Rocci v. Massachusetts Accident Co.

222 Mass. 336
Massachusetts Supreme Judicial Court·Decided January 6, 1916·Published·Cited by 69 cases

Opinion

Rugg, C. J.

This is an action on a policy of health and accident insurance. There was evidence tending to show that the plaintiff was taken ill on October 9, 1909. A certificate of an attending physician states that on December 16, 1910, he still was unable to do any work.

It was a condition of the policy that “F. Failure to make any payment on or before the date when the same is due shall terminate this Policy. . . . J. Cancellation. — This policy shall terminate and cease to be in force upon failure to pay a premium when due.” [342] The provision as to payments was, “Regular Payments. $1.00 Monthly Commencing December 1, 1906.” Another provision was, “Notice of regular payments stipulated hereon is hereby expressly waived. Failure to comply with all of the agreements, provisions and conditions of this policy shall invalidate all claims hereunder.” There was evidence that all premiums were paid up to December 1, 1909, and that none were paid after that date. This provision as to payments is valid and not unusual in contracts of this sort. Dolan v. Court Good Samaritan, 128 Mass. 437. When the payment due on January 1,1910, was not made, then the policy became cancelled according to its own terms without any further' act. It is a self executing provision. No claim can be made to benefits which otherwise might have accrued after the date of the avoidance of the policy in that way. Kidder v. United Order of the Golden Cross, 192 Mass. 326, 336. O’Toole v. Jennings, 219 Mass. 105. There is nothing in the terms of the policy or in the circumstances disclosed to warrant an inference that the definite and explicit words as to cancellation for non-payment of premiums are not to be given their ordinary signification. The fact that illness had begun before the payment was due does not excuse payment. There can be no successful contention that this condition was waived because of the illness. All liability after the first month has been contested by the insurer. There is no liability .after January 1, 1910.

The jury found that the period for which the plaintiff was entitled to recover ended on October 18, 1910. The policy provided :that “proof ... of any sickness for which claim can be made, must be furnished to the Company . . . within thirty days from the. date ... of the termination of disability.” Such proof was filed with the company on January 2, 1911. It is contended that this was not a compliance with the policy and that the plaintiff’s .claim thereby is forfeited. The policy provides for two different sick benefits, one, “Benefit No. 6,” a “Sickness Indemnity” payable: when the “insured by reason of sickness is necessarily and continuously confined within the house,” and the other, “Benefit No. 7,” “Non-Confining Sickness Indemnity,” payable when “the insured shall be wholly and continuously disabled from performing every duty pertaining to any business or occupation.” The equivalent of “disability” occurs in this clause and not in “Bene[343] fit No. 6 ” under which the plaintiff’s claim arises. While the policy is not very clear in this regard, it does not require the proof to be made within thirty days after the end of the period for which the sick benefit is claimed. Apparently there is no requirement as to the time of making proof applicable expressly to Benefit No. 6. But the time for proof as to both sick benefits is the same, namely: within thirty days after the “termination of disability.” Looking to the policy for a definition of the meaning of these words, it is found in Benefit No. 7 as quoted above. While this sometimes may be inconvenient and prolong unduly the adjustment of claims, yet it seems to be the reasonable construction of the policy. It follows that it could not be ruled as matter of law that the proof must be furnished within thirty days after the termination of the time for which the plaintiff was entitled to indemnity. The defendant’s eighth request for ruling was denied rightly.

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Rocci v. Massachusetts Accident Co., 222 Mass. 336 (Mass. 1916).

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