Stafford v. Old Heritage Mutual Ins.

70 Pa. D. & C.2d 544, 1975 Pa. Dist. & Cnty. Dec. LEXIS 386
CourtPennsylvania Court of Common Pleas, Fulton County
DecidedJanuary 18, 1975
Docketno. 50
StatusPublished

This text of 70 Pa. D. & C.2d 544 (Stafford v. Old Heritage Mutual Ins.) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Fulton County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stafford v. Old Heritage Mutual Ins., 70 Pa. D. & C.2d 544, 1975 Pa. Dist. & Cnty. Dec. LEXIS 386 (Pa. Super. Ct. 1975).

Opinion

KELLER, J.,

This is an action in assumpsit on a “Personal Income Disability Policy” issued by defendant to plaintiff s decedent. From the allegations of the complaint, it appears defendant issued policy no. 12419-101-003 to Flora G. Booth on November 18, 1970, that Mrs. Booth kept the policy in effect by the timely payment of premiums, that, as a result of illness, she was disabled and hospitalized at the Fulton County Medical Center from June 16,1973, to July 11,1973, and confined to her home from July 11, 1973, to August 1, 1973, when she expired. On August 6, 1973, letters testamentary were issued to plaintiff herein, who filed her proof of claim for benefits under the policy in the amount of $1,016. Defendant has failed and refused to pay the sums allegedly due.

Plaintiffs complaint was filed on June 11, 1974, and served upon defendant by the deputy sheriff of Montgomery County, on July 15, 1974. On September 19, 1974, plaintiff filed preliminary objections in the nature of motions to strike and for a more specific answer and a demurrer. The case was listed for argument and heard by the court en banc on December 17, 1974. At argument, plaintiff requested leave of court to file amended prehminary [546]*546objections in the nature of (a) abandoning the motion to strike; (b) demanding a more specific answer as to paragraph 6; and (c) asserting an additional reason in support of the demurrer. With the approval of counsel for defendant, who had received no notice of the proposed amended preliminary objections, plaintiff was granted leave to abandon the motion to strike and to demand a more specific answer as to paragraph 6 of the answer. On objection of counsel for defendant, leave was not granted plaintiff to include the additional reason in support of the demurrer or to argue the same.

To facilitate consideration of the paragraphs of defendant’s answer, which plaintiff contends are insufficiently specific, we will set forth first the paragraph from plaintiffs complaint and then defendant’s responsive paragraph. Those paragraphs of defendant’s new matter objected to will also be set forth.

(Complaint Par. 5) “The Plaintiffs decedent, during the latter’s lifetime, made regular and timely payments of premium upon the said insurance policy (No. 12419-101-003), so that the policy was in full force and effect at the time of decedent’s déath at Thompson Township, Fulton County, Pennsylvania on August 1, 1973.”

(Answer Par. 5) “Denied in that said policy was not in full force and effect at the time of the decedent’s death.”

(Complaint Par. 6) “While the said policy was in full force, the insured, Flora G. Booth, became gravely ill on June 16, 1973, and was taken by ambulance to the Fulton County Medical Center, McConnellsburg, Pennsylvania, where she remained under medical care until July 11, 1973.”

[547]*547(Answer Pax. 6) “Admitted in part and denied in part for the aforementioned reason.”

(Complaint Par. 10) “The Plaintiff has performed all things on her part to be performed according to the terms of the said insurance contract.”

(Answer Par. 10) “Denied in that the decedent had not performed all things on her part required under the terms of the said policy.”

(Complaint Par. 11) “A reasonable period of time has elapsed since the Plaintiffs said claim has been presented to Defendant. Defendant has broken its covenants and has failed and refused to pay the sums to which the Plaintiffs decedent (the insured) is entitled under the terms of the said policy of insurance, even though Plaintiff has frequently requested that Defendant make such lawful payment of benefits upon said policy.”

(Answer Par. 11) “Denied in that the Defendant has not broken any of its covenants, and further denied that Defendant has refused to pay any sum payable under the terms and conditions of the policy. In fact, no claim has been presented, for the time periods referred to, which complies with the terms and conditions of the aforementioned policy of insurance.”

(Complaint Par. 12) “According to the terms of the said policy of insurance, there is due to the insured, Flora G. Booth, and payable to the Plaintiff, as Executrix, certain cash benefits in the following categories as embodied in the text of the policy:

“ ‘A. Sickness benefits — Part IX of the policy’ “While confined to the Fulton County Medical Center hospital June 16 to July 11, 1973 $200.00
[548]*548“While totally disabled at the home of the Insured
July 11 — August 1, 1973 $200.00
“B. Ambulance Expense — Part XI $ 10.00
“C. Increased Indemnity for Hospital Confinement Part XII June 16—
July 11, 1973 $200.00
“D. Refund of premiums paid from policy date, November 18, 1970 to August 1, 1973:
1970 $ 142.00
1971 132.00
1972 132,00
$ 406.00
“Total $ 1,016.00”

(Answer Par. 12) “Denied in that according to the terms and conditions of the said policy there are no sums payable to the insured, for the claim presented.”

New Matter 14, “Said application was duly executed by the Decedent, and witnessed by a representative of the Defendant.”

New Matter 16. “Information regarding the medical history of the Decedent has been furnished to the Defendant, by the Decedent’s Attorney, which indicates a significant medical history not found in the Decedent’s apphcationforinsurance.” New Matter 17. “Had the true and correct medical history been given by the Decedent in her application for insurance, the said policy would not have been issued because of the risk involved.”

New Matter 18. “As a result of the foregoing, the Defendant is entitled to recind [sic] said policy as of the date of its issuance.”

The essence of plaintiffs objections is that defendant’s responding paragraphs and paragraphs under new matter, presumably asserting one or more defenses, fail to inform plaintiff of the facts [549]*549upon which defendant declines to pay the policy claim. The response of defendant seems to be in part an assertion that it is not required to plead evidence; in part a contention that plaintiff has as much knowledge as to certain matters of defense as defendant; in part that its denials are sufficient, and in part that plaintiff can secure the information she seeks by following the available discovery procedures.

To place the matters here under consideration in their proper perspective, this court is of the opinion that certain fundamentals of proper pleading must be noted. First, and perhaps foremost, the bench and bar must be mindful of the legal fact of life that the Commonwealth of Pennsylvania does retain the concept of fact pleading as distinguished from “code pleading.” Pa. R.C.P. 1019(a) masterfully and eloquently enunciates the adoption and adherence to this concept in the following language:

“The material facts on which a cause of action or defense is based shall be stated in a concise and summary form.”

Discussing this subsection of the Rules of Civil Procedure, we find in 2A Anderson, Pa. Civ. Prac. at §1019.1:

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70 Pa. D. & C.2d 544, 1975 Pa. Dist. & Cnty. Dec. LEXIS 386, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stafford-v-old-heritage-mutual-ins-pactcomplfulton-1975.