Summary
holding that an insured who spent the majority of his pre-injury time operating a jig-boring machine and five to ten percent of his time on billing matters was totally disabled under the terms of his occupational disability policy when he could no longer operate the machine but could still review bills
Summary of this case from Giampa v. Trustmark Ins. Co.Opinion
The accident policy in suit contained an occupational disability clause providing a monthly indemnity for "total" disability preventing the insured "from performing every duty pertaining to his occupation." Total disability under such a clause does not mean a state of complete helplessness. It contemplates such disability at least as renders the insured unable to perform all the substantial and material acts necessary to the prosecution of his business or occupation in a customary and usual manner. The major portion of the duties of the insured involved the operation of a jig-boring machine and, as an incident to such operation, the reading of blueprints. Only 5 to 10 percent of his duties were concerned with the checking of billing and receipted bills. Since he could not operate a jig-boring machine, the fact that he could now read blueprints and check billing and receipted bills did not justify the defendant insurer in discontinuing payment of the monthly indemnity.
Argued May 6, 1964
Decided May 20, 1964
Action upon a policy of accident insurance, brought to the Court of Common Pleas in the judicial district of Waterbury and tried to the court, Wall, J.; judgment for the plaintiff and appeal by the defendant. No error.
Walter M. Pickett, Jr., for the appellant (defendant).
Vincent A. Miller, for the appellee (plaintiff).
The defendant, Aetna Life Insurance Company, discontinued the payment of monthly benefits which the plaintiff claimed were due him under an "Income Protection Accident Policy."
The insurance contract protected the plaintiff from loss resulting from accidental bodily injuries. It provided: "Total Disability . . .: If such injuries shall . . . disable and prevent the Insured from performing every duty pertaining to his occupation, the Company will pay monthly indemnity at the rate specified . . . for the period of such . . . total disability, but for not exceeding twenty-four consecutive months. After the payment of monthly indemnity for twenty-four months . . . the Company will continue the payment of monthly indemnity . . . so long as the Insured shall be . . . disabled by such injuries from engaging in any gainful occupation or employment . . . ." In this case we are concerned only with the portion of the above-quoted provision embraced in the first sentence. That portion is commonly known as an occupational disability clause. 29A Am.Jur., Insurance, 1516.
"Total disability" under such a clause "does not mean, as its literal construction would require, a state of absolute helplessness, but contemplates rather such a disability at least, . . . as renders the insured unable to perform all the substantial and material acts necessary to the prosecution of his business or occupation in a customary and usual manner. The fact that the insured is able to perform some inconsequential, trivial, or incidental duties connected with his usual employment or occupation does not preclude recovery under such a total disability provision, regardless of its particular phrasing." 29A Am.Jur., Insurance, 1517, 1518. This statement of the rule is in accord with the weight of authority and with the better reasoned cases. Morgan v. Aetna Life Ins. Co., 157 F.2d 527, 529 (7th Cir.); Heald v. Aetna Life Ins. Co., 340 Mo. 1143, 1149, 104 S.W.2d 379; notes, 24 A.L.R. 203, 98 A.L.R. 788, 789; see notes, 149 A.L.R. 7, 22, 26, 153 A.L.R. 430, 432; 1 Appleman, Insurance Law and Practice 671, 672; 7 Couch, Insurance Law 1670.
The major portion of the plaintiff's duties involved the operation of a jig-boring machine and the reading of blueprints. Five to ten percent of his duties were concerned with the checking of billing and receipted bills. There is no finding that the plaintiff was disabled from checking billings and receipted bills or from reading blueprints. Blueprint reading, however, was involved in the plaintiff's occupation only as a duty incidental to the operation of the jig-boring machine. The checking on billing and the checking on receipted bills were found by the court, in the form of a conclusion of fact, to be trivial duties. The court further concluded that owing to the plaintiff's inability to operate the jig-boring machine he was disabled from doing all the substantial and material acts of his occupation. These conclusions were fully supported by the subordinate facts. Under the applicable rule as stated above, the court did not err in deciding that the plaintiff was entitled to payment under the provisions of the policy.
The other claims of the defendant do not require discussion.