80 W. Va. 567 | W. Va. | 1917
Upon a demurrer to the evidence introduced by him on a trial in assumpsit, plaintiff, a railroad brakeman, recovered a judgment for the sum of $1500 against the Brotherhood of Railroad Trainmen, which it seeks to reverse upon this writ of error. Plaintiff bases his alleged right of recovery upon á beneficiary certificate issued to-him by the grand lodge of the brotherhood April 24, 1912, and upon sections 68 and 70 of the constitution of that order. The injury averred consisted of the loss of three fingers from the right hand. In addition to the general issue entered, defendant asked but was denied leave to file a special plea setting up the decision of its beneficiary board under section 70, disallowing plaintiff’s claim, as conclusive upon his right to a recovery in this action. The nature and existence of such liability, if any, is the sole question requiring consideration on this review.
By the constitution of the grand lodge, in addition to various other funds, there is created a beneficiary fund, “to be disbursed exclusively in paying death, total and permanent disability and benevolent claims, as defined in sections 68, 69 and 70”. In the maintenance of this fund all beneficiary members are required to participate by payment of monthly assessments levied upon them. For this purpose plaintiff was required to pay, and regularly did pay, an assessment of $2.50 per month. By virtue of section 60, “each certificate shall show in what class it is issued, and provide for the payment, in accordance with this constitution, of the full amount of such claims upon the death of the member insured therein, or upon his becoming totally and permanently disabled within the meaning of section 68.” Sections 64 and 67 provide that the required proofs of death or disability shall be forwarded to the general secretary and treasurer within six months after the accident. Upon receipt of proof of death, “if the same shall be regular and satisfactory to said general secretary and treasurer, and the claim be by him deemed valid, the same shall be adjusted in its regular order” and the beneficiary “shall be entitled to receive from the beneficiary'
Section 68 is entitled "total and permanent disability claims”. It provides that “any beneficiary member in good' standing who shall suffer the amputation or severance of an entire hand at or above the wrist joint, or who shall suffer-the amputation or severance of an entire foot at or above the-ankle joint, or who shall suffer the complete and permanent loss of sight of both eyes, shall be considered totally and permanently disabled, and shall thereby be entitled to receive, upon furnishing sufficient and satisfactory proofs of' such total and permanent disability, the full amount of his-benefieiarj’- certificate, but not otherwise”. Formal written proofs of such disability, signed by the insured member, his attending physician and certain officers of the subordinate-lodge, containing “a statement setting forth the nature and extent of the injury and all proofs, including the beneficiary certificate of the member and his receipt for all dues and assessments for the month in which he was injured, shall be forwarded to the general secretary and treasurer, and if the same are found to be' regular and satisfactory by him the claim shall be assessed for and paid in its regular order. But if the general secretary and treasurer shall for any reason disallow or reject said claim, it shall be referred to the beneficiary board, who may allow or disallow the claim. If allowed it shall be assessed for and paid in its regular order. If disallowed by the beneficiary board the claimant may appeal to the board of insurance, which may allow or disallow the claim, and its action shall be final”.
Section. 70, upon which the declaration supporting the judgment is based, is entitled "benevolent claims”. It is quoted in its entirety. "All claims for disability not coming within
The declaration alleges, and the proof sufficiently shows, that at the time of his injury in March, 1914, plaintiff was in good standing in the brotherhood. He has also complied 'with all the conditions of his contract of insurance, and all the laws and regulations of the order. He has exhausted all the remedies provided in its constitution. Upon presentation to it of proofs of injury, in the manner and form prescribed by sections 70 and 71, the beneficiary board disallowed his claim for benefits; and this decision, on a reference had thereto, was sustained by the board of insurance, and payment of the claim refused "as not proven”.
As disclosed by the foregoing and other provisions of its organic law, defendant is an unincorporated fraternal and mutual benefit society operating upon the lodge system. Its avowed purposes are "to unite the railroad trainmen, to promote their general welfare and advance their interests social, moral and intellectual, and to protect their families by the exercise of a systematic benevolence”. One of its principal objects is to provide for the payment of stipulated sums to its members and their beneficiaries in the case of death or disability, upon prescribed conditions. Its governing bodies consist of a grand and subordinate lodges. It is the province of the grand lodge to prescribe and determine the rights, privileges and duties of the members of the society and the beneficiaries of deceased members. The subordinate lodges
Clearly, the nature of plaintiff’s injury did not entitle him to an award or recovery of benefits under section 68 of the constitution. For he did not suffer the amputation or severance of an entire hand or foot or the loss of the sight of both eyes. That section is clear and unambiguous, and there is no occasion to resort to any rule applicable to the construction or interpretation of doubtful language. It “does not cover the case of an amputation or severance of only a part of a hand, although the hand is permanently disabled for use in performing any manual service whatever”. Brotherhood of Railroad Trainmen v. Walsh, 103 N. E. (Ohio) 759, wherein section 68 was construed and applied. Hence the liability of defendant, if any there, be, is confined to section 70.
The contention of plaintiff, in assailing the validity of section 70, is that the decision of the tribunal thereby established to pass upon disability claims is practically an arbitration, and that an agreement to submit such a claim to arbitration in advance of a controversy is invalid, as against public policy, because its object and effect are to oust the courts of their jurisdiction. The soundness of the general principle so invoked, as thus broadly stated, can not be questioned. The correctness of that doctrine is not a question
But the claim here asserted falls within another distinct .class of cases, requiring the application of a different rule. The basis of the difference lies in the voluntary character of the obligation assumed by defendant, as evidenced by section 70 of its constitution, which is expressly made a part of the contract sued on. The distinction is clearly drawn in Whitney v. Masonic Accident Association, 52 Minn. 378, wherein, after holding upon the facts proved that in a contract creating a definite obligation to pay a certain sum of money upon a specified contingency an agreement that the rights and obligations of the parties should be determined by arbitration without resort to a civil action is invalid, the court said: “The case before us is distinguishable from those where the agreement provides only for the determination by arbitration of some particular fact or facts, as well as from cases where the contract expresses no obligation to pay any definite sum or to do any particular thing, but only to pay such sum or do such thing as shall be determined by the arbitrators. In such cases, and perhaps others, the principle of law which is decisive of the present case is not controlling”. The same distinction is noted with equal clarity in Daniher v. Grand Lodge, 10 Utah 110, where it is said that such a provision or agreement to submit is binding in the absence of fraud, although the court did observe that where the sum to be paid is definite the clause in the constitution of the order making the decision of a board of its own creation on the claims of members final and conclusive is legally ineffectual to bar an action on the contract. “Such provisions have no more effect than a revocable agreement to submit to an award; because, otherwise, the attempt would be to usurp the functions of sovereign power, for it alone can create judicial tribunals”. So in Robinson v. Templar Lodge, 117 Cal. 375, where the constitution of the society provided that the provision for benefits should not be construed to create the re
Van Poucke v. St. Vincent De Paul Society, 63 Mich. 378, is a leading case on the question of liability when the right to benefits is predicated upon a provision similar to the one before us. The defendant was an incorporated mutual benefit society, formed for the purpose of raising a fund, through monthly payments-by its members, to assist its sick and needy members, and, in case of death, to bear certain expenses of the funeral. Its constitution and by-laws provided for a “sick committee” to “investigate and determine” whether a member was entitled to benefits on account of sickness, and that they were to be “the only and final deciders thereof”. The sick benefit, stipulated to be paid when awarded by the committee, was five dollars a week, during inability to work. Plaintiff, a member of the society, was disabled by an injury-to his wrist, and received benefits to the amount of $25. Thereafter complaint was made that he had resumed work, and- he was charged with receiving benefits when not entitled to them. The sick committee, upon a hearing had, decided that he was not entitled to receive any further benefits on account of his injury, although plaintiff claimed that as a matter of fact
By these decisions it was held competent for the society to enact a law, to which all parties assent, making a finding as to liability?' by its duly constituted committees a condition precedent to the right to receive benefits. Such power by a .voluntary relief association organized by certain railroads Kor the benefit of their employees was sustained in Pennsyl
A further practical illustration of the same principle is found in Rood v. Conductors’ Mutual Benefit Association, 31 Fed. 62. There the constitution of the organization provided that to a board of directors consisting of seven members “all claims against the association should be referred, and upon the approval of a majority of said board, with that of the president, the same shall be paid by the secretary and treasurer. * * They shall decide all points of dispute and questions of doubt that may arise, and their decision shall be final. * * Assessments shall be only made by authority of the board of directors”. It was held that, after the decision of the board refusing payment of a death claim, no suit upon the claim could be maintained, on the principle that “the power of the directors in regard to the allowance of this claim, and ordering an assessment to .pay it, is plenary. They are clothed with full authority to pass upon each and every claim presented against the association, and their decision is final. This is a purely voluntary association. The members of the association have, by their own organic law, provided a tribunal to hear and determine all claims against it, and I do not think any court can be invoked to review the action of the board in a matter so completely delegated to them. To attempt to enforce by suit any claim which the board of directors has acted upon, or refused to allow or approve, is equivalent to prosecuting an appeal from this board. It was certainly competent for the members of this association to agree among themselves that the action of their board of directors in reference to any claim presented against the association should be final; and there can be no doubt, from the language of the clause from the constitution just quoted, that they have so agreed. The duty of the board of directors is two-fold: first, to approve the claim, and, second, to order an assessment to pay it; and no member is under any obligation, express or implied, to pay an assessment for the liquidation of a claim against the association unless it has been approved by the board of directors and the assessment ordered by the board. It seems clear that the sole power of de
The certificates and constitution of the defendant will be liberally construed to promote its benevolent objects; and in interpreting a doubtful provision the insured will be given the benefit of the doubt. Brotherhood v. Border, 97 N. E. (Ind.) 125; Lewis v. Accident Co., 194 Mass. 1; Bond v. Brotherhood of Railroad Trainmen, 165 Ill. App. 491; Convery v. Brotherhood of Railroad Trainmen, 190 Ill. App. 479. The certificate is to be considered in connection with the constitution and by-laws, the same as though all these documents were combined in one. But, on the principle that the agreement evidenced by such documents is a contract of indemnity, their provisions, as in the case of any other contract of insurance, are to be construed according to their plain and obvious meaning and with a view to accomplish the purposes for which the association is maintained. Conductors’ Benefit Association v. Robinson, 147 Ill. 138; Brotherhood v. Aday, 134 S. W. (Ark.) 928.
Thus treating and construing the certificate issued to plaintiff and the constitution of defendant as embodying the contract between them, it is obvious no legal liability enforcible at law has arisen in this instance. This conclusion is inevitable from the nature of the brotherhood and the character of the obligation it has assumed, and is fully sustained by the decision cited. To these might be added many others of similar conclusiveness.
Nor is ample authority wanting expressly so construing the pertinent provisions of the constitution of the brotherhood which is the defendant in this action. In Eighmy v. Brotherhood of Railroad Trainmen, 113 Ia. 681, a conductor, who had lost the sight of one eye, sued the brotherhood under a certificate in class C in its beneficiary department. Section 44 of the constitution of the organization then provided that any member in good standing suffering the loss of an entire hand or foot or the sight of both eyes should be considered totally and permanently disabled and entitled to re
We can not assent to the exceptional interpretation of the certificates and constitution of the defendant made by the fourth district appellate court of Illinois in Bond v. Brotherhood of Railroad Trainmen, 165 Ill. App. 490, followed by the later case of Convery v. Brotherhood, 190 Ill. App. 479, whereby such certificates are given the effect of an absolute and enforcible legal obligation to pay a sum certain in any case of total and permanent disability of the member. Avowedly, that was a strained construction, made to avoid the otherwise conclusive effect of- the decision of the beneficiary board under section 70, as sustained by the overwhelming weight of authority. Apparently the question of liabih ity under these, certificates has not been determined by the supreme court of Illinois. But that court did hold in Conductors’ Benefit Association v. Robinson, 147 Ill. 138, that, although generally when one of the parties is sought to be made the final judge as to the rights involved the courts will not give such a construction to a contract as to have that effect if it is possible to give any other, yet "it is competent for members of benefit societies to so contract that their rights as members shall depend upon the determination of a tribunal of their own choice, Avhich shall be conclusive”. The true rule in determining the question of liability, we think, was applied in Pool v. Brotherhood of Railroad Trainmen, 143 Cal. 650, where, after rejection of his claim by the beneficiary board, plaintiff, whose alleged disability resulted from an injury to his spine, was denied recovery under a section of the constitution of defendant in the same language of section 70 now before us. After holding that "his right to recover must be measured by his contract, which must be read with the constitution and by-laws of the association, to which
It may be, as impliedly intimated in Daniher v. Grand Lodge, 10 Utah 110; Nelson v. Railroad Co., 157 N. C. 194; Pennsylvania Co. v. Reager, 152 Ky. 824; Supreme Lodge v. Raymond, 57 Kan. 651, and Van Ponche v. St. Vincent De Paul Society, 63 Mich. 378, that in a proper case, upon adequate proof, a member whose claim has been disallowed may recover at law because of arbitrary or oppressive action on the part of the beneficiary board. But no such ease is made here. If the declaration be deemed sufficient to admit proof of this kind, the testimony offered in support of the vague
The special plea tendered by defendant and rejected presented defensive matters appropriate to the attainment of just results upon a full inquiry into the merits; but the conclusion reached renders the rejection harmless. In conformity with the practice and procedure of this court upon writs assigning as erroneous rulings on demurrer to evidence,' as approved and applied in McNeer v. Railway Co., 76 W. Va. 803, and entering such judgment as the trial court should have entered, we sustain the demurrer, enter a nil capiat judgment against plaintiff, and award defendant the costs incurred in defense of the action in each court.
Demurrer sustained, judgment entered for defendant.