Blue Cross-Blue Shield of Alabama, Inc. v. Cook

298 So. 2d 248, 53 Ala. App. 162, 1974 Ala. Civ. App. LEXIS 471
CourtCourt of Civil Appeals of Alabama
DecidedJune 19, 1974
DocketCiv. 286
StatusPublished

This text of 298 So. 2d 248 (Blue Cross-Blue Shield of Alabama, Inc. v. Cook) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross-Blue Shield of Alabama, Inc. v. Cook, 298 So. 2d 248, 53 Ala. App. 162, 1974 Ala. Civ. App. LEXIS 471 (Ala. Ct. App. 1974).

Opinion

HOLMES, Judge.

This is an appeal from a judgment entered by the Circuit Court of Mobile County. The appellee-plaintiff, Bonnie J. Cook, sought recovery for hospital and surgical bills in an action ex contractu on a policy of insurance issued by appellant-defendant, Blue Cross-Blue Shield-of Alabama, Inc.

To the action the appellant-defendant filed a plea of the general issue and a special plea alleging that the policy sued upon [164]*164provided no benefits “for any condition, disease, disorder or ailment, congenital or otherwise * * * which existed on or before the Effective Date of such Member’s coverage hereunder, whether then manifested or known in any way or not * * * unless and until such Member shall have been covered by this Contract * * * for a period of nine (9) consecutive months immediately preceding the date of the commencement of the hospitalization * * The .plea then alleged that the hospitalization and surgery here involved were for such a pre-existing condition.

The original proceeding in this matter was held in the Court of General Sessions of Mobile County wherein a judgment was rendered for the appellee-plaintiff. Thereafter, an appeal was taken to the Circuit Court of Mobile County, where trial was before a jury which returned a verdict for appellee-plaintiff. After judgment was entered, the appellant-defendant filed a motion for new trial which, after a hearing, was overruled, and it is from this action that this appeal is taken.

Appellant’s single assignment of error is that the trial court erred in overruling the motion to set aside the verdict and judgment in favor of appellee-plaintiff and grant a new trial. He argues in brief the failure of the trial court to give the general affirmative charge and that the verdict is contrary to the weight of the evidence.

The basic facts giving rise to this appeal are not unusually complex and the following is gleaned from a stipulation entered into by counsel and contained in the record.

There was a policy of insurance in existence during the period in question; the policy of insurance in question was issued on the 20th day of February, 1972; premiums had been paid; there were hospital and surgical bills involved and the amounts were reasonable. The evidence concerning whether or mot appellee-plaintiff was barred from recovery under the terms of the policy because the claims were for a pre-existing condition reveal the following:

The period of plaintiff’s hospitalization and resulting surgical bills was the 17th of March, 1972, to the 27th day of March, 1972.

The plaintiff-appellant testified without objection that she started having severe headaches on March 12, 1972. On March 13, 1972, she called her physician who prescribed some pain pills. These pills did not relieve her discomfort in any way and on March 17, she was admitted to the hospital for tests. It was then discovered, as plaintiff testified, that she had a “severe sinus infection.” Surgery was advised and performed on March 21, 1972. Mrs. Cook further stated that she had never had any headaches like the ones she experienced beginning March 12, 1972, and has not had the headaches since the surgery was performed. Additionally, she testified she had been treated for allergies prior to this time which were manifested by a stuffy nose and sore throat.

Dr. John Taylor, an otolaryngologist, whose qualifications were admitted by appellant, testified that he had treated appellee-plaintiff previously for a chronic sore throat, postnasal discharge and some frontal headaches. This occurred in mid-January of 1972. At this time, Dr. Taylor testified he made a routine note to get sinus X-rays made. Additionally, at this time, Mrs.- Cook was given medication to lessen reaction from certain allergic material. She was again seen by Dr. Taylor on approximately February 1, 1972, and had not had any headaches since taking the aforementioned medication. She was next seen by Dr. Taylor on March 17, 1972, when she was experiencing a “different” headache. It was at this time the X-ray revealed infection in the sinuses and surgery was recommended.

At this point, we deem it necessary to quote certain pertinent testimony and begin with Dr. Taylor’s response to the following question, “. . . was there any indica[165]*165tion prior to February 17th that she had a sinus infection as you described it on March 17th?”

“A I wasn’t sure whether she did or did not have; but since she cleared with medication other than would usually be used for treatment of infection — in other words, I did not give her any antibiotics, and she cleared with cortisone and with medications usually used to clear up an allergic difficulty; but when she returned in February, I assumed she did not have.”

Dr. Taylor additionally testified as follows :

“Q Yes. Now, Doctor, on February the 1st, 1972, when she came to see you, she had symptoms that were consistent with chronic sinusitis, did she not ?
“A No, sir. February 1st the only thing she had was some clear nasal discharge and cough. She was not having headaches then — it had stopped. The biggest time was January 19th.
“Q All right. Now, on January 19th, she came to see you then and she did have symptoms which were consistent with chronic sinusitis, were they not?
“A Consistent with, but not diagnosed as such.”

The following testimony from Dr. Taylor on pages 44 and 45 of the record is as follows:

“Q Doctor, I want to ask you; in January, there was no indication that you saw from a complete examination of this woman that she had any chronic infection — from your observation ?
“A Yes, sir. She had chronic sore throat.
“Q Chronic sore throat; but sinusitis? “A No.
“Q Was there any indication in February that she had a chronic infection of the nose from your personal examination?
“A No, sir.
“Q When is the first time that she indicated that she did have a chronic infection — sinus infection?
“A The first time I knew she had a sinus infection was when I saw the x-rays. In fact, my examination on the 17th did not reveal anything; so this is strictly based on the x-ray report.
“Q You stated that her headaches at this point were different from any headaches that she had ever had before ?
“A They were much more severe than when she came in the previous time.”
“MR. THIR.Y: No. Doctor, in your opinion, is there any connection between —in your opinion, was she suffering from the same thing previous to March 17th as she was suffering from on March 17th or 18th?
“A No—
“Q Was it the same as that condition before—
“A No. Oh, no; this was not the same as that condition. As I stated before, sinusitis doesn’t usually improve on just cortisone and antihistamines.
“Q In other words, if this were an infectious type of disease, you would have treated it with antibiotics; is that right ?
“A Yes.

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298 So. 2d 248, 53 Ala. App. 162, 1974 Ala. Civ. App. LEXIS 471, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-of-alabama-inc-v-cook-alacivapp-1974.