When Is A Person “Totally Disabled”

Aledo insurance law lawyers need to be able to discuss how insurance companies interpret their policies that provide coverage for “total disability.” An old 1932 case from what was then called the Court of Commission of Appeals of Texas, Section A, is a good place to start reading. The style of the case is Kemper v. Police & Firemen’s Ins. Ass’n. Here is some information from that case.
The Kemper sued the insurer to recover $2,000 alleged to be due as insurance on the life of William H. Kemper, deceased husband, on a contract of insurance issued by the insurer to the deceased during his lifetime, in which certificate Kemper was named beneficiary. Trial in the district court with a jury resulted in a verdict and judgment for Kemper for the full amount of the policy. The policy of insurance made the basis of this suit contains, among others, the following provisions:
“Any and all such payments or liability to pay shall be and is in accordance with, subject to, each and all of the provisions of the by-laws of said association and of the provisions of any and all amendments, alterations and new issues of said by-laws, which said by-laws are hereby referred to and made a part hereof as fully as if they were recited at length over the signatures hereto affixed as soon as such amendments, alterations or new issues of said by-laws respectively are or may be duly adopted, and the said William H. Kemper hereby and by the acceptance hereof agrees to abide and be bound by said by-laws and each of them and by any and all lawful amendments, alterations and new issues thereof or of any of them.”
“It is hereby agreed by the member holding this certificate that the certificate, the charter or articles of incorporation, the constitution and laws of the society and the application for membership and medical examination, signed by the applicant, with all amendments to each thereof, shall constitute the agreement between the society and the member and any changes, additions or amendments to said charter or articles of incorporation, constitution or laws duly made or enacted subsequent to the issuance of this certificate shall bind the member and his beneficiaries and shall govern and control the agreement in all respects the same as though such changes, additions or amendments had been made prior to and were in force at the time of the application for membership.”
“Whenever any member of this Association in good standing shall, through external, violent and accidental means, receive bodily injuries which shall, independently of all other causes, result within ninety days from and after the date of such accident, and independently of all other causes, in the death of said member, or of the loss of both legs, or the loss of both arms, or the loss of one arm and one leg, or the loss of an arm or a leg, or the irrecoverable loss of the sight of both eyes, or one eye, there shall be paid to said member, or to the beneficiary of said member in case of loss of life the following benefits. * * * If the Member’s certificate is for $2,000 the Benefits shall be as follows:
“A. For loss of life $2,000.00 * * *
“* * * And provided further that the above Benefits for loss of life shall be payable only in the event that the disability resulting from said injury shall be total and immediate and shall be continuous from the time of the injury to the time of the death of said member.”
“There shall be payable to the beneficiary named herein, at the death of said member, if living at the time of such death (except by accident) the sum of $200.00 within ninety days after receipt by the said association of satisfactory proof of the death of said member.”
“I also agree that my physicians shall give evidence, whenever required, concerning any alleged injury or cause of death, and waive all provisions of the law to the contrary, and that I will permit the physician of this Association to make such examination as may be deemed necessary. And I further agree that in case I take additional accident insurance, I will notify this Association, failure to do which shall invalidate any claim on account of accidental injury received during such default.”

The facts show that about January 31st. or early on February 1, 1928, William H. Kemper received injuries which resulted in his death about twenty days later. At the time of such injuries the policy was in full force, and the deceased in good standing as a member of the association.
With reference to the injury itself and its resultant effects, immediately and later, the evidence is, in law, sufficient to establish the following facts: That William H. Kemper was a captain in the city fire department at the time of his injury; that on the date above shown there was a fire in a drug store which was attended by the insured in his capacity as a fireman; that the fire was in the prescription room full of drugs of various kinds; that insured entered this room during the fire in the performance of his duties; that chemicals were used in fighting this fire; that the chemicals so used and the chemicals and drugs contained in the building, together with the heat, caused the burning building to be full of gas and fumes; that some of the men fighting the fire wore masks to protect themselves from these fumes and gas; that the insured wore no mask; that the gas and fumes were breathed by insured for about an hour; that insured vomited at the fire while he was fighting it; that when insured got back from the fire he was coughing and throwing up phlegm, and complained about his chest and throat, saying that they were hurting him; that insured worked as a fireman thereafter for several days; that during such period insured was at all times feeling badly, and his chest and throat were very sore and hurting him, caused by the effects of the gas and fumes he had breathed at the fire; that he was in this condition at all times from the time of the fire to the time of his death; that while he continued to work he was hoarse–“whisper-like”; that insured was sick from the time of the fire until his death some twenty days later; that insured finally went to the hospital about a week before his death, and there remained until he died; that at times between the time of the fire and the time he went to the hospital, while he was trying to carry out his duties, he would become so sick that he would have to go home, but would thereafter come back to his work; that at all times between the fire and his death insured was sick and feeling badly, and only with difficulty and effort kept up and going; that about thirteen days after the fire insured was sent to the hospital where he died in about a week; that deceased died of pneumonia, which was brought on and caused by breathing the fumes and gas at the fire; and that while pneumonia was the exciting cause of death, the predisposed cause was the gas irritation and inflammation of insured’s lungs. In other words, to put it in simple language, the gas and fumes produced irritation and inflammation of the insured’s throat, lungs, and respiratory organs, and these injuries culminated in pneumonia, from which the insured died. The testimony, taken as a whole, is amply sufficient in law to justify the jury in the fact conclusion that, while insured continued to go to work for several days after he received his injuries, he should not have done so, and during all such time was a sick man, who by his own will power was forcing himself to perform duties which he was too sick to perform.
The case was submitted to the jury on special issues. Along with such issues the court gave the following general charge to the jury: “You are instructed that the phrase ‘independently of all other causes,’ as used in Question No. 2, of the Court’s main charge, means that if the death of said William H. Kemper was caused wholly or in part by a disease, or something else, then the injuries will not have resulted independently of all other causes, unless such disease or something else shall have been due to the injury received at the fire, if any. And should you find that said disease, or something else, was in fact caused by said injuries, then your answer to said question should be ‘yes’; but should you find that said disease, or something else, was not in fact caused by said injuries, your answer to said question should be ‘no.”‘
This court approved of the findings by the jury but questioned the way the trial judge submitted questions and thus the case went back to the trial court for further consideration.
This case is one of the earlier cases dealing with “total disability” and is a good starting point for an attorney to familiarize himself with the law in the area.