Procedural Posture

Procedural Posture

Defendant Salmon Norway, Inc. appealed from a judgment of the Superior Court of Merced County (California), which found plaintiff insured totally disabled. Plaintiff attempted to recover disability benefits under an insurance policy after being injured in a horse accident that resulted in being unable to work on his farm; plaintiff was awarded $ 2,300, but the case was remanded with directions to reduce the award to $ 1,600.

Overview

Plaintiff sought to recover on his disability insurance policy with defendants after being injured in a horse accident. Defendants stopped making monthly payments after a few months, claiming that plaintiff’s physician had stated his disability was only partial and did not wholly prevent him from working in his farm business. Several months later, after legal action was threatened, defendants asked plaintiff to be examined by their physicians and he refused. Plaintiff sued defendants on the policy and he was found to be totally disabled. Judgment was entered for plaintiff and he was awarded $ 2,300. Defendants appealed. In affirming in part and reversing in part, the court ruled that there was substantial evidence in the record to support the finding of total disability. However, total disability did not mean permanent disability, and because defendants had a right, under the policy and Cal. Ins. Code § 10,339, to have plaintiff examined for proof of continued disability, the case was remanded with directions to reduce the award to $ 1,600, the amount of benefits which had accrued until plaintiff’s refusal.

Outcome

The court affirmed the judgment in part, reversed in part, and case remanded with directions to enter judgment for plaintiff for $ 1,600.