Blue Cross-Blue Shield of Alabama v. Colquitt

168 So. 2d 251, 42 Ala. App. 471, 1964 Ala. App. LEXIS 246
CourtAlabama Court of Appeals
DecidedJune 30, 1964
Docket6 Div. 951
StatusPublished
Cited by6 cases

This text of 168 So. 2d 251 (Blue Cross-Blue Shield of Alabama v. Colquitt) is published on Counsel Stack Legal Research, covering Alabama Court of Appeals 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 v. Colquitt, 168 So. 2d 251, 42 Ala. App. 471, 1964 Ala. App. LEXIS 246 (Ala. Ct. App. 1964).

Opinion

CATES, Judge.

This is an appeal by a hospital service corporation from a judgment against it in favor of Colquitt for $120 damages for breach of a group hospital service policy with medical and surgical rider.

Appellee, in brief, states the facts as follows:

“The appellee, Ivey K. Colquitt, secured hospital and medical insurance from the appellant under a 'group plan’ in 1957. At that time appellee was an employee of the Alabama Novelty House of Montgomery, Alabama.
“Mr. Colquitt remained with Alabama Novelty House for about two more months after obtaining the insurance, and then went to work for Druid Life Insurance Company in Tuscaloosa, Alabama. Druid also had a group coverage with appellant and Mr. Colquitt’s coverage was transferred to the Druid group.
“In November 1960, Mr. Colquitt went to work in Opelika, Alabama for Alliance Insurance Company of Dothan. Alliance also had group coverage on its employees with appellant. During the months of December and January Mr. Colquitt took his premiums to Druid * * * In the meantime Mr. Colquitt asked his supervisor [for Alliance [473]*473Life], Mr. J. B. Woods, to have his coverage transferred to Alliance.
“ * * * Blue Cross-Blue Shield was notified [by Druid Life] that Mr. Colquitt was working for Alliance Insurance Company, and [Druid Life] requested that a transfer be made from the Druid group to Alliance group.
“On February 20, 1961 appellee received injuries in an automobile accident. At the time of the accident he was riding in an automobile driven by Mr. Coy Woods. As a result he was confined to two hospitals for treatment.
“Appellee contends that he had in effect at the time of the accident hospital and medical insurance with appellant and that appellant was liable for a portion of the hospital and medical expense. Appellant denied liability and defended the suit brought by appellee principally on the ground that appellee was covered under workmen’s compensation and therefore excluded from coverage under the policy of insurance issued to appellee by appellant. Appellant adopts the position also that Mr. Colquitt’s coverage terminated on February 15, 1961. Appellee submits that he was covered on February 20, 1961, and that his coverage extended until February 25, 1961.
“As a result of being confined to Lee County Hospital appellee incurred hospital and medical expense, $120.00 of which appellant was obligated to pay under the insurance policy in existence.”

The pertinent provisions of the policy and rider read:

“SECTION IX — FEES, TERM AND TERMINATION
“(1) Fees
“Fees are due and payable to the Corporation in advance on or before the effective date of this certificate in the amount and manner and for the term (either a month or a quarter-year or a half-year or a year) specified and set forth in the subscriber’s application, and, upon each renewal hereof, fees for the renewal term are due and payable to the Corporation in advance on or before the effective renewal date at the rate in effect at the time of the renewal. * * *
“(2) Term
“This certificate shall continue in force from and after its effective date for the term for which fees therefor have been paid in advance and may, with the consent of the Corporation, be renewed from term to term for successive terms by the payment of term fees in advance in accordance with the provisions of the preceding paragraph.
“(3) Grace Period
“A grace period of ten (10) days shall be allowed within which to make payment of any fees except the initial fee.
“(4) Automatic Termination
“Failure of the subscriber or of the remitting agent, if any, to pay fees on their due date shall thereupon automatically terminate the subscriber’s contract with the Corporation as of such due date, and the Corporation shall not be liable hereunder for any hospital service received by any member after said due date, unless such fees are paid within the ten (10) day grace period allowed hereunder.” (Italics supplied.)

Error is assigned in the trial court’s

(1) overruling defendant’s amended demurrer to the amended complaint;
(2) overruling demurrer to Count One;
(3) overruling demurrer to Count Two;
(4) overruling demurrer to Count Three;
(5) in rendering judgment in favor of the plaintiff for $120 against defendant; and
(6) and (7) are variants of (5) above.

We omit reference to Assignment of Error No. 1 because of the detailed discussion under 2, 3 and 4, below.

[474]*474Assignment of Error No. 2.

Appellant contends that the most serious defect in Count 1 is that it is not alleged therein that defendant (appellant) failed or refused to pay the “hospital and doctors’ bills incurred by the plaintiff.”

Count 1 claims a sum due to the plaintiff by the defendant under the contract and avers that the contract provided that the defendant therein “agreed to pay the hospital and doctors’ bills incurred by the plaintiff,” etc. The count further avers that the plaintiff incurred hospital and doctors’ bills and that the defendant has had notice of said hospital and doctors’ bills.

Under these allegations there is, in effect, a breach of an agreement to save the plaintiff harmless from the consequences from incurring hospital and doctors’ bills. The expression “incur” for services is definite and certain enough as herein used to withstand the scrutiny of a demurrer. J. B. McCrary Co. v. Town of Brantley, 202 Ala. 136, 79 So. 602.

Assignment of Error No. 3.

It is claimed here that the demurrers should have been sustained because the terms of the contract, in effect, are at cross purposes with the allegations of Count 2 in a material extent. The contract was incorporated into the complaint. This discrepancy is stated to be that the contract only calls for Blue Cross to furnish “hospital service” and, therefore, the express allegation of Count 2 that Blue Cross “agreed to pay hospital and doctors’ bills incurred by plaintiff” is a variance.

The contract expressly calls for the payment by Blue Cross of allowances to “nonparticipating hospitals” for hospital service. These allowances are agreed in the contract to be paid by Blue Cross directly to the hospital and consist of a “sum of Six ($6.00) Dollars per day as a credit toward the charge for room and board,” in the case of a “Z” contract which was the type held by Mr. Colquitt. The medical service rider provides also that Blue Cross will, among other things, pay to the subscriber’s-physician the sum of $3.00 for each hospital call made after the third day of any hospital admission. Accordingly, as tested by demurrer, this variance becomes immaterial even though there are other provisions, such as those in Section II of the hospital service contract relating to the value of hospital service to be given the subscriber in “participating hospitals.”

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Blue Cross-Blue Shield of Alabama v. Colquitt
168 So. 2d 256 (Supreme Court of Alabama, 1964)

Cite This Page — Counsel Stack

Bluebook (online)
168 So. 2d 251, 42 Ala. App. 471, 1964 Ala. App. LEXIS 246, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-of-alabama-v-colquitt-alactapp-1964.