Wells v. Metropolitan Life Insurance

131 S.E.2d 634, 107 Ga. App. 826, 1963 Ga. App. LEXIS 998
CourtCourt of Appeals of Georgia
DecidedApril 15, 1963
Docket40071
StatusPublished
Cited by20 cases

This text of 131 S.E.2d 634 (Wells v. Metropolitan Life Insurance) 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
Wells v. Metropolitan Life Insurance, 131 S.E.2d 634, 107 Ga. App. 826, 1963 Ga. App. LEXIS 998 (Ga. Ct. App. 1963).

Opinion

Ebbrhardt, Judge.

Under the general grounds plaintiff insists that the provisions of the policy as contained in the quotation above from it as paragraph 1 and those in paragraph 3 for maternity benefits are conflicting, that he was entitled to have the policy construed in his favor and against the company, and that the evidence demanded a finding that his wife’s pregnancy was a “sickness or physical condition [that] had not manifested itself prior to” September 16, 1959, the date of the policy.

It is true that if the provisions of an insurance policy are ambiguous, or if the provisions in it are conflicting, it is to be construed in favor of the insured and against the company. Gill v. Federal Life &c. Co., 86 Ga. App. 455, 458 (71 SE2d 683). However, there are other rules of construction which must also be employed. “Every insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy and as amplified, extended, or modified by any rider, endorsement, or application made a part of the policy.” Code Ann. § 56-2419. Even when there is an ambiguity “the construction must be reasonable and not strained.” Mattox v. New England Mut. Life Ins. Co., 25 Ga. App. 311 (103 SE 180). “Courts are not called upon, because of the rule that contracts of insurance are to be strictly construed against the insurer, and because the contract itself is one of insurance, to call forth doubt, through construction of plain and unambiguous provisions of such a contract.” Aetna Life Ins. Co. v. Padgett, 49 Ga. App. 666, 669 (176 SE 702). “A construction of an insurance policy to determine the liability imposed by it involves a consideration of all those essential provisions which fix, create, limit, or enlarge liability.” Fisher v. American Cas. Co., 194 Ga. 157, 159 (21 SE2d 68). “The whole contract must be construed together, so as to give effect to each material and valid clause thereof. It would be contrary to all rules of construction to select one clause in a contract and construe it to the exclusion of other clauses bearing on and affecting the same subject matter, and at variance with it. It is not a question of ambiguity, as argued; for both clauses are perfectly clear when standing alone. It is a *831 question of the meaning of both clauses of the contract when construed together.” Marbut v. Empire Life Ins. Co., 143 Ga. 654, 657 (85 SE 834).

We find no ambiguity or conflicting provisions in the contract here. It is obvious that the exclusion in paragraph 1 of the policy refers to conditions other than pregnancy, and that the conditions for coverage or non-coverage of maternity benefits are spelled out in paragraph 3.

But even if these provisions were held to be ambiguous it was a question to be resolved by the jury as to whether the pregnancy of plaintiff’s wife “had not manifested itself” prior to the date of the policy. While she testified on the trial, “As far as I know on that date [September 16, 1959] I was not pregnant. As far as I believe I was not pregnant. There were no manifestations of pregnancy about me. As far as I know, 31 days later, on October 17, I was not pregnant,” this was not a positive assertion that she was not pregnant. On cross-examination she admitted that her last menstrual period before the delivery had been about the first of August, 1959, and that when she was suffering from nausea and dizziness on September 23 she went to see Dr. LeRoy, who then told her that based on his examination of her he thought her to be pregnant. He testified on the trial that based upon his examination of Mrs. Wells it was his opinion that she was pregnant when he saw her on September 23. Dr. Mulherin, the physician who attended the delivery, testified that it was his opinion that she became pregnant around the middle of August.

There was sufficient evidence upon which the jury might have concluded that she was pregnant prior to the time the policy was issued and that it had manifested itself—at least in that her menstrual periods had ceased to appear. See Lovett v. American Family Life Ins. Co., 107 Ga. App. 603 (131 SE2d 70).

Additionally, it is to be noted that the experience of humankind and the consensus of medical authority is that there is normally an interval of nine calendar months or 270 days from the inception of pregnancy to the date of parturition or delivery. There are and have been, of course, exceptional cases in which the interval is either greater or lesser in time due to peculiar *832 conditions that may exist, but in the absence of any showing of some unusual or peculiar condition that may affect the interval it is to be presumed that the gestation and birth of the infant occurred according to the ordinary course of nature. People v. Swiggy, 69 Cal. App. 574 (232 P 174). “A presumption upon a matter of fact, when it is not merely a disguise for some other principle, means that common experience shows the fact to be so generally true that courts may notice the truth.” Per Holmes, in Greer v. U. S., 245 U. S. 559, 561 (38 SC 209, 62 LE 469). Here the attending physician testified that the delivery was in all respects normal, as was the child itself. The normal gestation period of human experience would place the time of conception or beginning of Mrs. Wells’ pregnancy around August 5, 1959.

Under our view of the policy provisions, however, unless the pregnancy began more than thirty days after the policy date no maternity benefits were afforded. Certainly there was an abundance of evidence upon which the jury could conclude that Mrs. Wells was pregnant within the thirty-day period. Their verdict has the approval of the trial judge and it is final and conclusive upon all issues of fact.

Headnotes 2 through 8 need no elaboration save headnote 6 which deals with special ground 8 of the amended motion wherein movant excepts to the refusal of the court to give the following requested charge: “Gentlemen of the jury, I charge you with reference to witnesses who testify not as experts, such as doctors or persons who give opinions, that a witness is not to be arbitrarily disbelieved where that witness testifies to a fact, unless such witness has been, in your opinion, impeached. As applied to this case, the testimony of Mrs. William H. Wells, the mother of the child about which this suit has been brought, would be entitled to have her testimony credited by you and accepted unless you find that her evidence has been discredited or impeached.”

Mrs. Wells was the wife of the plaintiff. The issue to be determined by the jury was whether her pregnancy began more than 30 days after the issuance of the policy. On this issue she did not testify to any fact that was in issue, but rather gave her *833 opinion as to whether she was pregnant. She testified that she was married to the plaintiff on May 3, 1959, that the insurance policy involved in the suit was issued September 16, 1959; that in May [1960] she was hospitalized at St. Joseph’s Hospital in Augusta where she delivered a male child on May 5 with Dr.

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Bluebook (online)
131 S.E.2d 634, 107 Ga. App. 826, 1963 Ga. App. LEXIS 998, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wells-v-metropolitan-life-insurance-gactapp-1963.