Thomas v. Mutual Benefit Health & Acc. Ass'n

123 F. Supp. 167, 1954 U.S. Dist. LEXIS 3125
CourtDistrict Court, S.D. New York
DecidedAugust 16, 1954
StatusPublished
Cited by2 cases

This text of 123 F. Supp. 167 (Thomas v. Mutual Benefit Health & Acc. Ass'n) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Thomas v. Mutual Benefit Health & Acc. Ass'n, 123 F. Supp. 167, 1954 U.S. Dist. LEXIS 3125 (S.D.N.Y. 1954).

Opinion

DAWSON, District Judge.

This is a motion for summary judgment. The action was commenced in the City Court of the City of New York, and removed to this Court by the defendant. .

It appears from the papers submitted on the motion that the following material facts exist without substantial controversy :

1. On or about March 19, 1943, the defendant (hereinafter called the “insurance company”) issued to the late husband of the plaintiff a certain health and accident insurance policy, No. 101S-58581-43.
2. The policy provided benefits for loss of life, limb, sight or time by accidental means, or for loss of time by sickness to the extent limited and provided in the policy.
3. The policy on its face had across the top of it, in letters larger than anything else which appeared on the policy, except the name of the insurance company, the words “Ten Year Annual Increasing Policy”.
4. The policy provided on its face as follows:
“Regular Death Benefit — $2,500
“Maximum Death Benefit — $5,000”

5. The policy provided on its face that:

“The payment in advance, and acceptance by the Association, of premiums of Fourteen (14.00) Dollars Quarterly thereafter, beginning with July 1, 1943, is required ■ to keep this policy in continuous effect.”

6. The policy provided on its face as follows:

“Part C. Annual Increase Two Hundred Fifty Dollars Per Year
“After the first year’s premium has been paid, each year’s renewal premium paid in advance on this policy shall add Two Hundred Fifty Dollars to the Regular Death Benefit until the same amounts to Five Thousand ($5,000.00) Dollars.”

7. The policy also provided, under the heading of “Standard Provisions” the following:

“17. If the Insured shall carry with another company, corporation, association or society other insurance covering the same loss without giving written notice to the Association, then in that case the Association shall be liable only for such portion of the indemnity promised as the said indemnity bears to the total amount of like indemnity in all policies covering such loss, and for the return of such part of the premium paid as shall exceed the pro rata for the indemnity thus determined.”

8. On or about November 28, 1952, while the said insurance policy was still in effect, the insured died as a direct result of accident, independently and exclusively of diseases and all other causes, and the plaintiff was the duly designated beneficiary under said insurance policy.

9. The plaintiff furnished the defendant with due and timely written notice and proofs of loss.

10. During the period commencing July 1, 1943 to, and including, November 28, 1952, the sum of $14 had been paid quarterly, in advance, by the insured to the insurance company.

11. At the time of the death of the insured, he had a. life insurance policy issued in ordinary form by the New York Life Insurance Company in the face amount of $3,000 providing for the benefit of double indemnity, or $6,000, in the event of accidental death. The insured’s life was also covered by a $500 ordinary life insurance policy with double indem[169]*169nity benefits for accidental death, which policy had been issued prior to the issuance of the policy concerned in this litigation, and defendant had notice of this earlier policy in that the same was referred to in the application for insurance, a copy of which is annexed to the insurance policy involved'in this action.

12. In 1943, 1951, and 1952, the insurance company mailed to its policyholders, who were paying premiums on a quarterly basis, communications seeking to induce them to pay premiums annually, and in none of those communications did the insurance company advise the policyholders that if they were to pay the premiums on an annual basis, they would receive an annual increase in the face amount of the policy, but if they continued to pay them on a quarterly basis, they would not receive these annual increases.

13. The insured was a resident of New York at the time the policy was issued to him. The insurance company is authorized to do business in New York. The policy was issued through The Jesse M. Mayper Organization, insurance brokers, in the City of New York. The policy form bears upon it the statement that it is a New York form.

The plaintiff has moved for summary judgment on the first cause of action involved in the complaint, seeking a judgment in the sum of $4,750. This amount is the face amount of the policy of $2,-500, plus nine annual increases of $250 per year, being the nine annual periods from July 1, 1943 to July 1, 1952.

The defendant urges two points: (1) that the plaintiff is not entitled to be paid the annual increase in the face amount of the policy on the ground that this annual increase would only become effective if, in each year, an entire year’s renewal premium had been paid in advance, and that inasmuch as the premiums were paid quarterly in advance and not annually in advance, the annual increases set forth on the first page of the policy never became effective; and (2) that inasmuch as the insured carried insurance giving to him life insurance in the sum of $3,000, with double indemnity in the amount of accidental death, the insurance company is liable only for that portion of the indemnity promised in this, particular insurance policy as such indemnity bears to the total amount payable under all policies covering the loss, and for. the return of such part of the premium paid as shall exceed the pro rata for the indemnity thus determined.

No issue is raised except as to the extent of the amount to be paid by the insurance company under the particular language of the policy. This issue is one of interpretation of such language and is, therefore, to be determined by the Court.

It is well established law that the interpretation of this policy is governed by the law of the State of New York where the insured applied for the policy and where he resided and where the policy was issued to the insured. Swift & Co. v. Bankers Trust Co., 280 N.Y. 135, 141, 19 N.E.2d 992; Union Nat. Bank of Chicago v. Chapman, 169 N.Y. 538, 543, 62 N.E. 672, 57 L.R.A. 513. It is the established law of New York that if an ambiguity exists in a policy, this ambiguity must be construed most strongly against the insurance company which has prepared the policy. Garelick v. Rosen, 274 N.Y. 64, 68, 8 N.E. 2d 279; Gerka v. Fidelity & Casualty Co. of New York, 251 N.Y. 51, 55, 167 N.E. 169; Bushey & Sons v. American Insurance Co., 237 N.Y. 24, 27, 142 N.E. 340; Janneek v. Metropolitan Life Insurance Co., 162 N.Y. 574, 577, 57 N.E. 182.

The reason for this rule of law is apparent. The insurance company, as a rule, is dealing with a layman. It presents to him a rather long and involved insurance policy. He does not customarily have the advice of counsel when he takes out insurance and, therefore, if the insurance policy is not clear upon its face and is susceptible of two constructions, that construction properly should be taken which is most favorable to the insured. Stroehmann v.

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123 F. Supp. 167, 1954 U.S. Dist. LEXIS 3125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thomas-v-mutual-benefit-health-acc-assn-nysd-1954.