Southern Travelers' Ass'n v. Masterson

48 S.W.2d 771, 1932 Tex. App. LEXIS 372
CourtCourt of Appeals of Texas
DecidedMarch 12, 1932
DocketNo. 10935.
StatusPublished
Cited by16 cases

This text of 48 S.W.2d 771 (Southern Travelers' Ass'n v. Masterson) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Southern Travelers' Ass'n v. Masterson, 48 S.W.2d 771, 1932 Tex. App. LEXIS 372 (Tex. Ct. App. 1932).

Opinion

LOONEY, J.

Southern Travelers’ Association, a mutual assessment company chartered under the laws of this state, issued to Wm. R. Master-son its certificate or policy of insurance entitling insured to sick benefits resulting from disease described as follows: “We cover all *772 diseases except hernia, orchitis, epididymitis, venereal, insanity, hay fever, asthma, epilepsy, cancer, cataract and diseases of organs and confinement peculiar to women. Everything else covered. * * * Eor first week of continuous illness $10.00, $25.00 weekly indemnity thereafter, not to exceed 52 weeks.” The articles of incorporation of the association, its by-laws, the application for membership, and the certificate of membership, constituted the insurance contract, it being provided that “the payment of the benefit herein provided for is conditioned upon its being collected by this company from assessments and other sources as provided in its by-laws.”

On June 19, 1927, Masterson became sick with “flu,” on June 23d called in a physician, and thereafter, as the result of the sickness, was confined within doors under the care of his physician until he died, April 29, 1929.

Assured gave immediate notice of his sickness, and on July 1,1927, defendant furnished blanks for. preliminary reports to be made both by himself and physician; and on receipt of these defendant, on July 12, 1927, furnished insured with blanks for final reports by himself and physician when recovery was complete. Mastexrson, however, did not recover, but lingered and died, and after the expiration of 53 weeks, that being the limit of defendant’s liability, insured and his physician having in the meantime made final reports to defendant on blanks furnished for that purpose, insured demanded payment of $1,310 sick benefits, being $10 for the first and $25 per week for the 52 succeeding weeks. On September 28, 1928, defendant rejected the claim on the ground that the membership of insured was in suspense at the time of the commencement of his sickness.

After the death of insured, Mrs. Margaret Masterson, his surviving wife and independent executrix, instituted this suit to recover the sick benefits alleged to have accrued under the policy prior to his death.

Defendant answered by general and special exceptions, general denial, and set up special defenses as follows: That insured failed and refused to make final proof of his claim, as required by the terms of the contract, in that material questions propounded in the blanks furnished by defendant were not answered, which would have disclosed, if truthfully answered, that flu was not the sole cause of insured’s sickness and confinement, but at the time of being thus attacked he was and had been for years suffering from a chronic disease called “progressive muscular atrophy”; also that insured failed to pay assessments called for by defendant within the period prescribed in the by-laws of the association, hence his certificate lapsed, and, at the beginning of his sickness, he was not a member of the order.

The case was submitted to a jury on two special issues, without objections or request by either party for additional issues, as follows:

“Special Issue No. 1: Did plaintiff’s husband, W. R. Masterson, in furnishing the defendant with the final statement of proof of loss conceal from the defendant any material information as to his illness, sickness or disease? The jury answered ‘no.’
“Special Issue No. 2: Was the plaintiff's husband, W. R. Masterson, at the time of the development of his illness complained of, in good standing with the defendant, or had he permitted his policy to lapse? Answer as you find the facts to be. The jury answered: ‘We find the plaintiff to be in good standing' with the defendant.’ ”

The court rendered judgment for plaintiff for the full amount sued for with interest, and directed defendant to make an assessment and collect the same for the payment of the judgment as provided both in the bylaws of the order and in chapter 6, title 78, R. S. 1925. Defendant appealed and by appropriate assignments presents for consideration the questions hereafter discussed.

Defendant assigned error on the refusal of the court to sustain its general and special exceptions to plaintiff’s petition on the ground that no showing was made that proof of the claim sued upon had been furnished defendant, as required by the by-laws of the association; the specific contention being that, where the contract sued upon, as in the instant case, requires the insured to furnish proof of loss, the petition should show compliance with this condition, and, in the absence of such showing, the pleading is subject to general demurrer.

Defendant cites as authority for its contention the decision of the Waco Court, in Mutual Benefit Health & Accident Ass’n v. Shelton (Tex. Civ. App.) 27 S.W.(2d) 845. We do not think this case is in point, for the reason that the policy sued upon in that case was made a part of the petition, a provision of which required insured, in case of claim thereunder, to furnish proof of loss within 9b days from the termination of the period of liability. The court held, in view of this status, that the petition, failing to allege compliance with this provision,, was fatally defective. In the instant case, however, no such disclosure is made, the petition simply alleged provisions of the contract relating to the contingency insured against, set up facts showing the accrual of benefits thereunder, alleged demand upon defendant for payment and rejection of the claim. We think the petition alleged a cause of action. In passing upon the exception urged, the court could not assume or judicially know that the contract made any requirement for proofs of loss; besides, the failure to furnish proofs, if re *773 quired to do so, was in our opinion purely a’ matter of defense. See article 5546 (5714) (3379) R. S. 1925; Francis v. International, etc., Ass’n (Tex. Civ. App.) 260 S. W. 938, 947, writ granted, but affirmed; International, etc., Ass’n v. Griffing (Tex. Civ. App.) 264 S. W. 263, 265, application dismissed for want of jurisdiction.

Defendant contends, further, that its general and special exceptions to plaintiff’s petition for failure to allege the furnishing of proof of loss having been overruled, such omissions could not be supplied in a supplemental petition. It is doubtful if this proposition is germane to any assignment, but, considering it so, it is not, in our opinion, well taken for the reason that defendant in its answer alleged defensively the by-laws of the order, among others the provision requiring proof of loss to be made within 90 days after the termination of the period of liability charging that, as insured failed to make this proof, no recovery could be had. In a supplemental petition, plaintiff denied these allegations and affirmatively pleaded that proof of loss had been in fact made and furnished defendant. Aside, however, from the allegations of the supplemental petition, an issue was joined on defendant’s allegation as to the failure of insured to furnish proof,. in that the statute, article 2005 (1829) (1193) (1197) R. S.

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Bluebook (online)
48 S.W.2d 771, 1932 Tex. App. LEXIS 372, Counsel Stack Legal Research, https://law.counselstack.com/opinion/southern-travelers-assn-v-masterson-texapp-1932.