Blue Cross-Blue Shield of Alabama v. Turner

195 So. 2d 807, 43 Ala. App. 542, 1966 Ala. App. LEXIS 582
CourtAlabama Court of Appeals
DecidedAugust 16, 1966
StatusPublished
Cited by18 cases

This text of 195 So. 2d 807 (Blue Cross-Blue Shield of Alabama v. Turner) 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. Turner, 195 So. 2d 807, 43 Ala. App. 542, 1966 Ala. App. LEXIS 582 (Ala. Ct. App. 1966).

Opinions

JOHNSON, Judge.

Suit was brought by appellee, Mrs. Doris T. Turner, to recover from appellant, Blue Cross-Blue Shield of Alabama, for various hospital and medical expenses incurred by .appellee. The verdict and judgment for appellee was for the amount of $422.85. Appellant’s motion for a new trial was •overruled and the company appeals.

The appellee was the only witness called by either party. Appellee testified that she first obtained insurance from appellant •eight or nine years previous to the trial. In January of 1962 her coverage was transferred from the Tuscaloosa County group to the group organized at the Central Foundry Company where the appellee’s husband was employed. In March of 1962 appellee became pregnant. On July 31, 1962, appellee received notice that the group insurance plan in which she participated would be discontinued by appellant effective August 25, 1962. During the month of August the parties exchanged letters and telephone calls and in one instance appellee told an agent of appellant that she was pregnant. On December 7, 1962, appellee was admitted to Druid City Hospital in Tuscaloosa, Alabama, and on the same day gave birth to a daughter by normal delivery.

The appellee introduced two different hospital service certificates, one providing for $25.00 deductible coverage and the other providing for a $50.00 deductible coverage. Both certificates contained the same provision with respect to termination of the coverage, which certificates state:

“Option of either party — The contract between the subscriber and the corporation and all rights hereunder may be terminated by either party at any time on Thirty (30) days written notice to the other.”

The bill from the hospital was in the amount of $277.35. The obstetrician’s bill for prenatal care ands delivery of the child was for $150.00.

Appellant contends that no liability attaches under the policy until the hospital services and benefits covered are actually rendered in the hospital. The only case cited by either party which involves similar facts is Lundquist v. Illinois Life & Accident Co., 24 Ill.App.2d 316, 164 N.E.2d 293. The policies in that case provided:

“When the Insured, if a married woman, or the wife of the Insured, if a dependent, shall, while this policy is in force and after 10 months from the effective date hereof, give birth to a child or children, the Company will pay the expense actually incurred in connection therewith * * * ”

In holding that the insurance company was not liable, the Illinois court stated:

[545]*545“The claim for indemnity here, *' *, originates, so far as material, only if the mother ‘give birth to a child or children’, at a time while this policy is in force, * * * and it is only for the expense actually incurred in connection with that birth * * * that this policy insures against.”

In the case at bar the policies provide:

“SECTION V — MATERNITY CARE —$25 [$50] DEDUCTIBLE PROVISION
“In any case where benefits are provided to a member wife for maternity care and for any condition arising out of and during pregnancy, including, but not limited to, any condition or disease of the genito-urinary tract, gastritis, hyperemesis or anemia, the deductible amount specified in Sections II and III hereof to be paid by the member shall not exceed Twenty-Five (25.00) [or $50.-00] Dollars, regardless of the number of hospital admissions, during any one pregnancy, subject to the limitation herein contained of ten (10) days for each such pregnancy.”
“SECTION VII — LIMITATIONS
“1. MATERNITY CARE — Hospital service for maternity care and for any condition arising out of and during pregnancy, including, but not limited to, any condition or disease of the genito-urinary tract, gastritis, hyperemesis or anemia, shall be limited to ten (10) days for any one pregnancy.”
“SECTION VIII — WAITING PERIODS
“1. MATERNITY CARE — Hospital service for maternity care and for any condition arising out of and during pregnancy, including, but not limited to, any condition or disease of the genitourinary tract, gastritis, hyperemesis or anemia, shall be available hereunder to a 'member wife only in the event she was, on the date of her hospital admission, covered by a Blue Cross hospital service contract providing maternity benefits, and only in the event she had been covered by such a contract for a period of nine (9) consecutive months immediately preceding the date of her hospital admission; provided, however, that hospital service shall be available to a member wife covered by such a contract in the event of termination of pregnancy by abortion or miscarriage, or termination of an ectopic pregnancy, if normal delivery would have occurred on a date after the said nine (9) months waiting period.”

The $50.00 deductible policy provides:

“14. ‘Maternity Care’ means care or treatment provided to a member who is subscriber or the wife of a subscriber, while such member is covered under a family contract, for any condition arising out of and during pregnancy, including but not limited to any condition or disease of the genito-urinary tract, gastritis, hyperemesis or anemia.”

The words and phrases used in the policies in the case at bar and the policies in the Lundquist case, supra, can be distinguished. In the Lundquist case, supra, the phrase “child birth” is used to denote the event insured. In the case at bar the following words are used, “maternity care”, “pregnancy”, “arising out of”, and “during”.

Under these policies of appellant, benefits are provided not just for child birth but “for any condition arising out of and during pregnancy”.

Pregnancy is the state of a female who has within her ovary or womb a fecundated germ. Dunglison, Dictionary of Medical Science and Literature. Necessarily, this condition begins at the moment of conception and terminates with delivery of the child.

[546]*546This condition of pregnancy raised such a high probability of belief by appellee that medical and hospital expenses would be incurred that appellee repeatedly resisted the cancellation of the policy.

Liability of the insurer attached at the moment of the insured’s conception regardless of the possibility of occurrence of events relieving it of liability. Appellee’s interest in the policy was obtained through an expenditure of her and her husband’s own money. This interest is sufficient to prevent cancellation or modification if such prevents the insured from timely exercise of any conversion privilege which may be available to her under the terms of the policy or, where such privilege is not given, if it prevents her from reasonably obtaining similar insurance protection on her own account elsewhere. Shears v. All State Life Ins. Co., 242 Ala. 249, 5 So. 2d 808.

Upon protest of the cancellation appellee was informed by appellant that similar coverage with appellant could not continue on a direct basis or by transferring to another payroll deduction group.

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Bluebook (online)
195 So. 2d 807, 43 Ala. App. 542, 1966 Ala. App. LEXIS 582, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-of-alabama-v-turner-alactapp-1966.