Shuman v. National Casualty Co.

193 A.2d 513, 80 N.J. Super. 310
CourtNew Jersey Superior Court Appellate Division
DecidedAugust 2, 1963
StatusPublished
Cited by3 cases

This text of 193 A.2d 513 (Shuman v. National Casualty Co.) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shuman v. National Casualty Co., 193 A.2d 513, 80 N.J. Super. 310 (N.J. Ct. App. 1963).

Opinion

80 N.J. Super. 310 (1963)
193 A.2d 513

BERNARD J. SHUMAN, M.D., PLAINTIFF,
v.
NATIONAL CASUALTY CO., A CORPORATION OF THE STATE OF MICHIGAN AUTHORIZED TO DO BUSINESS IN NEW JERSEY, DEFENDANT.

Superior Court of New Jersey, Law Division.

Decided August 2, 1963.

*312 Mr. Benjamin Rimm for plaintiff.

Mr. Michael D. Loprete for defendant (Mr. Merritt Lane, Jr., of counsel; Mr. Michael D. Loprete on the brief; Messrs. McCarter & English, attorneys).

NAAME, J.C.C. (temporarily assigned).

This is an action by plaintiff Dr. Bernard J. Shuman, a former practicing pediatrician, to recover indemnity payments under part II of an extended professional disability policy (No. X3310863) which purports to insure the plaintiff against total disability for the period not to exceed 60 months, provided the insured "shall be wholly and continuously disabled from engaging in any gainful occupation for which the Insured is reasonably fitted or qualified and under the regular care and attendance of a legally qualified physician or surgeon, other than himself * * *." (Emphasis added)

Plaintiff, who is now 43 years old, has a New Jersey medical license to practice "any branch of medicine and/or surgery, and any method of treatment of human ailment, disease, pain, injury, deformity, mental or physical condition * * *." N.J.S.A. 45:9-5.1 and 45:9-15. Plaintiff elected to specialize in pediatrics and continued that practice until December 6, 1959.

On December 6, 1959 plaintiff was making a call or driving to some place when he experienced a tightness or uncomfortable feeling in his chest. He ignored the pain but it persisted; he became alarmed and stopped at the office of Dr. Joseph A. Linsk, a hemotologist in Atlantic City. Dr. Linsk examined plaintiff, took an electrocardiogram and conducted laboratory and blood tests.

*313 It was discovered later that plaintiff had suffered a coronary occlusion, and he was confined to bed for some time — three or four weeks. Other tests and treatment followed, and plaintiff from the onset of the aforesaid heart attack began taking dicumerol, an anti-blood coagulant, and was still consuming dicumerol three times a day as of July 7, 1962.

After plaintiff was allowed to leave his bed he experienced very marked weakness for several weeks, and apparently did little if any work thereafter in his former occupation as a pediatrist. Furthermore, it appears from the record that plaintiff did nothing productive or remunerative until he commenced a residency in psychiatry at the Philadelphia Psychiatric Hospital in July 1960.

Plaintiff has had no symptoms following the alleged onset of the heart condition on December 6, 1959, nor has he been under the regular care and attendance of a physician or surgeon for the past year or more.

Plaintiff, after sustaining the above heart attack, received monthly sickness indemnity payments from defendant under policy No. P310863 for a period of 24 months, until December 11, 1961, the terminal date, at the rate of $300 a month, a total of $7,200. However, defendant refused to continue monthly sickness indemnity payments (for purported "total disability") under part II of the extended professional disability policy (No. X3310863) beyond December 11, 1961, the terminal date of policy No. P310863 as aforesaid.

The reason advanced by defendant for the refusal — and this is the principal if not sole issue in this matter — is that plaintiff is now and has been since July 1960 engaged in a gainful occupation for which he is reasonably fitted or qualified, which activity allegedly disqualifies him from receiving the aforesaid indemnity payments under the extended professional disability policy.

The aforesaid allegedly gainful occupation originated or was initiated when plaintiff began a residency at the Philadelphia Psychiatric Hospital, which was completed there by July 1, 1962 but which continued at the Philadelphia Guidance *314 Center. The residency at the latter institution will terminate in June 1964. This residency carried with it a special trainee stipend from the afore-mentioned institutions of $12,000 a year, which was paid by the National Institute of Mental Health, hereinafter designated the Institute. Plaintiff has received $12,000 a year during the past three years. These stipends are given to the aforesaid institutions by the Institute under a program of grants to support psychiatric training programs for general practitioners and other physicians in practice, one of the purposes of which is to provide support at an adequate level for psychiatric residency training for physicians in practice who wish to become psychiatrists.

During plaintiff's residency at the Philadelphia Psychiatric Hospital he was at the hospital Monday through Friday and frequently the morning hours of each week. His hours were from 9 A.M. to 5 P.M. Monday through Friday, and 9 A.M. to noon when he was there on Saturday. Half a day was spent in didactics, conferences and seminars, the other half interviewing new patients or patients in the out-patient department. He also treated ward patients.

At the present time he is continuing his training as a resident at the Philadelphia Guidance Clinic, which is wholly out-patient. His hours are 8:30 A.M. to 5 P.M. five days a week. This employment will continue until he completes his training in June 1964.

The parties have stipulated that (1) the adjusted gross income received by plaintiff as a pediatrist in the three years immediately previous to his heart attack was $20,890.30 in 1957, $22,187.36 in 1958, and $22,152.81 in 1959; (2) Dr. Shuman's present remuneration from the Philadelphia Guidance Clinic is $12,000 per year; (3) the foregoing amount is subject to federal income tax, and (4) items of expense, such as tuition, books and laboratory or other fees, are not payable by plaintiff.

Defendant now moves for summary judgment.

Plaintiff alleges that defendant is not entitled to summary judgment because there are numerous factual questions involved *315 which should be determined by a jury, and that he is totally disabled within the contemplation and meaning of extended professional disability policy No. X3310863, i.e., "wholly and continuously disabled from engaging in any gainful occupation for which the Insured is reasonably fitted or qualified and under the regular care and attendance of a legally qualified physician or surgeon, other than himself * * *."

Defendant contends that there is no genuine issue of material fact and, as a matter of law, plaintiff, in undergoing the training and performing the duties as a resident in psychiatry at the aforesaid institutions, has been heretofore engaged in and is now engaging in a gainful occupation for which he is reasonably fitted or qualified, thereby disqualifying him from receiving the indemnity payments for "total disability" under part II of the extended professional disability policy.

The foregoing summary of the facts is not materially disputed, and if there be numerous factual questions involved which should be determined by a jury, as alleged by plaintiff, they have not been called to the attention of the court and do not appear in any of the pleadings, proofs, arguments and briefs of counsel. To the contrary, defendant admits all of the recited facts.

The issue here involves the construction of the indemnity clause under part II of the extended professional disability policy.

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193 A.2d 513, 80 N.J. Super. 310, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shuman-v-national-casualty-co-njsuperctappdiv-1963.