Sauers v. Mutual Benefit Health Acc. Ass'n

60 P.2d 103, 187 Wash. 262, 1936 Wash. LEXIS 634
CourtWashington Supreme Court
DecidedAugust 12, 1936
DocketNo. 25818. Department One.
StatusPublished
Cited by6 cases

This text of 60 P.2d 103 (Sauers v. Mutual Benefit Health Acc. Ass'n) is published on Counsel Stack Legal Research, covering Washington Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sauers v. Mutual Benefit Health Acc. Ass'n, 60 P.2d 103, 187 Wash. 262, 1936 Wash. LEXIS 634 (Wash. 1936).

Opinions

Tolman, J.

This is an action on an accident and health insurance policy tried to a jury, resulting in a verdict in favor of the plaintiff. From a judgment on the verdict, the defendant has appealed.

*263 Several of the errors assigned question the sufficiency of the evidence, hence it will be necessary to mention, as briefly as may be, the facts as indicated' by substantial evidence upon which the verdict rests.

The respondent is a married man with children, and at the time of trial below was fifty-three years of age. He is not an educated man and had been employed as a driver of a laundry truck for many years, operating one of the large commercial routes in the city of Seattle and delivering heavy laundry bundles.

In the year 1919, respondent injured his left knee. A claim was filed with the state department of labor and industries, and he received compensation for five months loss of time and a permanent partial disability award amounting to five hundred dollars. Thereafter, he returned to his employment and performed the same heavy work without any difficulty except that he noticeably limped.

In 1926, a physician, representing the state department of industrial insurance, removed fluid from his left knee. On that occasion, he lost two months time and received state compensation therefor. Again he resumed his duties, and except for the obvious limp he apparently performed his work without difficulty and with efficiency.

Early in the year 1928, respondent suffered with a cold and cough. He went to see the physician for the laundry drivers and procured medicine for his cough, but was not under treatment then or at any time for tuberculosis.

Shortly prior to April 9, 1928, he was solicited by an agent of the appellant insurance company to take out a policy of accident and health insurance. Respondent advised the agent of the injury to his left knee, the resulting limp, and of the trouble with his knee and loss of time in the year 1926. The agent *264 rode with the respondent in his truck while he performed his usual duties, watched him at his work, and advised the respondent that he was an insurable risk.

The application for insurance was filled out entirely by the agent. The questions relating to the age, place of birth, height, weight, place of residence, name of his employer and the nature of his occupation, were all correctly answered. To the question “Are you sound physically and mentally,” the answer “yes” was written. As to whether the applicant had had any one of a number of diseases, including tuberculosis, the answer was “no” as to each. The question “Have you received medical or surgical advice or treatment, or had any local or constitutional disease within the past five years” was answered “no,” as also was the question as to whether the applicant had ever been operated on by a physician or surgeon. The applicant duly signed the application so filled out, which called for a policy paying one hundred dollars per month in case of total disability.

On April 10, 1928, the day following the signing of the application, respondent was advised by the doctor who had treated him for his cough that he had tuberculosis. Respondent then consulted another physician, who advised him to the same effect, but upon the trial, the only doctors who testified rather clearly indicated that, if respondent had ever had tuberculosis, he was but slightly affected, that the disease had been arrested and that it was impossible that the tuberculosis, if it ever existed, had any effect in producing the disability for which recovery was here had. There seems to be little or no dispute upon this point.

When the insurance policy was delivered, it w,as not the policy for which respondent had applied, but was one providing for the payment of two hundred dollars per month for total disability. Respondent at *265 once declined to accept this policy, informed the agent that he had tuberculosis, of which he had just been advised, and indicated a desire to have the policy returned to the company, but, according to his testimony, the agent prevailed upon him to accept the policy upon the assurance that the recent discovery that he was affected with tuberculosis would not void the policy.

In November, 1928, the respondent again injured the knee which had been originally injured in 1919. The company sent its adjuster, who investigated the claim and paid the respondent $463.33 for seventy-seven days of time loss under the policy then in force. Thereafter, and before another premium matured on the policy, respondent voluntarily requested that the policy be reduced to a maximum of one hundred dollars per month for total disability. He was told to wait until the end of the policy year and, accordingly, did, two days before the end of the first policy year, surrender that policy and make application for the policy which is involved in this suit.

A new application was made, which seems to have been copied verbatim from the preceding application. Respondent testified that the new application was prepared by appellant’s district manager in Seattle without any information from him, none being sought, and that he simply signed the application as directed without knowing what it contained. Of course, the new application was obviously untrue and must have been known to be so by the appellant and its officers and agents, because only a month or so previously they had paid respondent the substantial sum of $463.33 for injury to his knee and had in their possession, of course, the proof concerning the injury upon which the payment was based.

After the delivery of the last policy, the respondent *266 had arthritis in his right leg, made claim for benefits under the policy, and was paid fifty dollars. In September, 1930, the respondent fell and accidentally injured his left knee, as the result of which he claims to have become totally disabled, though not immediately. He testified that he notified the appellant by letter of his accident and later made a claim for loss of time from May 1, 1931, when total disability developed. For some months, respondent was in the hospital, where an operation was performed on the injured knee, and later a second operation was performed on the knee.

During this period, appellant investigated the claim, asked and obtained information, at no time suggesting lack of proper notice, and finally rejected the claim, not on the ground of want of notice or false representations, but on the sole ground that the impairment of the knee was due to conditions arising long before the policy was issued. Correspondence and negotiations continued notwithstanding the rejection, until March 7,1932, when an adjuster personally interviewed the respondent. Each testified on the trial, and each told a diametrically different story.

According to the respondent, the adjuster indicated that he had come to make payment for what had accrued under the policy and started to write him a check for nine hundred dollars.

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Bluebook (online)
60 P.2d 103, 187 Wash. 262, 1936 Wash. LEXIS 634, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sauers-v-mutual-benefit-health-acc-assn-wash-1936.