Bybee v. John Hancock Mutual Life Insurance Co.

507 S.W.2d 330, 1974 Tex. App. LEXIS 2127
CourtCourt of Appeals of Texas
DecidedFebruary 14, 1974
Docket748
StatusPublished
Cited by5 cases

This text of 507 S.W.2d 330 (Bybee v. John Hancock Mutual Life Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bybee v. John Hancock Mutual Life Insurance Co., 507 S.W.2d 330, 1974 Tex. App. LEXIS 2127 (Tex. Ct. App. 1974).

Opinion

DUNAGAN, Chief Justice.

Mildred Bybee, the appellant here and plaintiff in the trial court, brought suit against appellee, John Hancock Mutual *331 Life Insurance Company, to recover upon a hospitalization insurance policy issued by appellee. The facts of the case are simple. Appellant’s husband, a covered dependent under the policy in question, incurred $17,421.50 in actual hospital expenses. Because the appellant’s husband was over 65 years of age he was entitled to receive certain benefits from medicare. The amount paid by Medicare amounts to $16,416.30, thus leaving the sum of $1,005.20 owing to the hospital. Appellant then filed her claim for the amount of hospital expenses that Medicare failed to pay. The appellee denied liability on the basis that an amendment to appellant’s insurance policy precluded liability whenever medicare payments exceeded the total policy limits, which according to the policy was $6,566.-50. Appellant and appellee both moved for summary judgment and the trial court granted judgment in favor of the appellee insurance company.

It is undisputed that the appellant’s husband is an insured under the John Hancock Mutual Life Insurance Company’s policy. The amount of medical expenses incurred, and the amount of medicare payments are also undisputed. The sole controversy involves the interpretation of an amended provision which became part of the policy in 1968. The relevant portions of the provision read as follows:

“Each coverage in this policy which provides benefits for expenses incurred is amended by the addition of the following exclusion:
“The benefits payable under this coverage for expenses incurred by a subject person, as determined prior to the application of the provision for the coordination of Benefits under this Policy with other benefits, shall be the excess, if any, of (a) the benefits determined without regard to this amendment, over (b) the amount of benefits provided for the same expenses under full Medicare coverage. (Emphasis added.)

Appellant’s first point of error is that the policy language is vague, confusing, and poorly worded, thus causing the policy to be ambiguous and susceptible of two meanings. If such a contention, as appellant makes in the point of error, is correct, then under existing case law several legal principles are used to construe the policy. These principles are outlined with authorities cited in 32 Tex.Jur.2d, sec. 60, Insurance, pages 121-125 as follows:

“It is a settled principle of insurance law that language of a policy that is susceptible of more than one construction should be interpreted strictly against the insurer and liberally in favor of the insured. In other words, when the contract is capable of two constructions, under one of which recovery is allowed but under the other of which it is denied, that construction will be given which permits a recovery * * *. However, the rule as to interpretation in favor of the insured is invoked only where there is ambiguity calling for construction; when a party dealing with an insurance company has made a contract that is unambiguous in its terms, courts will construe and enforce it in the same way as if it had been made between natural persons. This rule is not so applied as unreasonably to destroy the plain meaning of policies, nor to make new contracts between insured and insurer, since equal justice must be done between the parties.”

It is elementary that the basic rules of construction are to be used only when there exists some uncertainty as to the meaning of the contract or some portion thereof. General American Indemnity Company v. Pepper, 161 Tex. 263, 339 S.W.2d 660 (1960); Wood Motor Company v. Nebel, 150 Tex. 86, 238 S.W.2d 181 (1951); Hinson v. Nobel, 122 S.W.2d 1082 (Tex.Civ.App., Fort Worth, 1938, n. w. h.); Hughes v. American Nat. Ins. Co., 177 S.W.2d 801 (Tex.Civ.App., Dallas, 1944, n. w. h.); J. R. Gray Co. v. Jacobs, 362 S. *332 W.2d 167 (Tex.Civ.App., Austin, 1962, writ ref’d n. r. e.). If the language of the above quoted insurance contract is not susceptible of two meanings, then the above rules of construction do not come into play. A court therefore is not at liberty to revise an insurance provision while purporting to construe it. General American Indemnity Company v. Pepper, supra; Members Mutual Insurance Company v. Randolph, 477 S.W.2d 315 (Tex.Civ.App., Houston (1st), 1972, writ ref’d n. r. e.). Insurance contracts are to be construed the same as other contracts. General American Indemnity Company v. Pepper, supra. It is also well established that a contract is to be viewed in accordance with its plain language. General American Indemnity Company v. Pepper, supra. A contract can be said to be ambiguous if the language used is susceptible to more than one interpretation or meaning. Smith v. Davis, 453 S.W.2d 340 (Tex.Civ.App., Fort Worth, 1970, writ ref’d n. r. e.); Jones v. Dumas Development Co., 229 S.W.2d 936 (Tex.Civ.App., Amarillo, 1950, writ ref’d n. r. e.); Piper, Stiles & Ladd v. Fidelity and Deposit Company of Maryland, 435 S.W.2d 934 (Tex.Civ.App., Houston (1st), 1969, writ ref’d n. r. e.). However, if such a contract is not reasonably susceptible of more than one meaning, the effect that is given the contract will be determined from the language of the contract alone. Piper, Stiles & Ladd v. Fidelity and Deposit Company of Maryland, supra; Pritchard & Abbott v. McKenna, 162 Tex. 617, 350 S.W.2d 333 (1961).

The disposition of this case will be made according to the interpretation this court gives to the particular clause which is in controversy. Appellant submits that there is ambiguity in the above mentioned clause. After careful consideration we find that we cannot agree with such a contention. The purpose of the clause is explained in the introductory language of the amendment, i. e., “each coverage in this policy * * * is amended by the addition of the following exclusion.” The amendatory clause is therefore an exclusion as the language plainly states. The relevant portions of the clause are as follows :

“The benefits payable under this coverage * * * shall be the excess, if any, of
(a) the benefits determined without regard to this amendment, over,
(b) the amount of. benefits provided for the same expenses under full Medicare coverage.” (Emphasis added.)

This language means simply that the benefits payable are the excess, if any, of (a) over (b).

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507 S.W.2d 330, 1974 Tex. App. LEXIS 2127, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bybee-v-john-hancock-mutual-life-insurance-co-texapp-1974.