Continental Casualty Company v. Street

379 S.W.2d 648, 7 Tex. Sup. Ct. J. 310, 1964 Tex. LEXIS 658
CourtTexas Supreme Court
DecidedMarch 11, 1964
DocketA-9706
StatusPublished
Cited by35 cases

This text of 379 S.W.2d 648 (Continental Casualty Company v. Street) is published on Counsel Stack Legal Research, covering Texas Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Continental Casualty Company v. Street, 379 S.W.2d 648, 7 Tex. Sup. Ct. J. 310, 1964 Tex. LEXIS 658 (Tex. 1964).

Opinions

STEAKLEY, Justice.

Our former opinions, delivered December 11, 1963 are withdrawn. The following is the opinion of the Court.

The suit was by Respondent, John G. Street, Jr., against Continental Casualty Company, Defendant below and Petitioner here. It has had quite a history. See the opinions reported in Tex.Civ.App., 339 S.W.2d 680; Tex.Civ.App., 358 S.W.2d 746; and Tex., 364 S.W.2d 184. It reaches us on this occasion from a judgment of the Court of Civil Appeals, with one Justice filing a dissenting opinion, reversing the judgment of the trial court for Petitioner, and remanding the cause. Tex.Civ.App., 367 S.W.2d 894. We reverse the judgment of the Court of Civil Appeals, and affirm the judgment of the trial court.

The suit sought a recovery under the Surgical Expense portion of a Comprehensive Hospital, Nurse, Medical and Surgical Expense policy issued by Continental Casualty Company to Street. The basis of the suit was the performance upon Street by a legally qualified dental surgeon of a series of curettages whereby deposits on the teeth and portions of the periodontal tissue were removed. The treatment was for suppura-tive periodontitis.

The surgical expense section of the comprehensive policy is introduced by an opening paragraph which reads:

“When injury or sickness shall cause any member of the Family to undergo any operation named herein which is performed by a legally qualified physician or surgeon while this policy is in force as to such member, the Company will pay the actual expense incurred for such operation, including post operative care in the hospital, but not in excess of the amount set opposite the operation nor in excess of $500.00 for all operations performed as the result of any one accident or any one period of sickness.”

There follows a specific listing of 198 operations, together with the maximum amount of the actual expense incurred for each operation which the company will pay. The maximum amounts range from $5.00 for a pinch skin graft to $500.00 for a total removal of the stomach, or for the radical removal of both breasts, or for the removal of an intervertebral disc with spinal fusion. Dental surgery is not listed.

This schedule is followed by a concluding paragraph:

“The Company will pay, subject to the limit provided, for operations not named above amounts objectively determined on the basis of comparative severity with operations which are named, but not less than the minimum nor more than the maximum amounts provided for operations named.” (Emphasis added)

Upon the trial of the case, Street offered the testimony of the admittedly legally qualified dental surgeon who performed the series of curettages upon his teeth and gums. This witness sought to compare the dental surgery which he performed to a sinus operation, one of those listed in the surgical expense schedule of the policy. The Court of Civil Appeals found the testimony of this witness to be “that the maxillary sinus operation was the only one of the 198 in the policy schedule that had any comparability to the work he did on plaintiff.” 367 S.W.2d at page 897. Street offered no other testimony upon the question of the comparative severity of that which was performed upon his teeth and gums with any other of the operations listed in the policy.

As pertinent here, the case was submitted to the jury upon special issues inquiring if the acts performed upon the mouth of Street constituted operations, to which the [650]*650jury answered in the affirmative; upon issues inquiring what amount of money would be comparable and reasonable for Continental Casualty to pay Street upon the basis of a comparison of the severity of the operations upon Street with those specifically listed in the insurance policy, which issues were not answered by the jury; and upon an issue inquiring if the operations performed upon Street were not of comparative severity with the sinus operation listed in the policy, to which the jury answered “They were not comparative.”

Judgment for Continental Casualty Company was entered by the trial court upon the verdict of the jury. Street did not except to the action of the court in receiving, accepting and filing the verdict. He had not previously objected to the issues submitted, or requested any other issues. He made no motion for a mistrial, or for judgment non obstante veredicto, or to disregard the jury findings.

We construe the policy in question as constituting an agreement on the part of Continental Casualty Company to pay the actual expense incurred1 for any operation, subject to the specified limitations. The maximum amounts of actual expenses which would be paid were predetermined in the policy for those operations specified; for those not specified the amounts were to be determined on the basis of comparative severity with the operations listed. The burden was upon Street to establish that the acts performed upon him constituted operations; that they were performed by a legally qualified physician or surgeon; and, finally, the amount he was entitled to be paid under the policy provisions.

As to the first, the jury found that the acts performed upon Street constituted operations. Cf. Century Indemnity Co. v. Carroll, 126 Tex. 214, 86 S.W.2d 1083. As to the second, we affirm the correctness of the holding of the Court of Civil Appeals in Street v. Continental Casualty Co., Tex.Civ.App., 339 S.W.2d 680 (in which wc dismissed the application for writ of error for want of jurisdiction). It is our opinion that a legally qualified doctor of dental surgery is a “legally qualified physician or surgeon” within the provisions of the insurance policy. The emphasis in the insurance contract is upon the legal qualification of the individual to perform the operation and not upon a particular field in the healing art. Article 4551a, Vernon’s Annotated Civil Statutes, expressly recognizes that a dental surgeon operates. The policy did not expressly exclude dental surgery, or operations performed by a dental surgeon, from its coverage. To effect this exclusion would require the addition of the qualifying words “in the field of medicine” following the phase “legally qualified physician or surgeon.” We made clear in Providence Washington Insurance Co. v. Proffitt, 150 Tex. 207, 239 S.W.2d 379, that a limitation of liability will not be added where none exists in the policy itself. Cf. Continental Casualty Co. v. Warren, 152 Tex. 164, 254 S.W.2d 762; Western Reserve Life Insurance Co. v. Meadows, 152 Tex. 559, 261 S.W.2d 554; State v. Beck, 21 R.I. 288, 43 A. 366, 45 L.R.A. 269.

But Street failed in the third requirement. There was no basis in the jury verdict for a recovery in his behalf.

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Bluebook (online)
379 S.W.2d 648, 7 Tex. Sup. Ct. J. 310, 1964 Tex. LEXIS 658, Counsel Stack Legal Research, https://law.counselstack.com/opinion/continental-casualty-company-v-street-tex-1964.