Traut v. Pacific Mutual Life Insurance

53 N.E.2d 262, 321 Ill. App. 374, 1944 Ill. App. LEXIS 618
CourtAppellate Court of Illinois
DecidedFebruary 2, 1944
DocketGen. No. 42,497
StatusPublished
Cited by2 cases

This text of 53 N.E.2d 262 (Traut v. Pacific Mutual Life Insurance) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Traut v. Pacific Mutual Life Insurance, 53 N.E.2d 262, 321 Ill. App. 374, 1944 Ill. App. LEXIS 618 (Ill. Ct. App. 1944).

Opinion

Mr. Justice Burke

delivered the opinion of the court.

Eugene F. Traut filed separate suits at law against the Continental Casualty Company and Pacific Mutual Life Insurance Company to recover the indemnities provided for in four noneancelable accident and health policies issued by defendants by reason of having suffered a total disability to practice his profession. The defendants filed answers denying that plaintiff had suffered any disabilities compensable under the terms of the policies, and each defendant filed its counterclaim in equity to rescind and cancel the policies upon the ground that the plaintiff made certain misrepresentations in his application for the policies. By stipulation the actions were consolidated for the purpose of trial and the causes were submitted to the trial court, sitting in the dual capacity of law judge and chancellor to hear and determine the legal and equitable issues. At the outset of the trial the defendants conceded the prima facie case of the plaintiff with reference to his injury and length of disability and the amount of indemnities due him. It was conceded by the defendants that if they were unsuccessful in their counterclaim in equity and special affirmative defenses in law, judgment should be entered for the plaintiff and against the defendant Continental Casualty Company in the sum of $1,'412.50 and against the defendant Pacific Mutual Life Insurance Company in the sum of $3,427.51. At the conclusion of all the evidence the court found for the defendants and entered a decree in accordance with the prayer of the counterclaims. By stipulation of the parties the appeal of the plaintiff from the decree entered in the consolidated cases is consolidated for all proceedings on appeal. Plaintiff’s theory of the case is that each and every ailment, injury or illness,at any time suffered by him and not disclosed in the applications was slight, trivial and fully recovered from at the time of the making of the applications; that prior to the issuance of the policies he never had any bodily infirmity; that the matters relied upon by the defendants to rescind the policies were neither material to the acceptance of the risk nor to the hazard assumed by the defendants; and that defendants are not entitled to a rescission of the policies. Defendants’ theory of the case is that in his applications for the policies of insurance plaintiff falsely answered the questions asked of him regarding ailments, diseases and infirmities which he had suffered and medical attention which he had received; that the misrepresentations were material to the acceptance of the risk or the hazard assumed by the defendants; and that by reason of the misrepresentations the defendants are entitled to rescind the policies.

On April 21, 1924 the Continental Casualty Company issued to plaintiff a noncancelable accident and health policy, by the terms of which it agreed to pay to him, if by reason of sickness or injury he should be disabled and thereby suffer a loss of business time, a certain stipulated monthly indemnity. On October 6, 1926, July 1, 1928 and April 28, 1929 the Pacific Mutual Life Insurance Company issued to the plaintiff policies of accident and health insurance containing substantially the same provisions as the Continental policy, except with regard to the amount of monthly indemnities'payable thereunder. Prior to the issuance of each policy plaintiff was required to answer various questions relating to ailments, diseases and infirmities which he had had and medical attention which he had received. On each occasion he was also examined by a physician employed by the prospective insurer. On December 26, 1937, plaintiff became sick of tuberculosis and suffered a total disability to practice his profession as a physician until August 31, 1938. By reason of this illness he was confined in the Trudeau Sanitarium at Saranac lake, New York. Plaintiff gave the defendants notice of his disability and demanded payment of the indemnities proyided for by the policies, but the respective defendants denied liability. During the pendency of the actions and on May 10, 1939 plaintiff submitted to an operation on his spine at the Mayo clinic, at Rochester, Minn., at which time he again suffered a total disability to practice his profession until July 22,1939, and a partial disability for six months. Thereupon he filed his supplemental complaint in each of the pending actions to recover the indemnities provided for in the policies. The defenses made to the original complaint were extended to the supplemental complaint.

The insurance provided for in the policies was not only against loss of limb, sight or time resulting from accidental injury or sickness, but also for a limited hospital indemnity. Attached to each of the four policies and made a part thereof was an application in two parts. Plaintiff answered the various questions propounded in each application and signed it. The second part of the application consists of declarations made to the medical examiner. In the application for the Continental policy plaintiff certified that he had “read the above statements and answers and that each of them is recorded as made by me, and I agree that they shall form a part of the contract or contracts of insurance for which I have applied.” Paragraphs No. 29 and 30 of the Continental policy read, in part, as follows: “This policy is issued in consideration of the statements and agreements contained in the application therefor and the payment of premium as herein provided. Copy of the said application is hereto attached or hereon endorsed and is hereby made a part of this contract. . . . The falsity of any statement in the application, materially affecting either the acceptance of the risk or the hazard assumed hereunder, or made with intent to deceive, shall bar all right to recovery under this policy.” The policy further provides for the payment of indemnities for disabilities resulting in the inability to perform work substantially essential to his occupation but not resulting in a total loss of business time. The indemnities to be paid under the latter provision are contingent upon the fact that the disability immediately succeed a period of total loss of all business time for which indemnities are payable. It is only if such partial loss of business time is preceded by a total loss of business time for which indemnity is payable that the insurer is obligated to pay one half of the stipulated monthly indemnity and then but for a period not exceeding six months. In other words, under the policy issued by the Continental, indemnities are not payable for partial loss of business time unless the disability is of such a character as results in a total loss of business time for a period of time exceeding three months and are not payable for a period exceeding six months. In part 1 of the Continental policy interrogatory No. 15 reads: “Do yon agree (1) that the falsity of any answer in this application.for insurance or of any answer made to the company’s medical examiner in continuance of this application shall bar all right to recovery under the proposed policy if such answer is made with intent to deceive or if it materially affects either the acceptance of the risk or the hazard assumed by the company . . . t” Plaintiff answered: “Yes.” Interrogatory No.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Jessen v. Aetna Life Ins. Co
209 F.2d 453 (Seventh Circuit, 1954)
Marshall v. Metropolitan Life Insurance
86 N.E.2d 262 (Appellate Court of Illinois, 1949)

Cite This Page — Counsel Stack

Bluebook (online)
53 N.E.2d 262, 321 Ill. App. 374, 1944 Ill. App. LEXIS 618, Counsel Stack Legal Research, https://law.counselstack.com/opinion/traut-v-pacific-mutual-life-insurance-illappct-1944.