Total Disability

Aledo insurance attorneys need to know how the court interpret “total disability” in an insurance policy. The 1961, Texas Supreme Court case styled, Prudential Insurance Company of America v. Tate is a good case to read for understanding. Here is some of the relevant information.
This policy provided for certain benefits to be paid to Tate in the event he was disabled before reaching the age of 60 years. It was stipulated that Tate was under 60 years of age at the time he claimed he became totally and permanently disabled. Upon answer to special issues in favor of Tate by the trial jury, the trial court granted Tate’s motion for judgment on the verdict for the sum of $2,922, due under the terms of the policy, and $350.64 as 12% penalty provided by statute for failure of Prudential to pay upon demand by Tate.
This court held that the lower courts were in error in determining the amount due under the terms of the policy and reversed the judgments of both lower courts and remand the cause to the trial court.
Prudential had three points of error in the Court. The first point contends that it was error for the trial court to overrule Prudential’s motion for an instructed verdict because Tate admitted on cross-examination that he was able to perform the duties of (1) a timekeeper and (2) an effective salesman of construction material.
Prudential’s second point is that the trial court was in error in not submitting Prudential’s requested special issues Nos. 1 and 2 whereby the jury could determine whether Tate was able to perform the kind of work set out in the first point.
Tate testified that he could be a timekeeper if he knew how to operate a typewriter, and could sit at that job. He also testified that he could not operate a typewriter and that he could not walk or stand very long at a time and he did not believe his physical condition would permit his holding a timekeeper’s job. The same testimony applied to the job of a material checker. He testified that he had been a carpenter or a construction superintendent all of his active working days and that he was no longer able to do either kind of work. Tate thought he might be a construction material salesman, but he had never had any experience as a salesman, and knew of no jobs open in such occupation.
The law in Texas has held that the language of the policy is fairly and justly susceptible of the interpretation which should be given to it, that the larger (total) indemnity was promised if the injuries rendered the insured substantially unable, in the exercise of ordinary care, to perform every material duty pertaining to his occupation.
On the issue of total disability, the courts have said: such a clause in the policy should be reasonably construed; a literal construction would require a complete loss of all physical power and mental capacity-in fact, it would scarcely happen that one could live and bring himself within the literal language of the contract. Here the policy says ‘if any work may be performed for compensation or profit, or any gainful occupation may be followed,’ recovery is precluded. The court will not give such a literal interpretation to the language of this contract * * * as to practically relieve the insurer of all obligations thereunder. Such would be the effect of a decision discharging Tate in error from all liability if Prudential in error, after his injury, could do anything required of him.
A policy requiring payment for total disability ordinarily is not one of indemnity against loss of income but against loss of capacity to work. Total disability is necessarily a relative matter, and must depend chiefly on the peculiar circumstances of each case and on the nature of the occupation or employment and the capabilities of the person injured. It does not mean absolute physical disability of the insured to transact any kind of business pertaining to his occupation, but exists if he is unable to do any substantial portion of the work connected therewith.
The insurance company contended that the trial jury should have been instructed that if the Tate’s ability to labor and earn money in some occupation, which the evidence showed he could follow, or if Tate could qualify himself by education, training or experience to discharge the material duties of an occupation for remuneration or profit, then Tate was not totally disabled within the provisions of the policy.
Other courts have said, “We do not believe it was within the contemplation of the parties that the insured should educate himself, or go through apprenticeship for another occupation, and, perchance, be able to do some occupation, thereby be able to relieve the Insurance Company from the obligations of its contract. * * *”
This Court upheld the trial court.