Jefferson Standard Life Insurance v. Nelson
Jefferson Standard Life Insurance v. Nelson
Opinion of the Court
1. The defendant contends that under a proper construction of the contract of insurance, the plaintiff has failed to state a cause of action by virtue of his failure to allege that the defendant had agreed in writing, by endorsement on the policy, to pay the stipulated monthly benefits for total and permanent disability, and the plaintiff failed to allege that the defendant had likewise agreed in writing, by endorsement on the policy, to waive premiums which became due after receipt and approval of proof of total disability, since such agreements in writing endorsed upon the policy constituted conditions precedent to the plaintiff’s right to receive these benefits under the policy.
As we construe the contract of insurance, in order for the plaintiff to be entitled to the total and permanent disability payments and to the waiver of premiums, it must appear (a) that the plaintiff, prior to the anniversary of the policy on which
However, “any provision of a policy made for the company's benefit may be waived by the company either expressly or impliedly by the company's action.” Jones v. Pacific Mutual Life Ins. Co., 57 Ga. App. 16, 23 (194 S. E. 249); Rogers v. American National Ins. Co., 145 Ga. 570 (89 S. E. 700); Guaranty Life Ins. Co. v. Pughsley, 57 Ga. App. 588, 591 (196 S. E. 265). The clause of condition in the policy providing that upon receipt and approval of due proof of total disability the insurer would agree in writing by endorsement on the policy to pay the benefits and waive the premiums was for the benefit of the defendant and could be waived; and, when this clause is considered in connection with other provisions of the contract and the allegations of the petition, it is apparent that it was waived by the defendant insurer.
A proviso to this very clause provides: “But no disability income will be paid or premium waived for any period of disability which preceded receipt of written notice of such disability at the Home Office of the Company.” The plaintiff alleges that
2. The plaintiff alleged in paragraph 3 of his petition: “At the time of the filing of this suit the defendant is indebted to' plaintiff in the principal sum of $373.98 with interest thereon, because of a payment of premium made by plaintiff to defendant on September 17, 1949, under protest, in the amount of $73.98 (hereinafter more fully stated) and on account of permanent and total disability benefits due plaintiff by the defend
“As a general rule, if the premium is paid through mistake as to the facts, under the supposition, which is unfounded, that there is an obligation to pay, it is returnable; or, in other words, if a premium is paid under a supposition that a certain state of facts exists whereby the company would be entitled to the money, and the supposed facts do not exist, and the premium would presumably not have been paid had the actual facts been known by the payer, such premium so paid may be recovered back. Thus, if a premium be paid after a forfeiture of the policy under a mistake as to the fact of waiver, it shall be returnable. So, also, in case an assessment collected by mistake after a forfeiture, or in a case of an endowment policy which has matured, on which the insured, induced by the representations of the insurer’s agent, continues to pay premiums.” 3. Couch, Cyclopedia of Insurance Law, p. 2397, § 729.
Here the petition in its entirety shows that it was based upon a consistent statement of a single state of facts arising under one insurance contract; that the premium was paid under the supposition, which was unfounded, that to keep the policy in
3. Grounds 13, 14, and 15 of the defendant’s demurrer, lodged against paragraphs 16,17 and 18 of the plaintiff’s petition, upon the ground that they set forth no fact showing liability for attorney’s fees and damages for bad faith and that there was a continuation of the alleged disability. It is alleged that on two occasions, once upon request of the defendant and once voluntarily, the plaintiff had furnished proof of his total disability, but the defendant refused to continue the disability payments. These allegations were in aid of the plaintiff’s contention that the defendant so acted in bad faith as to entitle him to statutory damages and attorney’s fees. It was not incumbent upon the plaintiff to show a continuation of the alleged disability under the provisions of the contract of insurance. The fact that he had recovered or had refused to furnish proof of his continued disability would be a matter of defense. Guardian Life Insurance Co. v. Snow, 51 Ga. App. 280 (180 S. E. 241); New York Life Insurance Co. v. Bradford, 55 Ga. App. 248 (189 S. E. 914). The court properly overruled these grounds of the demurrer.
4. In ground 2 of the defendant’s demurrer objection is made that the petition “is duplicitous in that in one count plaintiff sues as the basis of his cause of action a default in the continuance of payments of monthly claims of $30.00 per month for disability already existing and also for the failure to pay $30.00 monthly claims for a disability to which due proof was given by plaintiff.” Assuming for the sake of argument that this language of the demurrer means something and that it objects, as counsel says in his brief, “to'the petition and points out that in one count plaintiff has sued on a special provision of the policy which contains two (2) distinct and different causes of
It is clear that the plaintiff is setting up that he has been totally and permanently disabled since the latter part of November 1947; that the defendant commenced payments for total and permanent disability on November 22, 1948, and discontinued these payments on July 19, 1949; and that the plaintiff is now seeking only those payments for total and permanent disability which have accrued between the time the defendant discontinued the payments and the filing of the petition, or trial of the case. We find no intimation in the petition that the plaintiff anywhere seeks to recover for total (but not permanent) disability which has continued for a given number of months more than three, and prevented the plaintiff from pursuing any gainful occupation or employment.
5. Grounds. 4, 5, 6, 7, 8, 9, 11, and 12 of the defendant’s demurrer which object to the allegations of certain designated paragraphs of the petition as being conclusions of the pleader and irrelevant to the cause of action are without merit.
Judgment affirmed.
070rehearing
ON MOTION FOR REHEARING. '
Paragraph 5 of the plaintiff in error's motion for a rehearing seeks to raise the question that the plaintiff in the allegations of his petition is claiming too much interest and also too much damages based on this excess of interest under Code § 56-706. A defect in the petition, in that the wrong measure of damage is set out, can be- reached only by special demurrer, which specifically points out the defect in the petition and is directed to that particular portion of it. Atlanta Plow Co. v. Bennett, 49 Ga. App. 672 (6) (176 S. E. 822); Koch Co. v. Adair, 49 Ga. App. 824 (3) (176 S. E. 680); National Bondholders Corp. v. Cheeseman, 190 Ga. 166, 168 (8 S. E. 2d, 391).
Rehearing denied.
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