Norager v. Mountain States Life Insurance Co.

KNIGHT, J.

This action involves the alleged breach of the provisions of a policy of health insurance. Judgment was entered in favor of plaintiff, the insured, and the insurance companies appeal.

The policy was issued by the appellant Sierra Nevada Life and Casualty Company, whose business was subsequently taken over by the appellant Mountain States Life Insurance Company; and three years after the issuance of the policy and on March 29, 1932, the insured suffered a paralytic stroke which completely paralyzed his left side; and since then he has been totally disabled and under the care of a physician. The clauses of the insurance policy out of which the controversy arises read as follows: “Confining Illness for Life. The Company will pay at the rate of $75.00 per month for disability resulting from disease, the cause of which originates more than fifteen days after the date of this policy, and which confines the Insured continuously within doors and requires regular visits therein, at least once in every seven days, by a legally qualified physician, provided said disease necessitates total disability and total loss of time, and provided that no indemnity will be paid for. the first seven days of such disability.” “Non-Confining Illness. The Company will pay at the rate of $75.00 per month for the first month, and $37.50 per month for the next two months, for disability resulting from disease, the cause of which originates more than fifteen days after the date of this policy and which does not confine the Insured continuously within doors, but requires regular visits, at least once every seven days, by a

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legally qualified physician, provided said disease necessitates total disability and total loss of time, and provided that no indemnity will be paid for the first seven days of such disability, unless such non-confining illness shall immediately follow confining illness, indemnity for which is payable hereunder. ’ ’

As called for by thé “Confining Illness” clause above quoted, the insurer paid the insured $75 a month up to and including the month of April, 1933, at which time he was informed that thereafter the monthly benefit would be reduced to $37.50 for two months, as provided in the “Non-Confining Illness” clause, and that at the expiration of said two months the policy would terminate. Accordingly he was given two checks for $37.50 each, covering the months of May and June, 1933, and in July, 1933, said companies purported to cancel the policy. The insured refused to accept said checks in settlement of his claims, and in October, 1933, brought the present action wherein he asked that it be declared that the policy was still in full force and effect, and that he be given judgment for $450, which sum represented the allowance of $75 a month for the preceding- six' months as provided in said “Confining Illness” clause. The trial court found that the policy was still in full force, and accordingly awarded judgment in favor of the insured for $450.