Group Hospital Service, Inc. v. Bass

252 S.W.2d 507, 1952 Tex. App. LEXIS 1775
CourtCourt of Appeals of Texas
DecidedSeptember 11, 1952
Docket4824
StatusPublished
Cited by3 cases

This text of 252 S.W.2d 507 (Group Hospital Service, Inc. v. Bass) 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
Group Hospital Service, Inc. v. Bass, 252 S.W.2d 507, 1952 Tex. App. LEXIS 1775 (Tex. Ct. App. 1952).

Opinions

WALKER, Associate Justice.

This action was brought on a contract of insurance to recover the cost of care and services rendered the insured by a hospital in' which an operation was performed on the feet of the insured and also to recover the cost of the services rendered by the attending physician. The appellant Group Hospital Service, Inc., also the defendant, was the insurer. The wife of E. J. Bass was the person insured, and Mr. Bass is the plaintiff. The cause was tried to the court without a jury, and the trial court rendered judgment in plaintiff’s behalf only for the cost of the hospital care and services; this amounted to $146.25. From this judgment the defendant has appealed. No findings of fact have been- filed and we must, therefore, assume that all issues of fact were resolved in favor of the plaintiff.

The defendant is a nonprofit corporation, organized and operating under Acts 1939, 46 Leg., p. 123, formerly Chapter 14, Title 71, V.A.T.S. and now Chapter 20 of the Insurance Code, V.A.T.S. Insurance Code, § 20.01 et seq.

The contract of insurance between defendant and Mrs. Bass is expressed in a certificate, dated June 15, 1950, issued to Mrs. Bass by defendant. On June 11, 1951, about a year afterward, Mrs. Bass entered the hospital for the purpose of having an operation performed to correct bunions. This was the operation which we have mentioned, and the hospital care and services which constitute the basis of the claim against defendant were rendered as incidents of, and consequences of this operation. Mrs. Bass had a bunion on each foot, and an operation was performed on .each bunion. Mrs. Bass had these bunions when she made the .contract of insurance with defendant, and the defendant argues that the treatment given her in the hospital was excluded from the contract by the following provisions of the certificate: “VI. Services not included, The benefits of the plan are not available for: F. Treatment for physical conditions existing at the time the patient became a subscriber to the plan. * * * I. Care 'received for any condition while plaintiff is confined to hospital for a condition for which the benefits of the plan aré not available—

Although the bunions were in existence when the certificate was issued to Mrs. Bass (and had been in existence and in the process of formation for several years prior to 'that date) these bunions did not then interfere with Mrs. Bass’ activities and did' not require treatment of the sort given Mrs. Bass in the hospital. Indeed, there is no evidence that any other treatment had ever been given the bunions. Mrs. Bass was a practical nurse, and she testified that the bunions “wasn’t bothering me to amount to anything. I was able to do my nursing and house work.”

However, after the policy was issued and while it was in force, Mrs. Bass struck the left bunion against a door, and the condition of this bunion became worse and eventually required the treatment which was given it in the hospital. The evidence raises, the issue, which the-trial court has resolved in plaintiff’s favor, that the blow caused this condition, and that this condition was not the result of a natural development of the bunion, unaffected by the blow.

The ’bunion on the right foot did not require the treatment given it in the hospital, but the attending physician concluded that it probably would do so eventually, and he recommended that the operation be performed. on both feet to avoid a second operation in the future; and this was the reason why the bunion on the right foot was given the treatment it received. The [509]*509following testimony of the physician - expresses these conclusions: “The left foot was a therapeutic operation or treatment for an existing condition, and the right foot was prophylactic. This is an exceedingly painful operation. I think some of these people suffer from these operations more than from large bone operations I perform, so I did not feel right putting her through the operation to treat the condition then existing and then waiting a year or two until she had trouble -wi-th .the' right o.ne and bring her back to it. I just did them both at one time to prevent further. expense, hospitalization.”

We hold that the treatment given Mrs. Bass’ left foot was covered by the contract of insurance and that it was not' excluded from the contract by the provision quoted above. That provision excluded liability for treatment for “physical conditions existing” when the contract was made; and the condition of the left foot which was treated did not exist then and was not a consequence of a condition which did exist then. It was the product of a blow which happened afterward. Perhaps the bunion was more susceptible to injury by such a blow than another part of the foot was, .but that fact alone was not a defense to the claim for the hospital treatment given Mrs. Bass’ left foot.

However, so far as we can perceive from the record before us, the condition of the bunion on the right foot at the time of the operation did exist when the certificate was issued to Mrs. Bass; and the cost of the hospital treatment given the right foot was not covered by the contract of insurance.

These conclusions suggest the question, whether the sum charged for the hospital care and services rendered Mrs. Bass would have been less if only the left foot had been operated on. It is not entirely clear to us that defendant intends to raise this issue; but there is some evidence, though not much, that the cost of Mrs. Bass’ hospital treatment would have been the same if the operation had been performed on only the left foot. • Thus, the parties made the following stipulation: “It is stipulated that in the event the defendant -is liable at all that the bill for $146.25 rendered by St. Mary’s hospital for hospitalization services would be reasonable and proper and would be within the schedule of obligations of. the hospitalization certificates issued by. the defendant.” The trial court could construe this .under the facts as meaning that- the total charge would be proper if defendant was liable for the operation on only one foot. The attending physician testified: “Q. As a matter of fact, the cost of the hospital care she had would have been the same .or approximately the same if you had operated only on one foot instead of the two, and your fee wotild have been the same, .or approximately the same? A., Slightly lower.” The question asked by counsel included several questions, and the physician’s answer may have been made in response to the last of the questions included, that concerning this fee. Such an answer would imply an assent to counsel’s statement that the cost of the hospital care would have been the same, or approximately the same, if the operation had been performed on only one foot, and this implication would afford some support for the trial court’s judgment. We accordingly give the testimony -this construction because we must interpret the testimony so as to support the judgment of the trial court.

Points 1 to 4, inclusive, are overruled on the basis of the conclusions which we have expressed.

Defendant filed a plea of privilege, praying transfer to Dallas County, the county of its domicile. Plaintiff controverted this plea and alleged that the trial court had venue of the suit under Section 28 of Art. 1995, V.A.T.S. The plea and the merits of the cause were tried together, and the plea was overruled. Point 5 assigns error to the order overruling the pleá. The only argument made by defendant under Point 5 is founded, upon the following provisions of Art.

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Group Hospital Service, Inc. v. Bass
252 S.W.2d 507 (Court of Appeals of Texas, 1952)

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Bluebook (online)
252 S.W.2d 507, 1952 Tex. App. LEXIS 1775, Counsel Stack Legal Research, https://law.counselstack.com/opinion/group-hospital-service-inc-v-bass-texapp-1952.