Smith v. Travelers Insurance

76 Misc. 441, 135 N.Y.S. 18
CourtAppellate Terms of the Supreme Court of New York
DecidedMay 15, 1912
StatusPublished
Cited by2 cases

This text of 76 Misc. 441 (Smith v. Travelers Insurance) is published on Counsel Stack Legal Research, covering Appellate Terms of the Supreme Court of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Travelers Insurance, 76 Misc. 441, 135 N.Y.S. 18 (N.Y. Ct. App. 1912).

Opinion

Guy, J.

The plaintiff herein appeals from a judgment dismissing the complaint in an action brought to recover under a policy of health insurance issued by defendant to plaintiff against disability by disease. The policy provides that “ for the term of continuous disability during which the plaintiff shall independently of all other causes be necessarily confined to the house, and totally disabled and prevented by bodily disease, not excepted under such- policy, from performing any and every kind of duty pertaining to his occupation,” he is to receive a weekly indemnity of twenty-five dollars.

Plaintiff proved that in November, 1910, after the policy was issued, he was taken ill with a nervous disease and totally disabled for the term of twenty-seven and one-half weeks. The answer contains a general denial, and a separaté defense of the breach of three warranties made by plaintiff at the time of the issuance of the policy. These warranties are as follows:

“ L. I am in sound condition mentally and physically; * * * Í have never had nor am I now suffering from or subject to * * * any bodily or mental
infirmity or' deformity, except as herein stated.”
O. I have not been disabled nor have I'received medical or surgical attention within the past five years.”
“ P. Last physician consulted was none in five years.”

[443]*443On cross-examination of plaintiff, it developed that in Hay, 1909, prior to the issuing of the policy of insurance by defendant to plaintiff, plaintiff made a written application to the department of education for a leave of absence, with pay, on account of his absence from school work from Hay 10 to Hay 21, 1909, in which application he stated that he was away on account of “ serious personal illness.” Attached to the application was the certificate of a physician that plaintiff’s illness was influenza and tonsilitis. Plaintiff testified that he did not know or remember, at the time the policy was issued, of this illness in Hay, 1909. Defendant also introduced in evidence a letter admitted to have been written by the plaintiff to the district superintendent of schools, in Hay, 1910, in which he -stated that his record of attendance, prior to Hay, 1909, was good, and that the fifteen.days’ absence in Hay, 1909, was but a forerunner of the illness from which he suffered from November, 1909, to Hay, 1910. Plaintiff, in rebuttal, stated that the nature of his illness in Hay, 1909, was that he had a severe cold and that he was worried; that his throat was very sore; that he found difficulty in talking, and that he had a running nose and a cold in the head. 'His physician testified that what he meant by the certificate that plaintiff’s illness was influenza and tonsilitis was “grippe” or a “ cold;”.we generally call it “ La Grippe.” “ The nature of the tonsilitis that I spoke of generally goes with the grippe. It consisted of a redness of the throat and little follicles in the tonsils. The tonsilitis was simply the-result of the cold. I don’t remember whether I examined him. He did not call me to examine him., I don’t remember whether I examined him. I was at the house during the day and treated his wife and he complained of having a bad cold, but I don’t remember having examined him or having prescribed for him. I certified in the paper to what I saw from the visit to his home.”

At the close of plaintiff’s case, on this evidence, the learned trial justice dismissed the complaint, holding that the application made to the department of education, and the certificate attached thereto, established a violation of warranties “ O ” and- “ P ” of the policy. .

[444]*444It is clear that this certification by the physician, without ' an examination of the plaintiff, and in the absence of evidence that the plaintiff consulted him for the purpose of being treated by him as a physician, established no.violation of warranty “ P.”

As to warranty “ O,” “ I have not been disabled nor have I received medical or surgical attention within the past five years,” this warranty must be construed in the light of the purpose for which it was made, viz., to convey to the assurer full knowledge of all serious disabilities from which the person applying for insurance has suffered during the previous five years. Unless it is to be assumed that the business of health insurance is conducted solely for the profit of the insurance companies,- without any corresponding possibility of benefit on the part of the assured, it cannot be supposed that the warranty had reference to any such temporary illness as the evidence shows thé plaintiff suffered in the month of May previous to the issuing of the policy. Though in his application to the board of education, the plaintiff described it as a serious personal illness, that is but an'expression of his opinion, not from a medical point of view, or the point of view of obtaining insurance, but as a compliance with certain established rules of the department of education regulating the pay of its employees. There is no evidence that -the disease was of a nature which seriously disabled him, or such as left any serious effects having a bearing upon the purpose and meaning of the policy. His subsequently formed, and subsequently expressed, opinion, in May, 1910, that the illness of May, 1909, was the forerunner of the illness in November, 19 0 9‘, is also but an expression of opinion of one not an expert, and having no probative value or force.

In Cushman v. United States Life Ins. Co., 10 N. Y. 12, the Court of Appeals say: “ In construing contracts- words must have the sense in which the parties used them, and to understand them as the parties understood them, the nature of the contract, the objects to be attained, and all the circumstances must be considered. By the questions inserted in the application, the defendant was seeking for [445]*445information bearing upon the risk which it was to take, the probable duration of the life to be insured. It was not seeking for information as to 'merely temporary disorders or functional disturbances, having no bearing upon general health or continuance of life. Colds are generally-accompanied with more or less congestion of the lungs, and yet in such a case there is no disease of the lungs which an applicant for insurance would be bound to state * * *. In construing a policy of life insurance it must be generally true that, before any temporary ailment can be called a disease, it must be such as to indicate a vice in the constitution, or be so serious as to have some bearing upon general health * * * or such as according to common understanding would be called a disease.”

This is no reason why this same principle should not apply in construing the policy of health insurance. The purpose of the questions which the assured is required to answer does not contemplate that he shall establish, before he can enter into, such a contract of insurance, that he has never suffered from any temporary illness or slight disability. As before intimated, if such construction is to be placed upon health policies, it would be the duty of the state to forbid the making of such policies; they would be in fact but traps for the unwary, from which the insured could derive no possible benefit.

In the case of Bancroft v. Home Benefit Association of New York, 120 N. Y.

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Related

Travelers' Insurance v. Pomerantz
124 Misc. 250 (New York Supreme Court, 1924)
Smith v. Travelers' Insurance
135 N.Y.S. 1143 (Appellate Division of the Supreme Court of New York, 1912)

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Bluebook (online)
76 Misc. 441, 135 N.Y.S. 18, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-travelers-insurance-nyappterm-1912.