Craver v. Union Fidelity Life Ins.

298 N.E.2d 918, 35 Ohio Misc. 15, 64 Ohio Op. 2d 147, 1973 Ohio Misc. LEXIS 220
CourtCourt of Common Pleas of Ohio, Hamilton County
DecidedApril 10, 1973
DocketNo. A-262679
StatusPublished
Cited by8 cases

This text of 298 N.E.2d 918 (Craver v. Union Fidelity Life Ins.) is published on Counsel Stack Legal Research, covering Court of Common Pleas of Ohio, Hamilton County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Craver v. Union Fidelity Life Ins., 298 N.E.2d 918, 35 Ohio Misc. 15, 64 Ohio Op. 2d 147, 1973 Ohio Misc. LEXIS 220 (Ohio Super. Ct. 1973).

Opinion

Bettman, J.

Plaintiff’s action herein seeks a declaratory judgment as to the meaning of a health and accident insurance policy and damages. It was stipulated by the [16]*16parties that plaintiff’s Exhibit A is the policy issued to plaintiff by defendant and that plaintiff’s Exhibit C is the advertisement run in a Cincinnati daily newspaper pursuant to which plaintiff purchased the policy. It was further stipulated that plaintiff’s spouse was confined in a hospital for a period of 28.14 weeks, and that defendant paid plaintiff $500 for five weeks of such confinement and refused to pay under the policy issued by it for the balance of 23.14 weeks. It was further stipulated that the 23.14 weeks of confinement was a result of conditions of plaintiff’s spouse preexisting the date of issuance of the policy.

The policy, plaintiff’s Exhibit A, on the first page under the large caption “Weekly Hospital BeNefit,” states:

“When injury or sickness necessitates hospital confinement as a resident patient, we will pay at the rate of the Weekly Indemnity designated in the Policy Schedule for the period of hospital confinement, beginning with the first day of confinement and not exceeding one-hundred (100) weeks as a result of any one injury or sickness.”

In the middle of page 2, under the caption “Definitions,” the fifth of eight paragraphs states:

“ ‘Sickness’ means sickness or disease resulting in hospital confinement where such sickness or disease is first manifested after the effective date of the policy and while the policy is in force.”

Also on page 2, under the heading “Becurbent ConditioNs, ’ ’ the policy states:

“If benefits have become payable under this policy and you are again confined to the hospital due to the same or a related injury or sickness, the subsequent period of hospital confinement shall be considered a continuation of the prior period, unless full normal activities were resumed for at least six (6) months between such confinements, in which event the subsequent period of hospital confinement shall be considered as resulting from a different injury or sickness. ’ ’

Under the caption “Exclusions” on page two, the policy states only:

[17]*17“We will not pay yon benefits for any loss caused by or resulting from: (1) war or any act of Avar; (2) any mental disorder; (3) pregnancy, childbirth or miscarriage or complications therefrom”

On page 3 of the policy, under the general heading “GeNeral Provisions,” the policy states in a paragraph captioned “Time Limit On Certain Defenses”:

“No claim for loss incurred or disability (as defined in this policy) commencing after tAVo (2) years from the effective date of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.”

This policy was purchased by plaintiff in response to defendant’s advertisement (plaintiff’s Exhibit C). This advertisement starts out in oversized lettering “You get $100 a week whenever you go to the hospital!”:

“At last, here is a plan that actually pays you . . . Extra Cash from the first day in the hospital. ’ ’

On the second page, also in very large letters, it says:

“You get $100.00 a week tax-free ... Avithout any qualifications whatsoever.”

And then in smaller letters the following appears:

“Wouldn’t it be comforting to know these financial problems could be solved by your extra cash plan? This plan gives you tax-free extra cash from the first day in the hospital for up to one hundred full weeks.”

Then, on page 3, also in large letters, it says:

“You can be secure, knowing that when hospitalization is necessary, you will receive: $100.00 a week tax-free when you go to the hospital; $100.00 a week from the first day in the hospital.”

Finally, on page 5, in small print, the advertisement states:

“These are the only exclusions! The new Union Fidelity ‘Extra Income Hospital Plan’ has No Waiting Period. It covers you immediately for every kind of sickness and accident except, of course, hospitalization caused [18]*18by mental disorders; act of war; pregnancy, childbirth or miscarriage; or care provided in a government hospital. What’s more, if you’ve been sick before, or if yon are sick now, you’ll be covered even for this condition after your policy has been in effect for only 2 years. EverythiNg Else Is Covered.”

The principle is long established that where an insurance contract is ambiguous it is to be construed most strongly against the company which drew it. The policy in this case provides that the defendant Company will pay $100.00 per week when injury or sickness necessitates hospital confinement. It defines sickness by saying that means sickness or disease resulting in hospital confinement where such sickness or disease is first manifested after the effective day of the policy and while the policy is in force. The company contends that this definition of sickness means that any hospitalization due to a condition of the patient existing prior to the policy is not covered. We cannot accept this interpretation.

It would have been a simple thing for the policy to say: “No coverage is provided for any hospitalization which was due to a condition of the plaintiff which existed prior to the effective date of the policy.” It did not say this. It said: “where such sickness or disease is first manifested after the effective date of the policy.” This could perfectly well mean that if you were sick at the time the policy was taken out, that sickness would not be covered, but if you got sick sometime after the policy went into effect, you would be covered. In our judgment this is a patent ambiguity which must be interpreted against the defendant company.

It must be borne in mind that this type of policy is designed to be sold to the ordinary person. In fact, the policy, according to the advertisement, could be put into effect upon the payment of $1. The words of the policy must, therefore, be given their ordinary meaning to an average person not the meaning they might have to the highly wary or to someone skilled in the law. Furthermore in interpreting the contract one must bear in mind the [19]*19thrust of the advertising brochure. Although the contract provides: “This policy, including endorsements and attached papers, if any, constitute the entire contract of insurance,” the words of the advertising brochure put out by the Company should be considered as they affect the thinking of an ordinary person as to the meaning of the words in the policy itself. For that reason the constantly reiterated language in the advertising brochure that $100.00 a week will be paid from the first day the policyholder enters the hospital must be borne in mind.

Our conclusion therefore is that the language of the policy covers any new hospitalization for a sickness which manifested itself after the date of the policy and that plaintiff is therefore entitled to coverage at the rate of $100 per week for the 23.14 weeks in which his wife was in the hospital.

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Cite This Page — Counsel Stack

Bluebook (online)
298 N.E.2d 918, 35 Ohio Misc. 15, 64 Ohio Op. 2d 147, 1973 Ohio Misc. LEXIS 220, Counsel Stack Legal Research, https://law.counselstack.com/opinion/craver-v-union-fidelity-life-ins-ohctcomplhamilt-1973.