Commercial Travelers Casualty Co. v. Johnson

217 S.W.2d 160, 1949 Tex. App. LEXIS 1519
CourtCourt of Appeals of Texas
DecidedFebruary 4, 1949
DocketNo. 15009.
StatusPublished
Cited by3 cases

This text of 217 S.W.2d 160 (Commercial Travelers Casualty Co. v. Johnson) 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
Commercial Travelers Casualty Co. v. Johnson, 217 S.W.2d 160, 1949 Tex. App. LEXIS 1519 (Tex. Ct. App. 1949).

Opinion

SPEER, Justice.

Appellees, Daniel Grover Johnson and wife, Ruth Marilla Johnson, sued appellant, Commercial Travelers Casualty Company, on a hospital and surgery policy of insurance.

For purposes of this appeal it is thought necessary only to state that appellees (plaintiffs below) pleaded that for a named premium paid by them appellant issued its policy contract insuring appellees “Against loss resulting from hospital confinement and surgical operation by bodily injury effected solely through accidental means or by sickness or disease, the cause of which had its beginning after thirty days from date of issue hereof.” That the policy' was issued August 20, 1947 and that all items claimed had their beginning about January 16, 1948 and more than thirty days after the effective date of the policy; that the policy provided that in case of sickness or surgery having its beginning more than thirty days after the effective date 'of the policy where hospitalization was required, appellant would pay $7.50 for a hospital room and general nursing; $5.00 for ambulance to or from the hospital and if surgery was necessary it would pay $15.00 for operating room; $10.00 for anesthetic; $3.00 for laboratory fee; and $75.00 for an appendectomy. They further claimed other items but they were disallowed by the court and we need make no further reference to them. They alleged that Mrs. Johnson was taken very sick on January 16, 1948 and was sent to' a hospital for surgery and that an operation was performed about midnight of that date.

Appellant plead general denial and special defenses, only one of which is involved here, it being a provision of the policy found on the fourth page captioned, “Exceptions and Limitations” with the subheading, “Waiting Period.” We will quote *162 and comment on this provision later in this opinion.

At the conclusion of taking testimony, both sides requested peremptory charges to the jury. That of appellant was refused and appellees’ was given, requiring the jury to return a verdict in their favor for $212.00. Judgment was entered for that amount and this appeal followed.

There is no conflict in the testimony; only appellees (the Johnsons) testified; in addition there were many identified exhibits introduced without objections and certain stipulations of fact were filed. One side or the other should have had an instructed verdict. The material facts appear to be as alleged by the appellees.

Appellant’s first point of error complains because the court refused its requested summary instruction based upon the claim that appellees had failed to establish a right of recovery in that they had not attempted to prove that the items for which they sued were “in accordance with the usual, customary and regular charges for such services and materials in the immediate locality where such services and materials were rendered and furnished.”

Points 2, 3, 4 and 5 assert error in the court giving appellees’ summary instruction based upon the absence of any evidence that the items for which they sued were in accordance with the usual, customary and regular charges in that locality.

We shall discuss these points together because if appellees were required in this case to prove that the items for which they sued were usual, customary and regular charges in that locality, as here contended by appellant, and having failed to make this proof, appellant was entitled to a judgment. But if such proof was not necessary, appellees should recover as against the errors asserted by appellant.

On page 2 of the policy there is a provision called “Part C” which reads: “The benefits under all parts of this policy are payable only if such hospitalization and/or services, etc., be at the direction or under the supervision of some regularly licensed and practicing physician or surgeon and for no greater length of time than may be deemed necessary by such physician or surgeon ; and provided further that the charges made for such services and/or materials, etc., are in stritt accordance with the usual, customary and regular charge made for such services, in the immediate locality where such services and/or materials, etc., may be rendered.”

We are keeping in mind that this is a suit for reimbursement for hospitalization and operation under a written contract entered into for a valuable consideration. Under “Hospitalization” the contract provides, “If such sickness or injury shall re-(juire the insured to be confined as a resident patient within an incorporated and licensed Hospital, the Company will reimburse the Insured for the actual Hospital Expense, or will pay the Hospital, if authorized by the insured to do so, for such expense as herein provided, subject however, to all the provisions and limitations herein set forth.” Following this provision reference is made to the first page of the policy where it is provided that “Policy pays $7.50 per day for hospital room, board and general nursing.” Next is a provision of $5.00 for ambulance to or from hospital; $3.00 general laboratory fee; $15.00 for operating room; $10.00 for an anaesthetic, and several other items not involved here.

Following the above quotation and items we find “Surgical Operation Indemnity”; which in part provides that the amounts stated in schedule of Surgical Operations are the maximum amounts payable. Under this caption there appears the item of $75.-00 for an appendectomy.

It is quite obvious that the primary purpose of this contract was that appellant would reimburse appellees for actual hospital and surgery expenses incurred by them, coming within the terms of the policy, in amounts which did not exceed those for the same items as named in the schedules in the policy, which amounts are recited to be “the maximum amounts payable.”

We note by the judgment that appellees recovered $10.00 for ambulance service; $10.00 for an anaesthetic; $15.00 for the operating room; and $3.00 for laboratqry fee. These are the identical amounts shown to have been paid by them and are *163 the same amounts provided in the policy for such items. The largest amount for a single item allowed was $98.00 for fourteen days in the hospital at $7.00 per day, whereas the policy provided for $7.50 per day. The next largest single item was $75.00 for an appendectomy; this was the maximum amount provided by the policy, whereas ap-pellees actually paid $125.00; however, the excess paid is of no significance here.

We have reached the conclusion that so long as the items claimed and sued for by appellees do not exceed the maximum amounts promised by appellant to be paid for the corresponding items in the policy schedules, there is no good reason existing requiring appellees to prove that such amounts are usual, customary and regular charges in that locality. Appellees pleaded, testified and were corroborated that they had incurred and paid the several items of hospitalization and surgery sued for. By this suit they sought reimbursement from appellant under the terms of the policy. Appellant did not plead or in any way attempt to challenge the amounts of appellees’ several items and claims sued for because they were not usual, customary and regular charges in that locality.

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Cite This Page — Counsel Stack

Bluebook (online)
217 S.W.2d 160, 1949 Tex. App. LEXIS 1519, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commercial-travelers-casualty-co-v-johnson-texapp-1949.