Turner v. Metropolitan Life Ins. Co.

179 So. 448, 189 La. 342, 1938 La. LEXIS 1188
CourtSupreme Court of Louisiana
DecidedFebruary 7, 1938
DocketNo. 34485.
StatusPublished
Cited by8 cases

This text of 179 So. 448 (Turner v. Metropolitan Life Ins. Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Turner v. Metropolitan Life Ins. Co., 179 So. 448, 189 La. 342, 1938 La. LEXIS 1188 (La. 1938).

Opinion

*345 ODOM, Justice.

Plaintiff, while at work as a common laborer for the Southern Kraft Corporation at Bastrop, La., fell from an upper story of a building to the ground, a distance of about 20 or 25 feet, and received injuries which he claims have rendered him totally and permanently disabled to do work of a reasonable character, and is therefore unable to earn wages. These injuries were sustained on June 12, 1934. At the time of the injuries, he was insured under a group policy issued by the Metropolitan Life Insurance Company, covering the employees of the Southern Kraft Corporation. This policy contained the following provision:

“The group life policy mentioned on page one of this Certificate provides that the benefits specified below in the case of any Employee who furnishes due proof to the Company that, while insured thereunder and prior to his 60th birthday, he has become totally and permanently disabled, as the result of bodily injury or disease, so as to be prevented thereby from engaging in any occupation and performing any ■ work for compensation or profit.”

And it is also provided in the policy that, “Upon receipt, at the Home Office in the City of New York, of due proof that any Employee, while insured hereunder, and prior to his sixtieth birthday, has become totally and permanently disabled, as the result of bodily injury or disease, so as to be prevented thereby from engaging in any occupation and performing any work for compensation or profit,” the insurance company shall commence to pay such employee a monthly sum stipulated in the table attached to the policy. According to the table, the plaintiff, if injured to the extent alleged, is entitled to 20 monthly installments of $51.04 each.

Plaintiff made proof of his injuries and sent it to the company on May 13, 1936, nearly 2 years after he received the injuries.

The insurance company refused to pay the installments, the refusal being based on three grounds: First, that the proof and notice of injury were not made out and served within a reasonable time; second, that plaintiff was not totally and permanently disabled; and, third, that plaintiff is judicially estopped from now claiming that he was totally and permanently disabled because of his injuries, by judicial allegations to the contrary which he made in another suit.

Plaintiff brought this 'suit to recover the 20 installments and, alleging that defendant had delayed beyond a reasonable time to make the payments, claimed interest, penalties, and attorney’s fees, as provided in act No. 310, page 527, of 1910.

Defendant in answer set up the defenses as stated above and.alleged that, even if it should 'be held that plaintiff was entitled to judgment for the installments claimed, he was not entitled to interest, penalties, and attorney’s fees under the circumstances shown to exist in this particular case.

There was judgment in the district court in favor of the plaintiff for $51.04 each month from June 12, 1934, the date on *347 which plaintiff was injured, for a period of 20 months, together with 5 per cent, per annum interest on each of said sums from May 13, 1936, until paid. Plaintiff’s demand for penalties and attorney’s fees was re-j ected.

Defendant appealed. Plaintiff answered the appeal, praying that the judgment be so amended as to allow the penalties and attorney’s fees.

The defense set up by the insurance company that plaintiff’s rights under the policy are barred because of his delay in making out and submitting proof of his injuries is without merit. The policy itself specifies no time limit within which these proofs shall be submitted. It merely says that, when the assured submits “due proof” of his injury, the company will begin to pay the installments. Counsel for defendant argue that the term “due proof,” as used in a policy of this kind, refers to the time when the proof is to be submitted and not to the nature of the proof, and they cite numerous authorities holding that under benefit policies such as this one, if no time is specified in the policy within which notice of injury is to be given, the notice must be given within a reasonable time. Their contention is that notice was not given within a reasonable time in this case.

The authorities cited by counsel do not support their contention. They cite 33 Corpus Juris, § 657, page 11. It is there stated that:

“Generally speaking, in order to justify a recovery, insured or the insurance claimant must comply with a lawful stipulation in the policy requiring notice to be given within a specified time, notwithstanding the company is not prejudiced by the delay.”

This refers to policies in which the time for giving notice is prescribed in the policy.

Further on in that section, it is stated that “if no time is fixed by the policy, notice must be given within a reasonable time. What constitutes a reasonable time for giving notice depends on the circumstances of the particular case.”

As we have said, no time was specified in this policy for giving notice of the injury to the company, and we do not think that the delay in this case was so unreasonable as to defeat plaintiff’s right of recovery. The policy does not specify that an injured employee is entitled to benefit merely because he is injured, but the benefit accrues under the policy only in case the insured is totally and permanently disabled from performing- labor of a reasonable character and is rendered unable to earn wages. It is manifestly impossible for the best medical experts to say that a particular injury will result in permanent and total disability. Until it becomes reasonably certain that an injured person will be totally and permanently disabled on account of the injury, he has no right of recovery. Therefore, we think it not-unreasonable for the insured, in a case like this, to await developments before submitting his proofs. The proof which this policy requires the injured person to make is not proof that the injury was sustained, but proof that the injury caused total and permanent disability. Lia *349 bility under the policy arises only when proof can be made that the insured is permanently and totally disabled.

Counsel cite Carey v. Southern Life & Health Insurance Company, 146 So. 770, and Curry v. Universal Life Insurance Company, 150 So. 408, both decided by the Court of Appeal, Second Circuit. In each' of these cases, the insured was denied recovery. But in each case the policy involved specifically provided that notice of sickness or accident should be given within a specified time. It was held that the policy itself was a contract between the parties and that it was not the function of courts to alter or rewrite policies.

Considering the nature of the injuries sustained by this plaintiff and all the circumstances, we think his right of recovery is not barred by the delay.

The next question is whether plaintiff’s injuries resulted in total and permanent disability. We think the testimony shows that they did. This case was tried more than two years after the injuries were received. The testimony shows conclusively that, from the date of the injuries down to the date of the trial, plaintiff had done no work of any kind.

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Cite This Page — Counsel Stack

Bluebook (online)
179 So. 448, 189 La. 342, 1938 La. LEXIS 1188, Counsel Stack Legal Research, https://law.counselstack.com/opinion/turner-v-metropolitan-life-ins-co-la-1938.