

The Provident Life and Accident Insurance Company had issued to the Clinchfield Coal Corporation its group disability policy No. 1239 whereby it insured “the employees of Clinchfield Coal Corporation * * * who pay the required premium * * * against the effects resulting * * * from bodily injuries sustained by the insured solely through external, violent and accidental means.”

The group policy by its terms contemplated the issuance of certificates to each employee covered by it evidencing the fact that he was insured thereunder; and such a certificate was issued to F. C. Nicholson.

On August 31, 1928, while Nicholson was an employee of Clinchfield Coal Corporation and the group policy and the certificate issued to him were in force, he was injured by falling slate while working in the mine of the corporation.

[348]*348The insurance company paid to Nicholson $242.00 for total disability to April 30, 1929, and admitted its liability for total disability to May 18, 1929; but contended that its liability for total disability terminated as of that date.

In December, 1930, Nicholson brought his action by notice of motion for judgment in the Circuit Court of Dickenson county, seeking to recover from the insurance company the additional sum of $940.00 which he claimed to be due him from the insurance company by reason of total disability resulting from this accident.

The amended notice, in so far as is here material, reads as follows:

“You are hereby notified that * * * the undersigned insured will move * * * for judgment * * * against you in the sum of $940.00 together with interest from March 8, 1929, * * * which is * * * owing from you to the undersigned under and by virtue of a certain * * * contract of insurance in writing, made by you, with the said undersigned, on the......day of.............., 1929, which contract is your policy No..........., * * * .”

“The said policy in writing is hereinafter set out in the words and figures following, to-wit:” (Here follows a copy of the certificate of insurance issued to Nicholson, which, so far as is here material, reads as follows.)

“This is to certify that F. C. Nicholson, age 35, occupation coal loader, the holder of this certificate is entitled to the benefits specified in accordance with the terms and provisions of Group Disability Policy No. 1239 issued to the employee of the Clinchfield Coal Corporation.

“Accident insurance * * * Weekly Accident Indemnity—Total disability seven ($7.00) dollars. Commencing on date of injury for the full time disabled, not exceeding 1,000 days for any one injury.”

No further reference is made in the notice of motion for judgment to the group policy No. 1239 issued to the Clinch-[349]*349field Coal Corporation than is contained in the foregoing quotations therefrom.

At the trial it was agreed that $708.00 was the maximum amount which Nicholson was entitled to recover, if he was entitled to recover anything. The case was tried before a jury, which rendered a verdict in favor of Nicholson for $708.00, upon which the court entered judgment against the Provident Life and Accident Insurance Company. To this judgment a writ of error has been allowed to the insurance company.

The plaintiff introduced in evidence the individual certificate of insurance issued to him by the insurance company, but did not introduce in evidence the group policy No. 1239. When the defendant offered in evidence the group policy No. 1239, the court permitted it to be introduced over the objection of the plaintiff’s attorney. The objection stated by counsel for the plaintiff was thus stated by him: “We object to the introduction of group policy No. 1239. * * * It is not part of the policy which is sued on, nor attached to nor written on the policy, which was delivered to the insured nor annexed thereto.”

In its assignments of error numbers one, five and nine, it is complained that the court erred in not holding and in not instructing the jury that there could be no recovery in this case because the plaintiff has not pleaded the group policy No. 1239 as the basis of the recovery sought, but has pleaded and relied only upon the individual certificate of insurance issued to him by the insurance company.

This position is not well taken. It is true that an action against the insurer under a group insurance policy must be brought upon the contract contained in the policy issued to the employer, and not merely upon the certificate issued to the employee. 7 A. L. R., note page 1035; Gallagher v. Simmons Hdw. Co., 214 Mo. App. 111, 258 S. W. 16; Hardie v. Metropolitan Life Ins. Co. (Mo. App.), 7 S. W., [350]*350(2d) 746. But the certificate sued upon by reference in effect incorporates therein the group policy No. 1239; and the effect of pleading the certificate was to plead the group policy.

The position taken by counsel for Nicholson that the group policy constituted no part of the contract of insurance between the insurance company and Nicholson was untenable. The correct pleading in such a case is to plead the group policy and the certificate issued to the plaintiff evidencing his individual coverage thereunder. The pleading in the instant case appears to have been dictated by a misconception on the part of counsel for plaintiff as to what constituted the contract of insurance between the parties; and is not to be commended. But though counsel for the plaintiff seems to have intended not to plead or rely upon the group policy, by fortuitous circumstance his object was defeated by the fact that the certificate pleaded referred to and in effect incorporated therein the terms and provisions of the group policy.

“No judgment or decree shall be arrested or reversed * * for any defect, imperfection, or omission in the pleading, which could not be regarded on demurrer; or for any other defect, imperfection, or omission in the record, or for any error committed on the trial where it plainly appears from the record and the evidence given at the trial that the parties have had a fair trial on the merits and substantial justice has been reached.” Section 6331, Code Va. 1919.

The second, third and seventh assignments of error raise in somewhat different forms the same question, which is that the court erred in not holding that the plaintiff had forfeited’all his rights under the policy by failure to comply with the following terms and requirements of the group policy, to-wit:

“Part V. Notice of Injury or Sickness—Section (1). The insured shall give within twenty days notice to the company [351]*351of any accident or sickness for which a. claim is to be made, full particulars thereof, and full name and address of the insured. If the insured is disabled by such injury or sickness for more than thirty days, the insured must furnish the company every thirty days if reasonably possible so to do, with a report in writing from the attending physician or surgeon, fully stating the nature and extent of disability.

“Filing Reports—Section (2). Affirmative proof of any claim must be furnished to the company on and in accordance with its forms in case of claim for disability within thirty days after the termination of the period for which the company is hable * * * .

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Bluebook (online)
160 S.E. 5, 157 Va. 345, 1931 Va. LEXIS 325, Counsel Stack Legal Research, https://law.counselstack.com/opinion/provident-life-accident-insurance-v-nicholson-va-1931.