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UNITED STATES v. GWIN
Opinion Summary: UNITED STATES v. GWIN; SINGLETON v. UNITED STATES; UNITED STATES v. HENNING
Factual and Procedural Background
This consolidated opinion addresses three separate appeals arising from suits by Wallace Edward Gwin (No. 6310), Bennett L. Gwin by Pleasant L. Singleton (No. 6337), and Willie L. Henning (No. 6415) against the United States involving war risk insurance claims. The appeals come from the United States District Courts for the Western Districts of Kentucky and Tennessee. In No. 6310 the district court entered judgment for the plaintiff on an action upon a policy of war risk insurance based on an asserted total and permanent disability at the time of the policy's alleged lapse following the insured's 1919 Army discharge. The case was tried to the court without a jury; the court made findings of fact and conclusions of law. The United States appealed. In No. 6337 the district court entered judgment for the defendant on a case in which the plaintiff, employed as an assistant storekeeper at a Government Marine Hospital for about eight years, appealed from a verdict directed for the United States. In No. 6415 the United States appealed from a judgment allowing recovery on a war risk insurance policy that lapsed immediately after the insured's discharge; the record contained evidence of subsequent employment and an X-ray taken in 1921. The panel disposed of the appeals as follows: the judgment for plaintiff in No. 6310 was reversed and remanded; the judgment for the defendant in No. 6337 was affirmed; and the judgment for the plaintiff in No. 6415 was reversed and remanded.
Legal Issues Presented
- Whether, in view of the insured's subsequent work record, the trial court erred in finding that the insured was totally and permanently disabled at the time of the alleged lapse of his war risk insurance policy (No. 6310)—i.e., whether the work record necessarily and as a matter of law required entry of judgment for the defendant.
- Whether the district court's directed verdict for the United States should be affirmed where the plaintiff had been employed with reasonable regularity in a substantially gainful occupation for about eight years (No. 6337).
- Whether the evidence (including subsequent employment from 1923 to 1930 and a 1921 X-ray) was sufficient to support a finding of total permanent disability at the time of the policy lapse and a permanency of that disability from the lapse to the present (No. 6415).
Arguments of the Parties
Plaintiff's Arguments (No. 6310)
- Plaintiff's counsel argued that the court below had substantial evidence showing the insured was totally disabled at the time of the alleged lapse because of incipient dementia praecox, and that evidence showed a continuance of this mental disorder to the present, at which time total and permanent disability was conceded.
- Based on the evidence of present total disability and the continuity of the mental disorder, plaintiff contended that the appellate court must accept the trial court's factual findings and affirm (i.e., the relative weight of the evidence was not for the appellate court to revisit).
Defendant's Position (as framed by the court)
- The central contention for the defendant (framed as the preserved question on appeal) was that the insured's subsequent work record—specifically substantial employment for a significant period—was dispositive and required, as a matter of law, entry of judgment for the defendant rather than a finding of permanent total disability as of the earlier date.
The opinion does not contain a detailed account of the parties' legal arguments in the other appeals beyond the factual summaries and the court's evaluation of the sufficiency of the evidence as described above.
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| Bartee v. United States, 60 F.2d 247 (6th Cir.) | Interpretation of Regulation 11: "continuously" means "with reasonable regularity"; "substantially gainful occupation" means performing a substantial portion of the world's work in competition with others; "impossible" means without risking serious physical injury. Emphasis on humanitarian and utilitarian grounds in construing total disability. | The court adopted and reiterated these definitions as guiding principles for determining whether an insured could "follow continuously any substantially gainful occupation," and used the Bartee construction to frame the analysis of when initial total disability may nonetheless be shown not to have been permanently total in light of later substantial employment. |
| United States v. Scott, 50 F.2d 773 (6th Cir.) | Authority that a relatively short period of employment (nine months in that case) is not necessarily conclusive evidence of ability to follow continuously a substantially gainful occupation. | The court distinguished Scott, noting that nine months was not of sufficiently substantial duration; this supported the court's determination that a substantially longer period (several years) is ordinarily required to bar a finding of permanent total disability as of an earlier date. |
| Pennsylvania R. Co. v. Chamberlain, 288 U.S. 333, 341, 53 S. Ct. 391, 77 L. Ed. 819 | General principle that an inferred conclusion (here, of permanency) must yield where it is inconsistent with undisputed facts. | The court invoked this authority to justify rejecting an inference of permanency of total disability when undisputed facts (subsequent substantial employment) were inconsistent with that inference. |
| Falbo v. United States, 64 F.2d 948 (9th Cir.) | Illustrative comparison that certain maladies (e.g., pulmonary tuberculosis) may be total disabilities in incipient stages yet capable of arrest so the patient can subsequently be industrious and useful. | The court cited Falbo as a comparison to show that some conditions thought to be totally disabling at first may not be permanently so; this supports the court's view that initial total disability may not be permanent if substantial later employment occurs. |
| United States v. Cole, 45 F.2d 339 (6th Cir.) | Applied in contexts determining whether periods of continuous employment meet the test of being a "substantially gainful occupation." | Used as part of the body of cases aligning with the court's determination that continuous employment of several years satisfied the Regulation 11 standard and undermined a finding of permanently total disability as of an earlier date. |
| United States v. Lyle, 54 F.2d 357 (6th Cir.) | Also applied on the question of what constitutes continuous employment at a substantially gainful occupation. | The court cited Lyle alongside Cole to support the conclusion that employment for over four years and five months met the test of continuous, substantially gainful occupation and thus affected the legal conclusion about permanency. |
Court's Reasoning and Analysis
The court's analysis centered on the interpretation and application of Regulation 11 and the statutory phrase "total permanent disability" under the War Risk Insurance Act (40 Stat. 409). The court relied on its prior construction in Bartee to define key terms: "continuously" as employment "with reasonable regularity," "substantially gainful occupation" as doing a substantial portion of the world's work in competition with others, and "impossible" as meaning that such work could not be done without risk of serious physical injury.
Building on that framework, the court articulated the following points:
- The insurance covers not simply total disability but total disability that is permanent in nature; the phrase "total permanent disability" requires both elements to exist throughout the period in question.
- If, after an initial total disability and before a later conceded permanent total disability, the insured engages in substantially gainful employment for a "substantial period of time," then the earlier total disability cannot, as a matter of law, be deemed permanently total. In such circumstances the disability was at best temporary when total and at best partial when permanent.
- What constitutes a "substantial period of time" is ordinarily a factual question, but the court indicated that several years is manifestly substantial. The court contrasted this with United States v. Scott, where nine months was held not to be, as a matter of law, sufficiently substantial.
Application to the three appeals:
- No. 6310 (Gwin): The insured worked for the Railway Express Company from August 1, 1920, to January 12, 1925—over four years and five months. The court concluded that this period meets the Regulation 11 test of continuous employment in a substantially gainful occupation. Because this substantial intervening employment was inconsistent with treating an earlier disability as permanently total, the district court's finding of permanent total disability at the time of lapse could not stand as a matter of law. The judgment for the plaintiff was reversed and the cause remanded for a new trial.
- No. 6337 (Singleton): The plaintiff had been employed as an assistant storekeeper at Government Marine Hospital No. 88 for about eight years, with no claim that he failed to attend to duties with reasonable regularity or that the employment was not substantially gainful. Applying the same principles, the court concluded the directed verdict for the defendant was correct and affirmed the judgment.
- No. 6415 (Henning): The record showed undisputed employment as a mechanic and machinist from 1923 to 1930 (about seven years) at normal compensation and with regularity comparable to other skilled workmen. The only evidence suggesting total disability at the time of lapse was an X-ray (taken in 1921, more than two years after the lapse) that one expert thought showed an old tuberculosis "slightly active." The court found that such evidence was insufficient—"less than a scintilla"—to prove total disability at the lapse or the permanency of such disability from that time. The district court's judgment allowing recovery was reversed and the cause remanded for new trial.
Holding and Implications
Holdings:
- No. 6310 (United States v. Gwin): REVERSED and REMANDED—the district court's judgment for the plaintiff was reversed and the cause remanded for a new trial because subsequent substantial employment precluded, as a matter of law, a finding that an earlier disability was permanently total.
- No. 6337 (Singleton v. United States): AFFIRMED—the district court's judgment directed for the defendant was sustained where the plaintiff's approximately eight years of regular, substantially gainful employment supported the ruling.
- No. 6415 (United States v. Henning): REVERSED and REMANDED—the judgment for plaintiff was reversed and the matter remanded for a new trial because the evidence of total disability at the time of policy lapse was insufficient in light of extended subsequent employment.
Implications:
The direct consequences are the reversal and remand for new trials in Nos. 6310 and 6415 and the affirmation in No. 6337. The court applied and clarified the application of Regulation 11 as previously construed in the Bartee line of decisions, emphasizing that prolonged, substantially gainful employment occurring between an alleged earlier total disability and a later conceded permanent total disability can preclude a finding that the earlier disability was permanently total. The opinion does not purport to announce a novel doctrinal rule beyond these applications of existing regulation and case law, and it does not state that it establishes new binding precedent beyond the interpretation and application of Regulation 11 to the facts at hand.
HICKENLOOPER, Circuit Judge.
Appeal No. 6310 is from a judgment for plaintiff in an action upon a policy of war risk insurance, the assertion of the right to recovery being predicated upon the claim that the insured, at the time of the alleged lapse of his policy, immediately following his discharge from the Army in 1919, was totally and permanently disabled, and that the policy had therefore matured before lapse. A jury was waived, the case was tried to the court below upon the testimony of witnesses and a stipulation of additional facts, both sides moved for judgment at the close of the evidence, and upon rendering judgment the court made separate findings of fact, and separately stated its conclusions of law thereunder, to which findings of fact and conclusions of law the defendant duly excepted. The sole question presented on this appeal, which question we think was properly preserved for our consideration, is whether, in view of the work record of the insured, the court erred in finding that he was totally and permanently disabled at the time of his discharge. Somewhat differently expressed, the question is whether that work record necessarily and as a matter of law required entry of judgment for defendant.
Counsel for plaintiff contends that, inasmuch as the plaintiff introduced substantial evidence of the insured's total disability, by reason of incipient dementia præcox, at the time of the alleged lapse of his policy, and of a continuance of this mental disorder, manifested by more or less pronounced symptoms, up to the present time, at which time it is conceded the insured is totally and permanently disabled, this court is not concerned with the relative weight of the evidence, but must affirm the fact finding of the court below. The fallacy of this argument lies in the second premise, that a continuance of the insured's mental disorder, from the time symptoms of it were first noticed down to the present time, is proof of, or substantial evidence tending to prove, a continuance of the earlier existing total disability (in all its totality) in the face of evidence that for a quite substantial period of time the insured was able to and did support himself by his own labor in the field in which he had formerly been employed.
In Bartee v. United States, 60 F.2d 247, 248, this court held that the word "continuously" in Regulation 11, defining total disability as "any impairment of mind or body which renders it impossible for the disabled person to follow continuously any substantially gainful occupation," was used in the sense of "with reasonable regularity"; that by "substantially gainful occupation" was meant some "substantial portion of the work of the world in regular competition with others"; and that "impossible," as contained in the regulation, meant without "the risk of serious physical injury resulting from such work." This places the whole matter of interpretation of Regulation 11 upon both humanitarian and utilitarian grounds; a man should not be prejudiced by working when in justice to his own well-being he should not be doing so, or where he works only at the risk of serious personal injury to himself. So also, he should not be required to pay the premiums upon his contract of insurance unless, during substantial periods of time subsequent to the alleged lapse of the policy, he was able to earn his own living, in whole or in substantial part, by doing a material portion of the world's work, working with reasonable regularity and for a substantial compensation.
In the above construction of Regulation 11, we have added to its meaning as stated in the Bartee Case only the element that if, between the cessation in payment of premiums and the conceded, subsequent, permanent, total disability, a "substantial period of time" occurs during which the insured was able "to follow continuously any substantially gainful occupation," as that clause has already been defined, then any disability existing before such period of time, even though it was then to be regarded as a total disability, may not, as a matter of law, be held to have been permanently total as of the earlier date. This distinction we think implicit in both the War Risk Insurance Act and the terms of the issued insurance certificate, for it is not total disability alone against which the soldier was insured, but only that total disability which was permanent in its nature; and we think that the words "total permanent disability" of the act ( 40 Stat. 409) require that such disability be both permanent and total for the entire period; that is, a permanent total disability. It should also be noted that the dissent in the Bartee Case was based, not so much upon the statement of the rule, as upon its application to the facts of that specific case.
This, then, would furnish a rule by which the cases which most frequently arise might be decided. There are, of course, a great number of maladies which are or may be steadily progressive, but which are not wholly incapacitating in their early stages. There are others which, though properly to be considered as total disabilities in the incipient stages, are often arrested to the extent that the patient may thereafter lead an industrious and a useful life. Pulmonary tuberculosis is one of the commonest of the latter class. Compare Falbo v. United States, 64 F.2d 948 (C.C.A. 9). Regulation 11 provides that "`total disability' shall be deemed to be `permanent' whenever it is founded upon conditions which render it reasonably certain that it will continue throughout the life of the person suffering from it." This, we think, is no more than a definition of those facts which, prospectively, will justify an inference of the permanency of the total disability. When, however, this inference is inconsistent with the undisputed facts, as where it appears that the plaintiff, after his initial total disability, has so far regained his health as to be able to earn his own living for a substantial period of time, thus showing that, in so far as the disability was permanent, it was at best partial, and, in so far as it was total, it was at best temporary, whatever inference might otherwise be justified under Regulation 11 must fail because of such inconsistency. Pennsylvania R. Co. v. Chamberlain, 288 U.S. 333, 341, 53 S. Ct. 391, 77 L. Ed. 819.
What amounts to a really substantial period of time is also a question ordinarily to be determined in each case, but it seems manifest to us that a period of several years must be regarded as substantial in duration. In United States v. Scott, 50 F.2d 773, 774, we held that it could not be said, as a matter of law, that nine months employment in a minor clerkship was conclusive proof of ability to "follow continuously a substantially gainful occupation." This is not inconsistent with the position here taken, for there, as in the Bartee Case, the period of continuous employment, and of earning capacity, was not, all things considered, regarded as of substantial duration.
In the instant case, the insured was regularly and continuously employed by the Railway Express Company, at Terre Haute, Ind., as a trafficman and chauffeur, from August 1, 1920, to January 12, 1925, a period of over four years and five months. This we think meets the test of continuous employment at a substantially gainful occupation, and definitely aligns the case with our decisions in United States v. Cole, 45 F.2d 339, and United States v. Lyle, 54 F.2d 357. The judgment of the District Court is accordingly reversed, and the cause is remanded for a new trial.
In No. 6337 plaintiff in the court below appeals from a judgment entered upon a verdict directed for defendant. In this case the plaintiff had been employed as an assistant storekeeper at the Government Marine Hospital No. 88 in Memphis for a period of about eight years. No claim is made that he was not, during this time, able to attend to the duties assigned him with reasonable regularity, or that the employment was not to be regarded as "substantially gainful." For the reasons already stated, we are of the opinion that the judgment in this cause must be affirmed, and it is so ordered.
In No. 6415 the United States appeals from a judgment allowing recovery on a policy of war risk insurance which was permitted to lapse immediately following the insured's discharge from the Army. The undisputed evidence showed that the insured had been employed for some seven years, 1923 to 1930, as a mechanic and machinist, at the compensation normally paid for such labor, and with the same degree of regularity of employment as enjoyed by other high-grade workmen. The only evidence of total disability at the time of the lapse of the policy was an X-ray plate which one expert thought showed an old tuberculosis then "slightly active." This picture was taken in 1921, more than two years after the lapse of the policy, and, even though it be conceded that the insured was afflicted with incipient tuberculosis at that time, this is less than a scintilla of evidence tending to prove total disability at the time of the lapse of the policy or a permanency of total disability from that time to the present. The judgment of the District Court is reversed, and the cause remanded for a new trial.
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