Boykin v. Physicians Mutual Insurance

682 F. Supp. 887, 1988 U.S. Dist. LEXIS 3107, 1988 WL 33126
CourtDistrict Court, S.D. Mississippi
DecidedMarch 2, 1988
DocketCiv. A. No. W86-0113(B)
StatusPublished

This text of 682 F. Supp. 887 (Boykin v. Physicians Mutual Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Boykin v. Physicians Mutual Insurance, 682 F. Supp. 887, 1988 U.S. Dist. LEXIS 3107, 1988 WL 33126 (S.D. Miss. 1988).

Opinion

MEMORANDUM OPINION AND ORDER

BARBOUR, District Judge.

This matter is before the Court on Defendant’s Motion for Summary Judgment under Rule 56 of the Federal Rules of Civil Procedure. This case presents a question of first impression in Mississippi. The Court finds there are genuine issues of material fact as to part of the Plaintiff’s case, but the Defendant is entitled to partial summary judgment as a matter of law on the issue of punitive damages.

FACTS

On January 23,1982, the Defendant Physicians Mutual Insurance Company (“Physicians Mutual”) issued to the Plaintiff a hospital confinement indemnity policy which provided for payment of $30.00 a day for each full day that a covered person was “confined as an inpatient in a licensed hospital due to accident or sickness.” Premiums, payable in advance, were due on the 23rd day of every month. The Plaintiff kept the policy in effect for 31/2k years by paying the monthly premiums. Plaintiff’s last premium payment was dated June 5, 1985, for the past-due May payment and the June payment. The June 5, 1985, payment kept the policy in effect up to June 23, 1985, after which the Plaintiff had a thirty-one day grace period of coverage under the policy until July 24, 1985. On July 23,1985, the thirtieth day of the grace period, the Plaintiff suffered a stroke. He was hospitalized in Mercy Regional Medical Center in Vicksburg, Mississippi, from July 23 to August 10, 1985. On August 10 Plaintiff Boykin was to be transferred to the Methodist Rehabilitation Center in Jackson, Mississippi, for further treatment. Although he was released from Mercy Regional, he was not admitted to Methodist Rehabilitation Center because there was no available bed space. Plaintiff therefore stayed at his son’s residence in Jackson waiting for space to open up in the Methodist Rehabilitation Center. On August 27, 1985, the Plaintiff’s condition worsened and he was taken to Hinds General Hospital for treatment until a bed became available in the Methodist Rehabilitation Center. Plaintiff has been in the Rehabilitation Center since that time.

It is uncontested that the Plaintiff has not paid another premium since June of 1985. Plaintiff made a claim to Defendant for the July 23 to August 10, 1985, hospitalization and it was paid by Defendant since the claim clearly began within the grace period. The Defendant has not paid any other hospital benefit claims after the July 23 to August 10 hospitalization at Mercy Regional Medical Center. Defendant contends the policy lapsed at the end of the grace period on July 24, 1985, and no other hospitalizations are covered.

ANALYSIS

The Plaintiff brought suit on November 3, 1986, alleging tortious breach of contract, breach of fiduciary duties, and fraud in the inducement. Plaintiff seeks compensatory damages and punitive damages for bad faith failure to pay the hospitalization claims. The Defendant seeks summary judgment on the basis that the Plaintiff’s failure to pay the premium caused the policy to lapse after the policy period and the thirty-one day grace period, and that it has no obligation to pay for hospitalizations beginning after that date. The Defendant correctly cites Mississippi law that non-payment of premiums will effect a forfeiture of benefits, and sickness or insanity will [889]*889not avoid the forfeiture. See American Life Insurance Company v. Hauer, 218 Miss. 560, 67 So.2d 523, 525 (Miss.1953); New York Life Insurance Company v. Alexander, 122 Miss. 813, 85 So. 93, 95 (Miss.1920).

The Plaintiff opposes summary judgment by urging a point that the Mississippi Supreme Court has yet to rule upon, although other jurisdictions have addressed the issue. The Plaintiff contends that his confinement was continuous based upon the debilitating effects of his stroke on July 23, 1985. If his confinement continued from July 23, 1985, and never terminated, then all subsequent hospitalizations would be covered under the policy. Plaintiff Boykin argues that he was to be hospitalized continuously and was at no time discharged from confinement; the period of time he spent at his son’s residence was due only to the unavailability of a bed at the Methodist Rehabilitation Center and was upon the advice of his physician.

The hospital indemnity policy contains this provision:

POLICY LIMITATIONS:

We will not pay for:
(b) Confinement that starts while your policy is not in force.

It is undisputed that the July 23, 1985, hospitalization started while the policy was still “in force” under the grace period. The question is whether subsequent to August 10, 1985, there were any new confinements which started while the policy was not in force or whether, as the Plaintiff maintains, the confinement due to the initial illness continued during the time Plaintiff was being transferred between Mercy Regional, Hinds General and Methodist Rehabilitation Center. The issue to be addressed by this Court is whether Mississippi courts, when confronted with this question, would construe the hospitalizations or confinements as continuous and not separate under this particular policy.

This case differs slightly from other state decisions cited by Plaintiff; those cases were interpreting policy clauses calling for “continuous confinement.” See National Central Life Insurance Company v. Anderson, 443 S.W.2d 786 (Tex.Civ.App.1969); United Equitable Insurance Company v. Padgett, 59 Tenn.App. 626, 443 S.W.2d 480 (1969); Fowler v. United Equitable Insurance Company, 200 Kan. 632, 438 P.2d 46 (1968). In the present case this Court is asked to interpret whether a confinement ended for purposes of determining whether a new confinement started after the policy effective date. The state cases did examine, however, how interruptions were viewed in the sequence of hospitalizations. Those principles may be applied to the question before this Court. The state courts found that temporary absences from the hospital did not constitute a fatal variance from confinement. Anderson, 443 S.W.2d at 789-90; Padgett, 443 S.W.2d at 481-82; Fowler, 438 P.2d at 49-52. The courts construed analogous cases regarding confinement to the insured’s house or bed and held that occasional absences for therapeutic reasons and under the advice of physicians did not terminate continuous confinement. See Anderson, 443 S.W.2d at 789; Fowler, 438 P.2d at 49-50. Mississippi case law also holds that temporary breaks do not terminate “continuous confinement” to house or bed because of the liberal construction given to confinement clauses. See Bedwell v. Automobile Owners Insurance Company, 240 Miss. 312, 127 So.2d 432, 433-34 (1961).

This Court has found another compelling case on point. In Johnson v. American Family Life Assurance Company of Columbus, 583 F.Supp. 1450 (D.Colo.1984), the district court was faced with construing a hospitalization policy regarding continued coverage despite brief periods of time when the claimant was not physically within a hospital. In

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Related

Blue Cross & Blue Shield of Miss. v. Campbell
466 So. 2d 833 (Mississippi Supreme Court, 1984)
Fowler v. United Equitable Insurance
438 P.2d 46 (Supreme Court of Kansas, 1968)
Johnson v. AMERICAN FAM. LIFE ASSUR. CO. OF COLUMBUS
583 F. Supp. 1450 (D. Colorado, 1984)
National Central Life Insurance Co. v. Anderson
443 S.W.2d 786 (Court of Appeals of Texas, 1969)
Standard Life Ins. Co. of Indiana v. Veal
354 So. 2d 239 (Mississippi Supreme Court, 1977)
New York Life Ins v. Alexander
85 So. 93 (Mississippi Supreme Court, 1920)
American Life Ins. v. Hauer
67 So. 2d 523 (Mississippi Supreme Court, 1953)
Bedwell v. Automobile Owners Ass'n
127 So. 2d 432 (Mississippi Supreme Court, 1961)
United Equitable Insurance v. Padgett
443 S.W.2d 480 (Court of Appeals of Tennessee, 1969)

Cite This Page — Counsel Stack

Bluebook (online)
682 F. Supp. 887, 1988 U.S. Dist. LEXIS 3107, 1988 WL 33126, Counsel Stack Legal Research, https://law.counselstack.com/opinion/boykin-v-physicians-mutual-insurance-mssd-1988.