Thompson v. Mutual Benefit Health & Accident Ass'n

184 S.E. 695, 209 N.C. 678, 1936 N.C. LEXIS 317
CourtSupreme Court of North Carolina
DecidedMarch 18, 1936
StatusPublished
Cited by16 cases

This text of 184 S.E. 695 (Thompson v. Mutual Benefit Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Supreme Court of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Thompson v. Mutual Benefit Health & Accident Ass'n, 184 S.E. 695, 209 N.C. 678, 1936 N.C. LEXIS 317 (N.C. 1936).

Opinion

Schenok, J.

Tbe assignments of error are treated in tbe briefs in two groups, and we will consider them as grouped.

Tbe first group of assignments relates to tbe motions for judgment as of nonsuit. It is conceded in tbe brief of tbe appellant that it “would not be entitled to a judgment of nonsuit unless tbe court finds that tbe policy was void as a matter of law under tbe evidence.”

Tbe fraud alleged, upon which appellant seeks to have tbe policy declared void, is in effect that tbe insured concealed from tbe insurer that be bad been ill over a long period for which be bad collected health insurance, and that a railway employee benefit association bad refused to renew a health policy be formerly carried with it, and that be bad suffered from and collected insurance for attacks of influenza, neuritis, and neurasthenia, and that tbe insured bad represented that be was “sound physically and mentally” at tbe time be made application for tbe policy when in truth and in fact be knew be was suffering from nervous exhaustion, “special weakness in right arm” (telegrapher’s cramp), and an irregular heart and sub-acute endocarditis, and, further, that within tbe last five years be bad been treated by only one physician and by him only for pyrogenic poisoning from bis teeth, whereas be bad been treated by a number of other physicians for various maladies.

Tbe plaintiff, in bis reply to tbe answer of tbe defendant, denied tbe allegations of fraud by either concealment or misrepresentations, and averred that at tbe time bis application for insurance was solicited and obtained be made a full and complete disclosure to tbe agent of tbe *680 insurer of the facts relative to his former illnesses, collection of health insurance benefits, the reason for the refusal of the railway employees benefit association to rewrite the policy formerly held by him, and had concealed no facts from such agent and had made no misrepresentation of facts to such agent.

The court, without objection, submitted the following issue: “Was the policy of insurance, plaintiff’s ‘Exhibit A,’ obtained from the defendant insurance company by means of false representations or concealments, as alleged in the answer?” There was evidence to sustain the allegations both of the defendant and of the plaintiff, and the jury answered the issue in favor of the plaintiff. There are no assignments of error either to the evidence or to the charge as they relate to this issue, the defendant having contented itself to rely upon its motions for judgment as of nonsuit.

The motions for judgment as of nonsuit cannot be sustained. It has been repeatedly held by this Court, and courts of other jurisdictions, that if an agent of an insurance company, while acting within the scope of his authority in soliciting and taking applications for insurance, is advised of the facts constituting any alleged fraud, and did not himself participate in such fraud, the knowledge of the agent will be imputed to the insurer. This principle applies to conditions existing at the time of the inception of the policy and not after the policy has been issued. The doctrine of waiver is applied upon well settled principles of equity. Smith v. Insurance Co., 208 N. C., 99; Colson v. Assurance Co., 207 N. C., 581.

In the case at bar there is no suggestion that the agent was not acting within the scope of his authority or that he participated in the alleged fraud. The defendant offered the agent as witness in its behalf and he testified that when he solicited and obtained the application for the policy he was not informed of the plaintiff’s illnesses or of his former policies, and was generally ignorant of the facts which the defendant set up as constituting the fraud. The evidence was sharply in conflict and presented a question for the jury, not the court.

The second group of assignments relates to the question as to whether the plaintiff’s claim for illness indemnity, under the evidence, falls under Part J or Part K oí the policy, relative to “confining illness” and “non-confining illness,” respectively. The plaintiff contends the claim falls under the former and the defendant under the latter. The portions of the policy involved are as follows:

“Part J. The association will pay, for one day or more, at the rate of seventy-five ($75.00) dollars per month for the first fifteen days and at the rate of one hundred fifty ($150.00) dollars per month thereafter *681 for disability resulting from disease, the cause of which originates more than thirty days after the date of this policy, and which confines the insured continuously within doors and requires regular visits therein by legally qualified physician; provided, said disease necessitates total disability and total loss of time.”
“Part K. The association will pay, for one day or more, at the rate of seventy-five ($75.00) dollars per month, but not exceeding one month, for disability resulting from disease, the cause of which originates more than thirty days after the date of this policy, and which does not confine the insured continuously within doors, but requires regular medical attention; provided, said disease necessitates total disability and total loss of time.”

There is no controversy as to the plaintiff having had a disability resulting from disease, the cause of which originated thirty days after the date of the policy, that required regular medical attention, and that such disease necessitated total disability and total loss of time. The controversy is over the court’s submitting to the jury, under the evidence in the case, the issue as to whether the plaintiff’s disability was such as to confine' the insured continuously within doors and to require regular visits therein by legally qualified physician.

The evidence is to the effect that the plaintiff’s disability due to disease during the time alleged, from 1 August, 1934, to 14 November, 1934, confined the plaintiff to his home and required regular visits of a legally qualified physician there, except that he sometimes went to his doctor’s office a half-block from where he lived for treatment, and occasionally went to the A. & P. Store and library, both within a half-block of his home, and had walked to the barber shop and shoe shop within a block and a half of his home, but that during all of this time he was totally disabled and was suffering a total loss of time, and had been able to do hut little except to sit in a chair, and that the doctor advised him to get out and walk some in order to regain the use of his legs, and that such walking as he did was not for pleasure or profit, but in obedience to the doctor’s advice.

The question presented is whether the fact that the plaintiff occasionally walked from his home when he was suffering total disability and total loss of time took his protection from Part J and placed it in Part K. The purpose of the provision relative to the insured’s being continuously confined within doors was to describe the character and extent of his illness, rather than to prescribe a limitation upon his conduct. The insured took out the policy as an indemnity against loss in ease of total disability to pursue his usual vocation.

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Bluebook (online)
184 S.E. 695, 209 N.C. 678, 1936 N.C. LEXIS 317, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thompson-v-mutual-benefit-health-accident-assn-nc-1936.