Stearns v. Prudential Insurance Co. of America

140 S.W.2d 766, 235 Mo. App. 135, 1940 Mo. App. LEXIS 46
CourtMissouri Court of Appeals
DecidedMay 21, 1940
StatusPublished
Cited by7 cases

This text of 140 S.W.2d 766 (Stearns v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stearns v. Prudential Insurance Co. of America, 140 S.W.2d 766, 235 Mo. App. 135, 1940 Mo. App. LEXIS 46 (Mo. Ct. App. 1940).

Opinion

TATLOW, P. J.

I. This is a suit on a health insurance policy. The policy provides:

*137 “If the Insured shall become totally and permanently disabled, either physically or mentally, from any cause whatsoever, to such an extent that he (or she) is rendered wholly, continuously and permanently unable to engage in any occupation or perform any work for any kind of compensation of financial value during the remainder of his (or her) lifetime, and if such disability shall occur at any time after the payment of the first premium on this Policy, while this Policy is in full force and effect and the Insured is less than sixty years of age, and before any non-forfeiture provision shall become operative, the Company, upon receipt of due proof of such disability, will grant the following benefits:

“ (1) Waiver of Premiums. — The Company will waive the payment of any premium or premiums the due date of which, as specified on the first page hereof shall occur after receipt by the Company of said proof of such disability.

“ (2) Monthly Income to the Insured. — The Company will, in addition to waiving premiums, pay to the Insured the Monthly Income specified on the^first page hereof under the heading ‘Total and Permanent Disability Benefits. ’ The first monthly payment shall be made immediately upon receipt by the Company of due proof of such disability and subsequent payments shall be made on the first day of .each month thereafter. ...”

The policy contains, in addition thereto, a rider to the effect that, should the permanent disability continue for a period of ninety consecutive days, it should be presumed to be permanent.

The petition alleged, among other things:

“. . . that on the 16th day of August, 1930, and while said policy was in full force and effect and before plaintiff had attained the age of 60 years, he became and is now totally and permanently disabled within the meaning of the terms of the policy issued to him on the date, as aforesaid, as a result of the following physical ailments: chronic pleurisy, chronic bronchitis, chronic bronchiectasis and active pulmonary tuberculosis; that immediately thereafter he furnished due proof of said total and permanent disability to the defendant and thereupon defendant commenced paying him the sum of one hundred ($100.00) dollars per month as provided for in said insurance policy, and paid said sum monthly from the 16th day of August, 1930, until the 16th day of April, 1932, at which time defendant ceased making the aforesaid payments.

“Plaintiff further states that at the time said payments were stopped, as aforesaid, he was still totally and permanently disabled and was entitled to the continuation of said payment of one hundred ($100.00) dollars per month, but plaintiff states that the defendant, wholly disregarding the terms and conditions contained in said policy, refused to pay him said amount or any part thereof and he was finally compelled to and did, on the 4th day of September, 1935, institute *138 an action in the Circuit Court of Butler County, Missouri, against the defendant, to enforce the resumption of the aforesaid payments; but plaintiff states that before said cause came to trial,' to-wit, on November 10, 1935, he was, at the- request of the defendant, examined by the defendant’s examining physician and that after said examination the defendant resumed the payment of his disability benefits of one hundred ($100.00) dollars per month, and continued to pay same up to and including' the payment due on the 14th day of December, 1938.

‘.‘Plaintiff further states that on January 6, 1939, the defendant again suspended his payments of his disability benefits, as aforesaid, and notified him that he would be required to resume the payment of the premiums on said policy which defendant expressly agreed to waive in case of plaintiff’s total and permanent disability.

“Plaintiff states that on August 10, 1939, he again submitted proof of his total and permanent disability to the defendant and on the same date demanded payment of the benefits then due him, being the aggregate of the monthly payments due on the 14th of each of the following months, viz.: May, June, July and August, 1939, which plaintiff states amounts to four hundred ($400.00) dollars, and on said date he also demanded the refund of a quarterly premium of thirty-nine and 40/100 ($39.40) dollars paid by him to the defendant on May 24, 1939.

“Plaintiff further says that on the 24th day of August, 1939, he paid to the defendant another quarterly premium of thirty-nine and 40/100 ($39.40) dollars, making a total of seventy-eight and 80/100 ($78.80) dollars in premiums paid to defendant which under the terms and conditions of said policy should have been waived by said defendant.”

The defendant’s answer first makes a general denial and then continues:

“. . . and without waiving its general denial hereinabove pleaded defendant denies that plaintiff was totally and permanently disabled under the terms of the policy sued upon, as alleged in plaintiff’s petition, and denies that plaintiff is now totally and permanently disabled so as to prevent him from engaging in any gainful occupation.

“Defendant, further answering the petition of plaintiff, states that prior to the filing of his petition plaintiff failed to make due proof to the home office of defendant in accordance with the terms and conditions of the policy of insurance sued upon to the effect that plaintiff became totally and permanently disabled so as to be unable to engage in any gairiful occupation; and defendant denies that there was any such proof so submitted by or on behalf of plaintiff sufficient in form and/or contents to comply with the requirements, terms and provisions of said policy.”

*139 The verdict of the jury is as follows:

“We, the jury, find the issues for the plaintiff: and assess his damages as follows: the sum of $400 for monthly payments due; the sum of $40 for vexatious refusal to pay; the sum of $100 as attorney fees, and the sum of $78 for the premiums paid by plaintiff to the defendant.”

Judgment was rendered in accordance with the verdict and proper stops were thereafter taken.by which the case, was appealed to this court.

II.

Numerous assignments of error have been made. Appellant’s first assignment of error is that the trial court should have directed a verdict for it for. the reason that, while the respondent offered evidence tending to support his claim of being totally and permanently disabled at the time of the trial, he offered no evidence to show what proof was submitted to the defendant as a basis for his claim at any time, either in 1930, 1932, 1935 or 1939, and cites in support thereof Jacoby v. N. Y. Life Ins. Co., 77 S. W. (2d) 840; Adams v. Metropolitan Life Ins. Co., 74 S. W. (2d) 899; Bergholm v. Peoria Life Ins. Co., 284 U. S. 489, 52 S. Ct. 230, 76 L. Ed. 416; and Feinberg v. N. Y. Life Ins. Co., 127 S. W. (2d) 82.

These- eases, of course, hold that it is necessary for the insured to make the required proof or show a waiver thereof.

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Cite This Page — Counsel Stack

Bluebook (online)
140 S.W.2d 766, 235 Mo. App. 135, 1940 Mo. App. LEXIS 46, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stearns-v-prudential-insurance-co-of-america-moctapp-1940.