Blue Cross of Florida, Inc. v. Dysart

340 So. 2d 970
CourtDistrict Court of Appeal of Florida
DecidedDecember 22, 1976
Docket75-1583
StatusPublished
Cited by14 cases

This text of 340 So. 2d 970 (Blue Cross of Florida, Inc. v. Dysart) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross of Florida, Inc. v. Dysart, 340 So. 2d 970 (Fla. Ct. App. 1976).

Opinion

340 So.2d 970 (1976)

BLUE CROSS OF FLORIDA, INC., a Florida Corporation, and Blue Shield of Florida, Inc., a Florida Corporation, Appellants,
v.
William O. DYSART, Jr., As Administrator of the Estate of William O. Dysart, Deceased, Appellee.

No. 75-1583.

District Court of Appeal of Florida, Second District.

December 22, 1976.
Rehearing Denied January 12, 1977.

*971 George D. Lynn, Jr., of Harrison, Greene, Mann, Rowe & Stanton, St. Petersburg, for appellants.

Kenneth C. Deacon, Jr., Law Offices of Harris, Barrett & Dew, St. Petersburg, for appellee.

PER CURIAM.

This is an appeal from a summary judgment entered in favor of appellee/plaintiff in its action against appellants/defendants whereby plaintiff recovered reimbursement for benefits under hospitalization and medical contracts issued by defendants to plaintiff's decedent. We reverse.

As a result of injuries sustained in a motor vehicle accident on December 26, 1972, plaintiff's decedent Dysart incurred hospital and medical expenses from December 26 to December 27 and from January 3, 1973, to the date of his death, January 20, 1973. The parties stipulated that Dysart's readmission to the hospital on January 3 was for injuries and complications resulting from the accident.

At the time of the accident the decedent was employed by Pasadena Community Church in St. Petersburg, and was a subscriber under group medical and surgical *972 and hospitalization policies issued by appellants. The contract year as defined by the policies expired on December 31, 1972. The policies were cancelled by the decedent's employer and replaced as of midnight December 31, 1972, with a health and accident insurance policy issued by Fireman's Fund America. Fireman's Fund America specifically excluded expenses incurred in connection with illness or injury sustained prior to the effective date of its policy.

Defendant refused to pay the medical and hospital expenses incurred by plaintiff subsequent to January 1, 1973. This action followed. Both parties moved for summary judgment, and the court entered summary judgment in favor of the plaintiff for hospitalization coverage, medical benefits, attorney's fees, interest and costs, concluding that:

"... while this contract expired on December 31, 1972, which date was subsequent to Plaintiff's covered illness, but prior to his rehospitalization on January 4, 1973, (which hospitalization `was caused by the accident and was the cause of injuries which possibly initiated the chain of events responsible for his death' and further that `the injuries received in the December 26 accident were in all likelihood the proximate cause of his hospitalization in January.'), the coverage in effect in December continued over and binding upon the insurance company in January."

The issue here is whether the Blue Cross Hospital Service contract and the Blue Shield Medical & Surgical contract afford coverage to a subscriber for expenses incurred after termination of those policies where the cause for such hospitalization and medical services and indeed the initial hospital and medical treatments originated prior to termination.

We think the trial court erred. While the court's rationale may, in proper instances, be applicable to an accident and health policy, it is not applicable to hospitalization and medical expense policies which afford benefits only during the time of coverage. Here, coverage was provided to the plaintiff as a Blue Cross/Blue Shield group subscriber. Continuation of that coverage was to be furnished in consideration of payment in advance of the rates applicable for the type and extent of coverage specified in the contract. Thus, it appears coverage, to be effective, is dependent upon continued payment of premiums by the subscriber. It seems, therefore, axiomatic that upon termination of the contracts and cessation of premium payments, the only coverage available is that stipulated in the contracts. We note the lack of any stipulated posttermination benefits in the contracts in this case.

Admittedly, there is a paucity of authority on the question of an insurer's liability under a hospitalization or medical expense policy which terminates prior to completion of hospitalization and medical treatment. An insurer's liability under an accident policy which terminates after accidental injury but prior to completion of medical treatment has been the subject of more frequent litigation with the cases reaching contrary results, accounted for in part by difference in language of the policies. These views are discussed in an annotation in 75 A.L.R.2d 876.

In the absence of specific language to the contrary, a good argument can be made for extending the liability of an insurer under an accident policy for medical and hospital expenses incurred after the termination of the policy because these policies generally contemplate coverage for all such expenses incurred as a result of an accident which takes place within the policy period. On the other hand, a hospitalization or medical expense policy relates to all hospital and medical expenses incurred during the contract period regardless of whether they were occasioned by an accident.

This point is illustrated in Bartulis v. Metropolitan Life Ins. Co., 72 Ill. App.2d 267, 218 N.E.2d 225 (1966), in which the court construed a hospital and medical expense policy. There the plaintiff was a Standard Oil Company dealer. As such, he was a certificate holder of one of Metropolitan's group hospitalization and medical expense *973 policies issued to dealers and employees of Standard Oil Company Service Stations. The plaintiff was injured in May 1959. His group coverage was terminated effective July 31, 1959, by the trustees who administered hospital coverage for owners and employees of Standard Oil Company Service Stations. Bartulis received medical treatment in September and entered the hospital incurring expenses there until October 11, 1959.

In reversing a judgment in favor of the group policy holder, the Illinois court wrote:

"It seems crystal clear that the coverage provided was for confinement as a patient in a hospital while the policy was in force and surgery performed while the policy was in force. Neither event occurred during the life of the policy. Neither in such provisions nor elsewhere in the policy is there language suggesting that the policy could or should be read as providing coverage for hospitalization or surgery resulting from injuries sustained while the policy was in force. To so read this policy is to annex to it a coverage neither specifically stated nor reasonably implied. We would observe that Section 10 entitled `Benefits after Cessation of Insurance' provided that if a certificate holder is totally disabled as a result of injuries or sickness on the termination date of the policy, the hospitalization and surgery coverages continue, for a period of 31 days. If a female, and pregnancy exists on the termination date of the policy, coverage is extended over a period of 9 months for hospitalization and surgery resulting from such pregnancy. It is thus apparent that this is not only a limited coverage policy, but its post-termination coverage is likewise specifically limited to specific circumstances. Coverage for injuries sustained during the lifetime of the policy with hospitalization or surgery resulting therefrom thereafter is conspicuous by its absence.

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340 So. 2d 970, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-of-florida-inc-v-dysart-fladistctapp-1976.