United Security Life Insurance Company v. Moore

157 So. 2d 674, 275 Ala. 642, 1963 Ala. LEXIS 399
CourtSupreme Court of Alabama
DecidedNovember 14, 1963
Docket5 Div. 768
StatusPublished
Cited by5 cases

This text of 157 So. 2d 674 (United Security Life Insurance Company v. Moore) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United Security Life Insurance Company v. Moore, 157 So. 2d 674, 275 Ala. 642, 1963 Ala. LEXIS 399 (Ala. 1963).

Opinion

PER CURIAM.

Judgment was rendered and entered in the Circuit Court of Chilton County in favor of plaintiff (appellee here) and against appellant for certain hospital and medical benefits provided in a policy of insurance issued by appellant to appellee. The policy also insured the wife of appellee. From this judgment, defendant appeals and seeks a reversal pursuant to several assignments of error.

The policy was limited in coverage to cancer originating after 12 o’clock noon, May 15, 1959, the effective date of the policy. The amount of the benefits, if any, due the plaintiff was stipulated by the parties and is not an issue in litigation.

' The sole factual issue presented on this appeal is whether or not the disease, for which Mrs. Moore, wife of appellee, was hospitalized and which resulted in her death qn October 30, 1959, originated prior to the effective date of the policy, or.after that time.. If it was manifested before, the exclusionary provision of the -policy bars recovery. - . ■ . ■

We have held that the word-“originates,” as appears in the exclusionary provision of the policy, refers ordinarily to the time the sickness or disease is manifested, although the medical cause existed prior to this time. United Security Life Insurance Company v. Hilyer, 41 Ala.App. 226, 128 So.2d 736(2), cert. den. 272 Ala. 710, 128 So.2d 741; Jefferson Life & Casualty Company v. Bevill, 38 Ala.App. 384, 86 So.2d 289(4), cert. den. 264 Ala. 206, 86 So.2d 292(4); National Casualty Company v. Hudson, 32 Ala.App. 69, 21 So.2d 568(4); 53 A.L.R.2d 686. The provision of such origination must be strictly construed against the insurer, and the illness or disease will ordinarily be deemed to have its inception when it first becomes manifest or active or when there is a distinct symptom or condition from which one, learned in medicine, can, with reasonable accuracy, diagnose the disease. 53 A.L.R.2d, supra.

We have also held that the burden of proof is upon the insurer to establish that the insured’s claim is within the limiting provisions of the policy. United Security Life Insurance Company v. Hilyer, 41 Ala.App. 226, 128 So.2d 736(1).

We have carefully read all the testimony in this case and conclude that the appellant’s contention that the motion for a new trial should have been granted, because the verdict of the jury was contrary to the great weight of the evidence, is without merit. There was evidence which we think supports appellant’s contention that the malignancy for which Mrs. Moore was examined and hospitalized existed prior to May 15, 1959, but we do not think the verdiet was contrary'to the great weight of [644]*644the evidence that the malignancy manifested itself prior to the effective date of the policy.

The plaintiff testified that he took his wife to the hospital on June 2, 1959, before which time she had not been treated for cancer. Further,- he testified, that she had been working in the home prior to that time; that on the day she was taken sick, she had been dressing chickens to put in the deep freezer; and that she had made no complaints about being sick.

On cross-examination, plaintiff admitted his signature to a claim filed with defendant for the benefits of the policy. The claim contained the following:

“On what date was the cause of disability first noticed? X6 wks ago”

The witness explained that he did not fill out the form and that he did not read it.

This proof of loss was not conclusive on plaintiff, only prima facie evidence of the facts therein stated, but subject to explanation, avoidance or rebuttal. Green v. Mutual Benefit Health & Accident Association, 267 Ala. 56, 99 So.2d 694(1), 72 A.L.R.2d 549.

Plaintiff introduced Dr. William H. De-Ramus, whose qualifications as a practicing physician were admitted by defendant; also defendant admitted that the witness was “a qualified doctor for the disease and trouble in this case.” This witness testified that he first saw Mrs. Moore on the night of May 30, 1959, and his findings were as follows:

“A Well, at that time, she didn’t feel well. She had some pain in her stomach, very low grade fever. I told her, at the time, I’d like for her to come in for a checkup to the hospital. At that time, she wanted to go back and keep working. She just didn’t think there was much wrong with her, and that she’d come back if she didn’t get any better.
“ * * * * * *
“Q You thought she had an inflam(m)atory trouble? Did you, was there anything there that, in any manner, on that occasion, that indicated cancer to you, Doctor?
“A Not at all. Not at that time.”

Witness then testified that he saw the patient again on June 2, 1959, at which time she was admitted to the hospital. Reading from the history given by the patient, the witness quoted as follows:

“A Well, the chief complaint is pain in the abdomen, pain when the bowels move, and some distention of the abdomen, * * *. That the patient has been feeling badly for the past six weeks, feeling- under par. The admission to the hospital: The general lay was loss of appetite, pain in the lower abdomen, and the pain was increased when the bowels moved. She was seen that night a week ago before admission.
U ‡ * Jjt * 'Jf. %
“A She was seen the week, seen at night a week before admission, and given some medication. * * * She returned on the date of admission, that was on the 6th. and 29th., I mean the 6th. and 2nd., this date * * * saying she was much worse, and unable to sleep at night, and the pain was increasing in the abdomen, and the pain was worse when the bowels would move. Past history: Patient has apparently been healthy all her life; no operations; no serious illness, and had been working every day up to the day of admission to the hospital. * * *
«* * * * * *
“Q * * * Let me ask you this? Was there anything, at the time * * * you first saw her, on May the 30th., at night, that indicated, in anyway, that she had cancer?
“A Well, there was no way I could tell. No, sir.
“Q Yes, sir.
[645]*645“A Nobody else, nobody could tell.”

Witness then proceeded to testify that on June 6th, 1959, he operated and found a cancerous condition in her abdomen.

“A Well, it was massive. She had the, the pelvis was a mass, and the left side, which was matted down, frozen, we call, so call it, just like ice. Also the right side, but the cancer, I thought, was coming from the left ovary. She had also some metastatics areas on the omentum, that is the big fat area going to the intestinal tract, and some in the peritoneum, the lining of the abdomen, cavity.
(t H* sfr :]c
“Q Then you, as I understand your testimony, Doctor, do not have any judgment as to the origination of that cancer, as to any time prior to the date you found it on June the 2nd., is that right, or not?
“A No, sir, I don’t know exactly. I didn’t know she had a cancer, at that time.

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

Related

Boston v. National Life & Accident Insurance
405 So. 2d 943 (Court of Civil Appeals of Alabama, 1981)
Boyington v. American Liberty Insurance Company
226 So. 2d 640 (Supreme Court of Alabama, 1969)
Group Hospitalization, Inc. v. Foley
255 A.2d 499 (District of Columbia Court of Appeals, 1969)
Malone v. Continental Life and Accident Company
403 P.2d 225 (Idaho Supreme Court, 1965)
Royal Family Insurance Co. v. Grimes
168 So. 2d 262 (Alabama Court of Appeals, 1964)

Cite This Page — Counsel Stack

Bluebook (online)
157 So. 2d 674, 275 Ala. 642, 1963 Ala. LEXIS 399, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-security-life-insurance-company-v-moore-ala-1963.