Seabra v. PURITAN LIFE INSURANCE COMPANY

369 A.2d 652, 117 R.I. 488, 1977 R.I. LEXIS 1717
CourtSupreme Court of Rhode Island
DecidedJanuary 26, 1977
Docket75-140-Appeal
StatusPublished
Cited by19 cases

This text of 369 A.2d 652 (Seabra v. PURITAN LIFE INSURANCE COMPANY) is published on Counsel Stack Legal Research, covering Supreme Court of Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Seabra v. PURITAN LIFE INSURANCE COMPANY, 369 A.2d 652, 117 R.I. 488, 1977 R.I. LEXIS 1717 (R.I. 1977).

Opinion

*489 Kelleher, J.

The plaintiff, the named beneficiary of a life insurance policy issued by the defendant, sued to recover the policy’s proceeds following the death of her hus *490 band. The case was tried before a Superior Court jury, who in turn awarded the plaintiff the sum of $47,170. The defendant has appealed. Hereinafter we will refer to the plaintiff as Dolores, to her late husband as the insured or Dr. Seabra, and the defendant as Puritan.

On April 24, 1963, Puritan issued a 20-year decreasing term policy on the life of Dr. Seabra. Attached to the policy was a rider containing a so-called waiver of premiums agreement for which Dr. Seabra paid an additional charge. The policy called for a total annual premium of $480, which was to be paid in quarterly installments. If a payment was not made on its due date or within the policy’s 31-day grace period, the policy would become void. However, the policy could be reinstated upon the insured’s written request, the payment of all past-due premiums plus interest, and the furnishing of satisfactory evidence that the insured was in good health.

Unfortunately, the quarterly payment due April 24, 1966, was not paid by that date or within the grace period. However, in early August Puritan received from Dr. Sea-bra a check dated July 30, 1966, for $240, which Puritan cashed. Later, on August 3, 1966, Puritan mailed Dr. Sea-bra a form which, when completed, would attest to the insured’s good health and told him that the form must be completed and returned to Puritan. After a month went by with no response, Puritan sent a second letter and a duplicate form to Dr. Seabra. It again asked its insured to complete the form and return it. This letter, which was dated September 2, 1966, closed with the warning: “If we do not hear from you by October 3rd, the amount of $240.00 will be returned to you and the policy can-celled.” Doctor Seabra did not live to bear the brunt of that admonition. On September 4, 1966, he died, and this litigation ultimately ensued.

At trial an abundance of evidence was adduced on two *491 basic questions. The first was whether Puritan had by its actions reinstated the policy during the summer of 1966. The second issue was whether the waiver of premiums rider had become operative, thereby preserving Dolores’ right to the policy’s proceeds. Dolores’ suit was based on two theories: either the life policy, having lapsed, had been reinstated in August or there was no lapse because Puritan was bound by the waiver of premiums clause.

In its appeal Puritan claims that the trial justice should have granted its motions for a directed verdict and a new trial. It also contends that the trial justice erred in that portion of his jury instructions which related to the insured’s failure to comply with the notice and proof of disability called for in the premium-waiver portion of his policy.

We will first concern ourselves with the waiver of premiums portion of the policy and the part it played in this litigation. In pertinent part, the agreement provides that upon the insurer’s receipt of “due proof” that an insured has become “totally disabled,” Puritan will waive the payment of any premiums that are due after the commencement of and during the continuance of the insured’s total permanent disability. The agreement goes on to define “total disability” and then delineates a timetable for the providing of a written notice of claim and proof of total disability, including a stipulation that claim and proof be given during the insured’s lifetime and the period he was disabled. The notice and proof portions of this proviso also provide that the failure to comply with the timetable will be overlooked upon a showing that the requisite notice and proof were given “as soon as was reasonably possible.” The trial justice, after discussing the rider’s notice and proof requirements, told the jury that “an insured may be excused from notice and proof of disability if mentally incapacitated.” The trial justice then expounded on this *492 proposition. It is obvious from the trial justice’s instructions that he assumed that an insured’s mental incapacity would excuse the giving of the necessary notice and proof. However, so far as we are concerned, this particular issue is one of first impression.

In Wolf v. Prudential Ins. Co. of America, 62 R.I. 270, 4 A.2d 897 (1939), we recognized that a properly phrased policy provision requiring proof of total and permanent disability could be a condition precedent to a successful suit on the policy. 1 However, there is a world of difference between Wolf’s amputated finger and Dr. Seabra’s mental acuity. There has been and continues to be a diversity of judicial opinion as to whether “insanity” or “mental incompetency” of the insured excuses the lack of or the delay in filing notice of proof of disability. See the cases collected in Mutual Life Ins. Co. v. Johnson, 293 U.S. 335, 55 S.Ct. 154, 79 L.Ed. 398 (1934). In an annotation in 142 A.L.R. 852, 853 (1943), appears the following statement :

“There is a conflict of authority upon the question whether the insanity of the insured will excuse, the giving of notice of disability under life policies providing for disability benefits and (or) the waiver of premiums, although, at least numerically, there seem to be more cases in favor of, than there are opposed to, the view that insanity excuses notice of disability.”

*493 Appleman observes that the better rule holds that “insanity” excuses a failure to make proof of disability within the time prescribed but he “regrets” that a “* * * majority of cases * * * hold that the insured has an absolute duty to submit proofs which is not excused by his insanity.” 15 Appleman, Insurance Law and Practice §8317 at 134-35 (1944).

To require a person who is described by some as being “insane” or “mentally incompetent” to do something that his disability prevents him from doing places that person in what some would refer to as a “catch-22” situation. Thus, it is that we agree with the proposition that it would be unreasonable to assume that an insane or mentally incompetent person could accurately assess the nature and degree of his ailment. Magill v. Travelers Ins. Co., 133 F.2d 709 (8th Cir. 1943). The insured is not bound to give notice of his disability when he is unable to do so by reason of the very disability insured against. As the court observed in Harris v. Pacific Mut. Life Ins. Co., 137 F.2d 272 (10th Cir. 1943), while the furnishing of due proof of disability is a condition precedent to the insurer’s obligation to waive premiums, it was not the event insured against, and since the inability to furnish proof grew out of the risk insured against, denial of recovery would be tantamount to a forfeiture.

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Bluebook (online)
369 A.2d 652, 117 R.I. 488, 1977 R.I. LEXIS 1717, Counsel Stack Legal Research, https://law.counselstack.com/opinion/seabra-v-puritan-life-insurance-company-ri-1977.