Price v. State Capital Life Insurance Company

Sharp, J. Whether plaintiff offered any evidence tending to show that -the operation performed upon Mrs. Price was the result ¡of an existing sickness is the question ¡posed by this appeal. Webster’s New International Dictionary, -Second Edition, Unabridged', defines sickness: “1. a Diseased condition; illness; ill health, b A disordered or weakened condition in general. ‘A great sickness in hiis judgment.’ ¡Sthak. 2. a A malady; a form of disease . . . .” This definition wais approved in Reserve Life Insurance Company v. Lyle, Okl. 288 P. 2d 717. This Court has several times quoted, with approval, the following ¡definitions of disease: “. . . . ‘an alteration in the state of the human body ... or of some of its organs or parts interrupting or 'disturbing -the per *155 ■formance of the vital functions, or of a particular instance or ease of'.this’; as 'deviation from the healthy or normal condition of any of the fuoctionis or tissue® of the body’; and as a ‘morbid condition of the body’.” Bailey v. Insurance Co., 222 N.C. 716, 24 S.E. 2d 614; McGregor v. Assurance Corporation, 214 N.C. 201, 198 S.E. 641. While the words “sickness” and “disease” .are technically synonymous, “.when given the popular meaning as required in .construing a contract of insurance, ‘sickness’ is a condition interfering with one’s usual activities, whereas disease may exist without such result; in other words, one is not ordinarily considered sick who performs his usual occupation, though some organ of the body -may be affected, but is regarded as sick when such diseased condition has advanced far enough to incapacitate him.” 29 A. Am. Jur., Insurance § 1154; 10 Cb-uch on Insurance 2d § 41:801. Closely analogous to the instant case is that of Reserve Life Insurance Company v. Whitten, 38 Ala. App. 455, 88 So. 2d 573. There suit was brought upon ;an insurance policy which provided for benefits for hospital 'confinement “resulting from sickness.” A tubal ligation was performed on the plaintiff because she had hemorrhaged very seriously during past pregnancies and another would .endanger her life. When asked if am existing illness necessitated the operation, plaintiff’s physician testified that the operation w.ais performed to- prevent a potential illness; that if plaintiff did not again -become pregnant she would have no further trouble. In denying recovery, the Alabama Court said, “. . . . (W)e are of the opinion his (the doctor’s) testimony shows conclusively that the operation for which plaintiff is seeking to. recover was not performed to relieve any existing 'condition, but was performed solely -for the purpose of preventing .a possible future pregnancy and a possible severe -hemorrhaging resulting therefrom.” We think it clear that the policy .involved herein does not cover an operation to prevent a potential sickness but was intended to- include only hospitalization resulting from an actual existing illness. Therefore, if the operation upon plaintiff’s wife was performed solely to prevent a future pregnancy, either because it might activate the arrested tuberculosis or cause -another emotional disturbance, it clearly wais not within the policy coverage. However, if one of the purposes proxi-tmately contributing to the decision to perform the operation was to eliminate a post-partum depression serious enough to- be classified as a sickness, -the operation was covered. The expression “confined to a . . . hospital by reason of . . . sickness,” contained in the policy in *156 suit, -camotas -an active state iof ilkuesis or -a 'condition which itself is toe cause of hospital ic-onfinemenit. Reserve Life Insurance Company v. Lyle, supra. Certainly 'daring the nine months of hear fourth -pregnancy, Mrs. Price 'had aoi illness oonniected with., but in addition ito, her pregnancy. The -evidence of Dr. Jones -tended to. show that following the birth of the child: she improved but did not compleitely recover. He observed her for one -month and came to the 'conclusion that she was headed for a post-piartum psychosis if the tubail ligation was not performed. A morbid condition of -the mind, a deviation from its healthy and normal state, can be a disease or illness as well as 1a morbid condition of the body. Severe 'emotional depression, while not necessarily amounting to insanity, is akin -to it. It is generally held that insanity is -a sickness within the meaning of a health and accident policy. See 29A Am. Jur., Insurance § 1154 and 10 Couch on Insurance 2d § 41:802 where the cases are collected. While there is evidence that a few weeks -after toé birth of her -child Mrs. Price had made a normal, recovery and was 'in good health again, diiscrqoiancies in the evidence -are for toe juay .and not the court. High v. R.R., 248 N.C. 414, 103 S.E. 2d 498. The evidence of to-e attending physician was sufficient to -take the case to toe jury. The judgment of nonsuit is Reversed.