Walsh v. United Insurance Company of America

Supreme Court of North Carolina

Walsh v. United Insurance Company of America

144 S.E.2d 817, 265 N.C. 634, 1965 N.C. LEXIS 1069

CourtSupreme Court of North Carolina

DecidedNovember 24, 1965

Docket368

StatusPublished

Cited by25 cases

This text of 144 S.E.2d 817 (Walsh v. United Insurance Company of America) 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

Walsh v. United Insurance Company of America, 144 S.E.2d 817, 265 N.C. 634, 1965 N.C. LEXIS 1069 (N.C. 1965).

Pincite

Opinion

Higgins, J.

In construing insurance contracts the courts generally take into account the fact that the contracts are carefully drawn by lawyers representing the insurance companies and the coverage is sold by skillful agents to individuals who are unfamiliar with the niceties of insurance law. By reason of the position of the parties, the courts construe the contracts most strongly against the insurer and most liberally in favor of the insured. Electric Co. v. Ins. Co., 229 *639 N.C. 518, 50 S.E. 2d 295; Glenn v. Ins. Co., 220 N.C. 672, 18 S.E. 2d 113; Duke v. Assurance Corp., 212 N.C. 682, 194 S.E. 91; Jolley v. Ins. Co., 199 N.C. 269, 154 S.E. 400; Underwood v. Ins. Co., 185 N.C. 538, 117 S.E. 790; Banks v. Ins. Co., 95 U.S. 673. This rule applies where the language used is ambiguous or is susceptible of more than one construction. However, it is generally held, certainly by this Court, that where the language of an insurance policy, is plain, unambiguous, and susceptible of only one reasonable construction, the courts will enforce the contract according to its terms. Huffman v. Ins. Co., 264 N.C. 335, 141 S.E. 2d 496; Hardin v. Ins. Co., 261 N.C. 67, 134 S.E. 2d 142; Parker v. Ins. Co., 259 N.C. 115, 130 S.E. 2d 36.

For man3^ years the courts have been construing confinement exclusively within doors provisions of health policies and many, including our own, have held that continuous confinement within doors clauses shall be construed as descriptive of the extent of the illness or injury rather than a restriction on the insured’s conduct or activities. Glenn v. Ins. Co., supra; Mutual Benefit Health and Accident Association v. Cohen, 194 Fed. 2d 232, 8th Ct., Cert. denied, 243 U.S. 965, 96 L. Ed. 1362; Occidental Life Ins. Co. v. Sammons, 271 S.W. 2d 922 (Ark.); Struble v. Occidental Life Ins. Co., 120 N.W. 2d 609 (Minn.); Suits v. Ins. Co., 249 N.C. 383, 106 S.E. 2d 579.

This case differs from all others in this one material respect: heretofore all courts have placed their own interpretations on the continuous confinement within doors clauses, giving the insured the benefit of the most liberal construction possible. This, however, is the only case insofar as our research has disclosed that the parties have agreed and placed in the contract their interpretation of what the clause means. The parties hereto have agreed that the clause means “confinement of the Insured continuously inside the house because of such sickness, except that the right of the Insured to recover under the policy shall not be defeated because he visits his physician for treatment or goes to the hospital for treatment when such treatment cannot be administered in the house of the Insured.” (emphasis added.)

In this case the plaintiff’s medical evidence shows total disability to carry on the business of farming. The plaintiff’s doctor testified that he advised reasonable activity- — walks over the level parts of the farm, trips to the beach, reasonable operation of an automobile, etc. The insured admitted he engaged in the permitted activities. By these admissions the plaintiff excludes himself from coverage under the continuous confinement within doors provision of the policy. Another section of the policy (not here involved) furnishes coverage *640 for total disability. The right of recovery in this action, however, required the plaintiff to show that his disability has confined him continuously within doors which, by agreement of the parties means inside the house except for visits to his doctor or to the hospital for treatment which cannot be “administered in the house of the Insured.” The parties having thus agreed, so shall they be bound.

The court should have granted the motion for nonsuit. This decision renders it unnecessary to pass on the defendant’s request for special instructions or to the form of the issues submitted. The judgment of the Superior Court of Caldwell County is

Reversed.

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Higgins, J.

In construing insurance contracts the courts generally take into account the fact that the contracts are carefully drawn by lawyers representing the insurance companies and the coverage is sold by skillful agents to individuals who are unfamiliar with the niceties of insurance law. By reason of the position of the parties, the courts construe the contracts most strongly against the insurer and most liberally in favor of the insured. Electric Co. v. Ins. Co., 229 *639 N.C. 518, 50 S.E. 2d 295; Glenn v. Ins. Co., 220 N.C. 672, 18 S.E. 2d 113; Duke v. Assurance Corp., 212 N.C. 682, 194 S.E. 91; Jolley v. Ins. Co., 199 N.C. 269, 154 S.E. 400; Underwood v. Ins. Co., 185 N.C. 538, 117 S.E. 790; Banks v. Ins. Co., 95 U.S. 673. This rule applies where the language used is ambiguous or is susceptible of more than one construction. However, it is generally held, certainly by this Court, that where the language of an insurance policy, is plain, unambiguous, and susceptible of only one reasonable construction, the courts will enforce the contract according to its terms. Huffman v. Ins. Co., 264 N.C. 335, 141 S.E. 2d 496; Hardin v. Ins. Co., 261 N.C. 67, 134 S.E. 2d 142; Parker v. Ins. Co., 259 N.C. 115, 130 S.E. 2d 36.

For man3^ years the courts have been construing confinement exclusively within doors provisions of health policies and many, including our own, have held that continuous confinement within doors clauses shall be construed as descriptive of the extent of the illness or injury rather than a restriction on the insured’s conduct or activities. Glenn v. Ins. Co., supra; Mutual Benefit Health and Accident Association v. Cohen, 194 Fed. 2d 232, 8th Ct., Cert. denied, 243 U.S. 965, 96 L. Ed. 1362; Occidental Life Ins. Co. v. Sammons, 271 S.W. 2d 922 (Ark.); Struble v. Occidental Life Ins. Co., 120 N.W. 2d 609 (Minn.); Suits v. Ins. Co., 249 N.C. 383, 106 S.E. 2d 579.

This case differs from all others in this one material respect: heretofore all courts have placed their own interpretations on the continuous confinement within doors clauses, giving the insured the benefit of the most liberal construction possible. This, however, is the only case insofar as our research has disclosed that the parties have agreed and placed in the contract their interpretation of what the clause means. The parties hereto have agreed that the clause means “confinement of the Insured continuously inside the house because of such sickness, except that the right of the Insured to recover under the policy shall not be defeated because he visits his physician for treatment or goes to the hospital for treatment when such treatment cannot be administered in the house of the Insured.” (emphasis added.)

In this case the plaintiff’s medical evidence shows total disability to carry on the business of farming. The plaintiff’s doctor testified that he advised reasonable activity- — walks over the level parts of the farm, trips to the beach, reasonable operation of an automobile, etc. The insured admitted he engaged in the permitted activities. By these admissions the plaintiff excludes himself from coverage under the continuous confinement within doors provision of the policy. Another section of the policy (not here involved) furnishes coverage *640 for total disability. The right of recovery in this action, however, required the plaintiff to show that his disability has confined him continuously within doors which, by agreement of the parties means inside the house except for visits to his doctor or to the hospital for treatment which cannot be “administered in the house of the Insured.” The parties having thus agreed, so shall they be bound.

The court should have granted the motion for nonsuit. This decision renders it unnecessary to pass on the defendant’s request for special instructions or to the form of the issues submitted. The judgment of the Superior Court of Caldwell County is

Reversed.

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Bluebook (online)

144 S.E.2d 817, 265 N.C. 634, 1965 N.C. LEXIS 1069, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walsh-v-united-insurance-company-of-america-nc-1965.

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