Warwick v. Mutual Benefit Health & Accident Ass'n

38 Pa. D. & C.2d 514, 1965 Pa. Dist. & Cnty. Dec. LEXIS 31
CourtPennsylvania Court of Common Pleas, Dauphin County
DecidedDecember 6, 1965
Docketno. 1209
StatusPublished

This text of 38 Pa. D. & C.2d 514 (Warwick v. Mutual Benefit Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Dauphin County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Warwick v. Mutual Benefit Health & Accident Ass'n, 38 Pa. D. & C.2d 514, 1965 Pa. Dist. & Cnty. Dec. LEXIS 31 (Pa. Super. Ct. 1965).

Opinion

Shelley, J.,

This matter is before us on a preliminary objection in the form of a demurrer to plaintiff’s complaint in assumpsit.

Plaintiff, as the beneficiary, brought an action on a policy of insurance, wherein the husband of plaintiff was the insured. A copy of the basic policy,1 with three [516]*516rider forms, is attached to the complaint as an exhibit. The rider forms are identified as rider form 1606M,2 rider form 1959M,3 and rider form 2162M.4 Rider [517]*517form 1959M was superseded by rider form 2162M.

There appears on the first page of the basic policy in large overwritten characters the words “THIS IS A LIMITED POLICY READ IT CAREFULLY”. The provisions of the basic policy restrict coverage to loss [518]*518of life or specific injuries received by the insured while riding, etc., in certain defined aircraft, or while in or upon premises or surface vehicles used for passengers and provided for or arranged by the airline or authorities controlling the established airport while beginning, continuing or completing an air trip.

[519]*519The policy issued to plaintiff’s decedent was dated April 4,1961, and in the schedule attached thereto provided for a premium of $61 and a principal sum of $100,000, and named plaintiff as beneficiary.

- To the policy is attached a rider form 1606M, entitled “Common Carrier Passenger Travel Accident Rider”, which states, inter alia:

“In consideration for the payment of the premium for this Rider the coverage of the policy is hereby extended to include5 accidental bodily injuries received while this Rider is in force and while the insured, as a passenger, is riding in, boarding or alighting from any public land, air or water conveyance provided by a common carrier primarily for passenger service”.

Likewise attached to the policy when issued was a rider form 1959M,6 entitled “Golden Anniversary Travel Accident Death Benefit Rider”, which provides for the payment of $2,000 to the beneficiary named in the policy, in addition to any other benefits payable under the policy, if the injuries occur during a policy term when an annual premium has been prepaid and the injuries result in death, independent of other causes, within 90 days of the accident; and likewise providing [520]*520for lesser sums for prepaid premiums for shorter periods, and under the heading “Covered Injuries”, the rider states:

“Accidental bodily injuries which you receive while you are driving or riding in any private passenger automobile or while you were riding as a passenger in any land, water or air conveyance provided by a common carrier, but not including injuries resulting in death caused by suicide or act of war or death occurring while in an armed service”.

Likewise attached, as an exhibit to the complaint, was a rider form 2162M7 carrying the heading “Travel Accident Death Benefit Rider”, at the top of which is the heading “Important Notice to Policy Owner”, which reads as follows:

“On its Golden Anniversary, the company began issuing the 1959M Travel Benefit Rider without additional cost to regular individual policy holders. The following rider includes and INCREASES THE BENEFITS of Rider 1959M and is issued as a replacement for it WITHOUT COST. You will be eligible for these benefits so long as you CONTINUOUSLY KEEP YOUR POLICY IN FORCE. Notice will be given to you of any further increases in benefits authorized”.

Form 2162M became effective May 1, 1962, and provides :

“The benefits of this rider will be paid in addition to any other benefits payable under the policy, except that if a Form 1959M rider is attached to your policy, the benefit of this rider will be paid in lieu of the benefit provided by Rider Form 1959M”.

Rider form 2162M provided various amounts of benefits, depending upon the amount of the prepaid premium, calling for $2,000 to be paid upon the prepayment of an annual premium, and likewise provided for var[521]*521ious increases of benefits depending on the length of time the rider was in force. The rider provides:

“The applicable benefit amount shown below will be paid to the beneficiary named in the policy, or to your estate if no beneficiary is named, if covered injuries result in your death, independent of other causes, within ninety days after the date of the accident”.

Rider form 2162M also provides, under the heading “Covered Injuries”:

“ ‘Covered injuries’ mean accidental bodily injuries which you receive while you were driving or riding in any private passenger automobile or while you were riding as a passenger in any land, water or air conveyance provided by a common carrier, but not including injuries resulting in death caused by suicide or act of war”.

The rider likewise provided under the heading “Additional Provisions”:

“This rider is subject to all provisions of the policy which are not in conflict with the provisions of this rider. If more than one rider of this form is attached to the policy, benefits will be payable under only one of them”.

The insured died as a result of injuries sustained while he was driving an automobile. As a result of the death of the insured, plaintiff is demanding the sum •of $112,500, which she claims is due her under the policy.8

[522]*522Notice of the accident, the claim under the policy, and proof of loss were filed with defendant. A check in the sum of $2,500, marked as payment in full of all liability under the policy, was issued by defendant to plaintiff.9

The issue before us is whether the statement in rider form 2162M10 as to the scope of its benefits, in terms of a definition of covered injuries, is sufficient to constitute an intent to redefine the term “covered injuries”, as used in the basic policy.11 Plaintiff contends she is entitled to recover, because there is ambiguous language in the basic policy and the riders attached thereto in that respect. She avers that the definition of “covered injuries” appearing in rider form 2162M should be read into the basic policy. Defendant contends it should not be so construed.

It is well settled in Pennsylvania that a policy of insurance provides coverage only for those risks or causes of loss which are assumed under its term and for no others. It is also well settled in Pennsylvania that where, by reason of ambiguity in the language employed in a policy or contract of insurance, there is doubt or uncertainty as to its meaning, and it is fairly susceptible of two interpretations, one favorable to the insured and the other favorable to the insurer, the former will be adopted: Weissman v. Prashker, 405 Pa. 226 (1961). It is also settled law in Pennsylvania that contracts of insurance, like other contracts, must receive a practical, reasonable and fair interpretation consonant with the apparent object and intent of the parties (Dzurko v. Pilot Life Insurance Company, 195 Pa. Superior Ct.

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Bluebook (online)
38 Pa. D. & C.2d 514, 1965 Pa. Dist. & Cnty. Dec. LEXIS 31, Counsel Stack Legal Research, https://law.counselstack.com/opinion/warwick-v-mutual-benefit-health-accident-assn-pactcompldauphi-1965.