222 N.W. 25 | Iowa | 1928
On or about April 16, 1926, the appellee took out a policy of health insurance in the appellant company. That portion of the policy involved in this appeal is as follows:
"Non-house Confinement — $40.00 Per Month for Three Months. Section (b) Immediately following said confinement, or by reason of non-confining sickness, during which the insured shall be wholly and continuously disabled and prevented from performing any and every duty pertaining to his business or occupation.
"Payment for confinement and non-confinement combined shall not exceed a period of four years. During the period of disability for which indemnity is claimed the insured shall be attended at least once every seven days by a legally qualified physician. *979
Appellant contends that its liability under the policy, for house confinement, could not, in any event, exceed a period of seventy days, from January 16, 1926, to March 26, 1926, or a total of $186.67; that it could not exceed $120 1. INSURANCE: under the non-house-confinement clause of the health policy, and could not exceed $80 for hospital insurance: benefits, under the additional indemnity clause; confinement making a total of $386.67. It sought such "within the limitation by the trial court by proper motion. house:" This the court denied; but, as finally scope. submitted, the question of liability was limited to the period from January 16, 1926, to May 16, 1927, and the court left it for the jury to determine for what portion of said time, if any, appellee was entitled to recover under the "house-confinement" clause, and for what portion, if any, recovery could be had under the "non-house-confinement" clause. Hospital benefits were limited to $80. The jury returned a verdict allowing the full amount claimed under the "house-confinement" clause.
It becomes necessary that we briefly review the material evidence in the case. The appellee is a man 34 years of age, married, and a plumber by trade. He was taken sick in January, 1926, and on the 16th day of the month, was unable to get out of bed. He remained in the house about a week, and on or about the 25th or 26th of January, he went to Des Moines, on the interurban, to consult physicians there connected with the Veterans' Bureau. A physician in Des Moines advised him to go to the hospital at Dwight, Illinois. He went back to his home at Fort Dodge, where he remained for about a week, during which time he was in bed. He then again went to Des Moines, and from there went to Dwight, Illinois, on the advice of the Des Moines physician. He was examined in the hospital at Dwight, Illinois, and was ordered to remain in bed, which he did for a period of ten days. The doctor at Dwight then advised him to get up and get out and take the air. He was then able to move about some. He remained at the hospital for about twenty days. The doctors told him to be careful what he ate, to get out in the air as much as possible, and not try to work. He then returned *980 to Fort Dodge, and remained in bed about seven days. He then went to Kansas City, under direction from the Des Moines physician, for observation. He was there two days, and from there went to Excelsior Springs, upon the doctor's advice. This was about thirty-eight miles. He was there eighteen to twenty-five days. He then returned to Des Moines. At Excelsior Springs, he was told to get out as much as he could, and did so occasionally. He then returned to Des Moines, to see the doctor there, who told him to go home, and be careful about his diet, and not try to work. He advised appellant to get out as much as he could possibly stand it, because it was the only thing left to do at that time. He was advised to go home and keep quiet, and keep away from all noise, and stay out in the open. He then returned to Fort Dodge, to his home. Thereafter, he took outdoor exercise. In June, he went back to Des Moines to see the doctors, who ordered him to go to Chicago to the Edward Hines Hospital. He was there fourteen or fifteen days, and while there, a harness or brace was prepared for him to wear. It was very uncomfortable, and hurt his flesh. When he left the hospital in Chicago, he returned to Des Moines, and consulted his physician there. The doctor again told him to be careful about his food, instructed him not to do any work or try to do anything, and to keep away from noises, and stay out in the open. Appellee's testimony shows that he avoided excitement, did not attempt to perform any work of any kind, and stayed out in the open as much as he could. On May 15, 1927, he returned to Des Moines, and was again examined by the physician, who again instructed him not to try to do any work, and to stay out in the open, and be careful about his food. Appellee testified that he left the house for the purpose of taking exercise; that he would go out before breakfast and walk around the block and come back home; that he was in constant pain, nervous, and could not sleep; that he followed the doctors' instructions as to his diet; and that his condition was at a standstill. His head kept pulling to one side, and he is badly bent over. He testified that, since January, 1926, he had done very little work. In January, 1927, he went out on a farm for two days. In May, 1927, he moved to Des Moines. On cross-examination, he testified that, when his sickness began, he was confined to the house about a week; that, about January 23d, he went down *981 town, to make preparations for going away; that he went down in the bus, and was gone a couple of hours; that he went to the bank; that he went to Des Moines about January 25th or 26th; that a neighbor took him to the interurban; that he took a taxicab to the Veterans' Bureau, and walked about three blocks to dinner and back; that he went to the depot in a taxicab, and from the depot home in a taxicab. From January 16th to February 8th, he did not have any doctors at the house. He went to Des Moines February 8th, and went to the Veterans' Bureau in a taxicab. All of the doctors he consulted told him to get out and take exercise and be out of doors as much as he could. After he came back to Fort Dodge, on March 26, 1926, he was out of doors practically every day, walking around or driving around. At times, when the weather was good, he walked down town, walked around to the neighbors' houses, went down town, and visited with friends. He purchased a car in the spring of 1926, and drove it some, and his wife drove it some. He said: "I suppose I put on about four thousand miles." He tried to work at a very few odd jobs. He said: "I tried to do lots of things by force, needing the money, and I suffered for it." He also testified:
"I drove my car down to Des Moines in the summer after I got it. I made trips to other places beside Des Moines. I started to work at the fairground sometime in May, 1927, and I worked until September 8, 1927."
He was an overseer, and inspected plumbing in this work. A physician who examined him in May or June, 1926, described his condition. His back was crooked and very tender; he was unable to stand up; he walked with great difficulty, with two canes; was very tender in the spine; there was an inflammatory condition of the joints. He had spinal arthritis. The spinal column or back is stiff almost from the base of the skull to the pelvis. The bone is out of line. Further testimony was given, describing more in detail the physical condition of the appellee. The appellant offered no evidence, and the foregoing is but a general outline of the testimony in behalf of the appellee.
The important question in the case is whether or not, under the record, the appellee is entitled to recover for house confinement for the entire period claimed. There is no contention that *982 the appellee is malingering, and he has, with commendable frankness, testified with regard to his conduct during the period in question. The policy clearly provides for indemnity for loss of time caused by sickness, and places such loss of time in two distinct classes. One is denominated in the policy "house confinement," the other, "non-house confinement."
Policies of insurance of the kind herein involved are of comparatively recent origin. Such policies are variously worded. The important question for our determination is the construction to be placed upon the words in the house-confinement clause of the policy, which authorizes recovery for the number of consecutive days that the insured, by reason of such sickness, "shall be strictly and continuously confined within the house." In some instances, similar policies of insurance use the phrase "strictly and continuously confined at the house;" others use the term "to the house;" and a distinction has been made in some of the authorities between these different expressions. The instant policy says, "within the house."
A few citations will show the trend of authority.
An early case is Scales v. Masonic Protective Assn.,
"It would be generally understood that a sick person was confined `to' the house, although he went into the dooryard to take sun baths or get fresh air. To the strict constructionist, the phrase `to the house' does not mean the same as `in the house.'"
The court held that the insured was confined "to" his house, notwithstanding the fact that he spent a portion of the time in the dooryard, as described.
In Sawyer v. Masonic Protective Assn.,
In Hoffman v. Michigan Home Hosp. Assn.,
In Cooper v. Phoenix Acc. S.B. Assn.,
In Rocci v. Massachusetts Acc. Co.,
"The word `continuously,' in its common and accepted significance, means uninterruptedly, an unbroken sequence, without intermission or cessation, without intervening time. While it should not be given a restricted interpretation as applied to the subject-matter, so as to exclude, for example, a transfer of a person seriously ill from his house to a hospital and back again, or other imperative removals, it cannot be extended to include frequent changes from one house to another. Such a *984 policy of insurance as that here in controversy means that its benefit is payable only to an insured suffering from such serious malady that he is not able to break his confinement to the house with journeys of any substantial character outside its confines. It is too plain for discussion that one cannot be `continuously confined within the house' and at the same time take a trip to Italy. `Within the house' naturally means one house, in the absence of some exigency, especially when construed with the next clause, which requires that the insured be `therein regularly visited by a legally qualified physician.' It is difficult to see how an insured who, as did the plaintiff, remained two weeks in his own house, then went in a carriage to his sister's house in Roxbury, where he stayed two weeks, and thereafter was three weeks in the city hospital, three or four weeks in a different hospital, and then, after another period at home, went to Medford, a city several miles north of Boston, for two weeks, and thereafter was at still another hospital in the south of Boston, can be said, with any due regard to the meaning of words, to have been `continuously confined within the house and * * * therein regularly visited' by a physician."
In Sheets v. Farmers Merch. Mut. L. Cas. Assn.,
In Dunning v. Massachusetts Mut. Acc. Assn.,
In Bradshaw v. American Benev. Assn., 112 Mo. App. 435 (87 S.W. 46), the clause in question was, "entirely and continuously confined to bed." The insured spent most of the hours of the day out of doors, on the advice of his physician, in the open air; took a trip to Texas, and another to St. Louis. Recovery was denied.
In Reeves v. Midland Cas. Co.,
"A health and accident policy which limited full indemnity to the period during which insured should be necessarily and continuously confined within the house, and therein regularly visited by a physician, did not render the insurer liable to pay full indemnity for a time when insured, though merely convalescent, and unable to go out for his ordinary affairs, nevertheless was able to sit on the porch, and make visits to his doctor."
In Interstate Bus. Men's Acc. Assn. v. Sanderson,
To the same effect, see Great Eastern Cas. Co. v. Robins,
In Hays v. General Assem. Am. Benev. Assn., 127 Mo. App. 195 (104 S.W. 1141), the clause permitted recovery when the insured was entirely and continuously confined to bed. It was held that a reasonable construction must be given; and while the evidence tended to show that the insured was sometimes out of the bed, sitting propped in a chair, and was occasionally out in the yard, under a shade tree, and on one occasion was driven a few blocks down town in a buggy, a verdict for the insured would not be disturbed.
In Jennings v. Brotherhood Acc. Co.,
In Metropolitan Plate Glass Cas. Ins. Co. v. Hawes' *986 Exrx.,
In Columbian Relief Fund Assn. v. Gross,
In Van Dusen v. Interstate Bus. Men's Assn.,
In Jentz v. National Cas. Co.,
In Mutual Ben. Assn. v. Nancarrow,
In Ramsey v. General Acc., Fire Life Ins. Co., 160 Mo. App. 236 (142 S.W. 763), it was held that, under such a clause, recovery was not defeated where the patient was occasionally out of the house and taken to a physician's office, and that the policy should be construed liberally, and not literally. *987
In American Life Acc. Ins. Co. v. Nirdlinger,
In Breil v. Claus Groth Plattdutschen Vereen,
"That a person `must remain constantly in the house' does not necessarily mean that one must remain perpetually within the four walls of a house."
The court held that a patient cannot be said not to be confined to his house constantly during an illness of recurrent periods of severity, although at intervals he may occasionally step into his yard, or make visits to his physician, or make other short and usual trips. Recovery permitted. There is an extensive note to this case, as reported in 23 L.R.A. (N.S.) 359.
In Olinger v. Massachusetts Prot. Assn., 221 Mo. App. 405 (278 S.W. 86), it was held that confinement was to be construed in a substantial sense, and not in such a literal sense as to require every moment to be confinement. The same rule was followed inMusser v. Great Northern Life Ins. Co., 218 Mo. App. 640 (266 S.W. 325).
In Aetna Life Ins. Co. v. Willetts (C.C.A.), 282 Fed. 26, under a clause permitting recovery where the insured was "necessarily confined to the house," and it appeared that, on the advice of his physician, he had taken trips to different places for his health, the court refused to disturb a finding that the insured's disability was such as required his necessary confinement to the house.
As bearing on the question, other cases might be cited.
It is impossible to reconcile all of the cases that bear upon a clause of somewhat similar import in such policies of insurance. The general and familiar rule is that a contract of this character is to be construed liberally in 2. INSURANCE: favor of the insured. This is especially true health where there is any ambiguity in the terms used. insurance: The parties have a right, however, to make a liberal contract in construction of policy. *988 whatever form they desire. In the instant case, it is very clear that the contract contemplated indemnity for an illness of different degrees: one whereby the sickness was of such a serious character that the insured was "strictly and continuously confined within the house;" the second described a period of convalescence, or moderate illness, whereby, "immediately following said confinement, or by reason of non-confining sickness," the insured should be "disabled and prevented from performing any and every duty pertaining to his business or occupation."
We are disposed to concur in the view expressed in some of the cases cited, that a too narrow and constricted construction should not be placed upon the terms of this policy. "Strictly and continuously confined within the house" in its most literal interpretation would require that the insured stay constantly within the four walls of the house. Such an interpretation would prevent recovery if an emergency, such as a fire, should arise, and the insured be removed from the house. It would preclude recovery in the event of transportation in an ambulance to a hospital, even for emergency treatment. It would bar recovery if the insured sat upon an uninclosed porch of the house, or slept upon a sleeping porch that was not "inclosed within the house." Such narrow and limited construction should not be adopted in the interpretation of contracts of this character. The record in this case disclosed that, for certain periods of time described in the evidence, the insured was in fact strictly and literally confined within the house, and during a portion of said time, was confined in bed. There is no question, under this contract, of his right to recovery for such period of time. Nor do we think that the insured is deprived of his right to recover for such period of time as he was temporarily absent from his house for consultation with a physician in the town where he lived.
But the record in the instant case calls for a determination of the question as to whether the terms of the policy can be so extended as to include journeys made by the insured from his home to distant points, which were made under the advice of a physician, and in quest of health. The undisputed record shows that the insured went from his home in Fort Dodge to Des Moines, to Excelsior Springs, to Dwight, Illinois, all under the advice of his physician, for treatment, and that he was under treatment, and substantially all of the time confined within a *989 hospital, while at said places. We are disposed to hold that the true purpose and intent of the contract of insurance, when liberally construed, were to cover a contingency of this kind. It does not provide that the house referred to must be his home. Certainly, if he were confined within a hospital, it would be "within the house," within the meaning of this policy. Appellant's motion was a demand that the right of the appellee to recover for indemnity under this clause be limited to the period from January 16, 1926, the inception of his illness, to March 26, 1926, when he returned to his home at Fort Dodge from the trips he had made to consult physicians, which terminated the time when he had been confined in the various hospitals. We are disposed to the view that the court should have sustained appellant's motion at this point, and instructed the jury that, under the undisputed evidence in the case, the appellee was not entitled to recover under the so-called house-confinement clause for a period in excess of seventy days, to wit, from January 16, 1926, to March 26, 1926. For how much of said time the appellee was entitled to recover under said clause of the policy was a question for the jury.
With regard to the period after March 26, 1926, for which appellee claims recovery under the house-confinement clause, it appears that the appellee was out of doors a large part of the time, until he secured employment, on May 16, 1927; that he purchased a car, and either drove or rode in it some four thousand miles; and that during said time he sought employment away from home. He contends that he did this because of the fact that his physician advised him to take exercise "out of doors" and "get out in the air." Under these circumstances, did appellee still come within the provisions of the house-confinement clause of the contract? We do not so construe it.
Under the record which we have previously recited, it would be doing violence to the contract to hold that, during this period of time, while the appellee was about the premises and other places, taking automobile rides and going apparently where inclination directed, he was within the house-confinement clause of the policy. We are of the opinion that the court erred in submitting to the jury the question as to whether or not the appellee was entitled to recover under the so-called house-confinement clause of the policy after the date of March 26, 1926, *990 and should have limited appellee's right to recover under this clause of the policy to said date. The right of appellee for hospital benefits and for the non-house-confinement period of three months before he obtained employment is not seriously questioned by the appellant, and we think appellee was entitled to recover therefor, under the record. For the error pointed out in submitting to the jury the question of the right to recover for house confinement for any period beyond March 26, 1926, the cause must be, and it is, reversed.
The costs in this court will be taxed one half to the appellant and one half to the appellee. — Reversed.
STEVENS, C.J., and EVANS, KINDIG, and WAGNER, JJ., concur.