Washington National Insurance v. Dukes

185 S.E. 599, 53 Ga. App. 293, 1936 Ga. App. LEXIS 71
CourtCourt of Appeals of Georgia
DecidedApril 27, 1936
Docket25072
StatusPublished
Cited by9 cases

This text of 185 S.E. 599 (Washington National Insurance v. Dukes) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Washington National Insurance v. Dukes, 185 S.E. 599, 53 Ga. App. 293, 1936 Ga. App. LEXIS 71 (Ga. Ct. App. 1936).

Opinion

Guerry, J.

On August 9, 1926, John Dukes was insured by [294]*294the Washington National Insurance Company. This contract of insurance provided in part for $10 weekly benefit payments for confinement caused by accident or illness. On November 14, 1933, he was confined to his bed with influenza. On November 15, 1933, the doctor attending Dukes made a report to the insurance company on a form furnished by it, and in accordance with the terms of the policy. This report set out the nature of Duke’s illness, his confinement to bed and its probable duration, which was certified to be 10 to 15 days. On November 21, 1933, Dukes executed a receipt to the insurance company, reciting the receipt of $10 as benefit payment from November 15, to November 22, 1933. On November 23, 1933, the doctor attending Dukes made a similar report, and on November 29, 1933, Dukes executed to the insurance company another receipt for $10 covering the period from the 23rd to the 30th of November. On December 1, 1933, another report was submitted by the doctor to the insurance company, and on December 7, 1933, Dukes executed another similar receipt for $10 for the period from December 1, to 8th. It was admitted that on this day the agent of the insurance company paid to Dukes $20, the additional $10 for which no receipt was given being for the next succeeding week, that is, through December 15, 1933. The agent of the insurance company, who had each week attended Dukes and who delivered the payments, and who had on each visit made an inspection report to the insurance company, which set out whether upon inspection the agent had found Dukes confined to his bed, room, or house, and in which he made recommendations as to how many days the company should pay for, marked his report as of December 7, 1933, as final. No further benefit payments were made; and in June, 1934, Dukes filed suit against the insurance company for weekly benefits from December 7 to the date of the filing of the suit. The defendant filed an answer, and on the trial the judge directed the jury to find for the defendant. Dukes appealed to the appellate division of the municipal court, which granted a new trial. To this judgment the insurance company excepted. It is admitted by Dukes that he did not make any further written report to the insurance company after December 1, 1933. The policy provides, in this regard, as follows: “The insured shall not be entitled to any benefits for sickness or accident under this policy unless a certificate on the [295]*295company’s form by a regularly licensed and practicing physician who is satisfactory to the company, showing the nature of the sickness or injury, shall first be furnished the company or its authorized agents; and if the sickness or accidental disability of the insured shall continue for more than one week, a like certificate must likewise be furnished at the beginning of each week of sickness or accidental disability. No liability for sickness or accidental disability shall begin to accrue under this policy for any week until such a certificate is received as above set forth.

Under the construction placed upon similar provisions of insurance contracts by the Supreme Court and this court in past cases, the furnishing of the certificates provided for in the above provision is a condition precedent to any liability for any benefits under its terms. In point are the cases of Jackson v. Southern Mutual Life Ins. Co., 36 Ga. 429; Graham v. Niagara Fire Ins. Co., 106 Ga. 840 (32 S. E. 579); Harp v. Fireman's Fund Ins. Co., 130 Ga. 726 (61 S. E. 704, 14 Ann. Cas. 299); Bailey v. First Nat. Fire Ins. Co., 18 Ga. App. 213 (89 S. E. 80). For the last decision of this court on this point see Sentinel Fire Ins. Co. v. McRoberts, 50 Ga. App. 732 (2) (179 S. E. 256). This seems to be the universal rule. See 7 Cooley’s Ins., § 1. However, provisions of this character are in purpose for the benefit of the insurance company, and it may of course waive the provision or a compliance therewith on the part of the insured, either by expressly so declaring or by acts amounting to a waiver. This principle is elementary, and is admitted by all authorities. See 7 Cooley’s Ins., 5943, § 11; Sentinel Fire Ins. Co. v. McRoberts, supra. Therefore, no certificates having been furnished to the insurance company by the insured, in order for any liability for benefits to attach it must be determined that the insurance company by some act waived this requirement as thus contended by insured. The insured does not rely on any express statement of the company waiving the provision requiring certificates to be furnished, but relies on acts of the company which he contends amount, as a matter of law, to an absolute implied waiver. Any acts by or conduct of the company which directly prevent the insured from complying with the conditions of his policy as to notice and proofs of loss, or which induce him to believe that strict compliance will not be required, will operate as a waiver of any default resulting [296]*296from such acts or conduct. It thus seems to he beyond question that an absolute implied waiver of the certificates so required by the policy, which are generally known as proofs of loss, results by a denial by the company of liability under the contract of insurance, whether the denial be upon some ground other than the failure to furnish required proofs or upon no specific ground at all. For cases dealing with contracts of insurance similar to that involved here, see Ætna Life Ins. Co. v. Palmer, 33 Ga. App. 522 (126 S. E. 862), conforming to answer to certified questions in 159 Ga. 371 (125 S. E. 829); National Life Ins. Co. v. Jackson, 18 Ga. App. 494 (89 S. E. 633); Williams v. Allas Assurance Co., 22 Ga. App. 661 (97 S. E. 91); Central Manufacturers Mutual Ins. Co. v. Graham, 24 Ga. App. 199 (99 S. E. 434); Coffee v. South Georgia Farmers Fire Ins. Asso., 29 Ga. App. 685 (116 S. E. 653). In a case involving a contract almost indentical, the Court of Appeals of Missouri held that where the insurer refused to make further weekly payments to the insured on the ground that the insured was no longer disabled, the insurer thereby waived the provisions of the policy requiring the insured to furnish a weekly physician’s certificate called for by the policy. Redd v. National Life &c. Ins. Co. (Mo. App.), 221 S. W. 397. To the same effect, see Rosenbaum v. National Acc. Soc., 170 N. Y. Sup. 27.

It has also been held, where a policy provides that the insured upon becoming disabled is to make and fill out a certificate to he furnished, by the insurer, that if upon request the insurer fails or neglects to furnish the blanks within a reasonable time, or if-without request the insured is advised that no further blanks will be furnished him, such action will amount to a waiver of a compliance with such provision. Cases supporting this view are Washburn-Halligan Coffee Co. v. Merchants Brick Mutual Fire Ins. Co., 110 Iowa, 423 (81 N. W. 707, 80 Am. St. R. 311); Davidson v. Guardian Assurance Co., 176 Pa. 525 (35 Atl. 220); Searle v. Dwelling-House Ins. Co., 152 Mass. 263 (25 N. E. 290); Winter v. Supreme Lodge, 96 Mo. App. 1 (69 S. W. 662); Supreme Lodge v. Goldberger, 72 Ill. App. 320; National Masonic Acc. Asso. v. Seed, 95 Ill. App. 43. For further cases see 7 Cooley’s Ins. 5996-7.

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Cite This Page — Counsel Stack

Bluebook (online)
185 S.E. 599, 53 Ga. App. 293, 1936 Ga. App. LEXIS 71, Counsel Stack Legal Research, https://law.counselstack.com/opinion/washington-national-insurance-v-dukes-gactapp-1936.