Jefferson v. Monumental General Insurance Co.

620 So. 2d 271, 1993 La. LEXIS 2166, 1993 WL 239948
Supreme Court of Louisiana·Decided July 1, 1993·No. No. 92-C-3182·Published·Cited by 1 cases

Opinions

CALOGERO, Chief Justice.*

We granted a Writ in this case to determine whether the plaintiff, Bobby Jefferson, is entitled to receive benefits for the amputation of his foot under an accident and dismemberment insurance policy which defines the loss of a foot as a “physical separation at or above the ankle joint.” For the following reasons we find that the physical separation of plaintiff’s foot occurred “at ... the ankle joint.” Therefore the injury was covered by the policy and plaintiff is entitled to the compensation provided, i.e., $25,000.

On August 6, 1988, plaintiff, Bobby Jefferson, was involved in an automobile accident which caused his severe injuries. He was treated initially at Jackson Parish Hospital in Jonesboro, Louisiana, and later transferred to Schumpert Medical Center in Shreveport. One of the injuries he suffered was a crushed left foot which required a Chopart amputation of the entire [272] foot at the level of the talus (ankle bone) and navicular bone and the calcaneus (heel bone) and cuboid bone.

At the time of the accident Jefferson had an accident and dismemberment policy with a principal sum of $50,000. According to the terms of the policy, Jefferson was to receive one-half of that principal sum ($25,-000) for “loss of one member.” 1 “Loss” was defined in the policy “with regard to foot, [as] physical separation at or above the ankle joint.” Jefferson filed a claim with defendant, Monumental General Insurance Company (hereinafter, Monumental), seeking compensation based on the loss of his foot at the ankle. Monumental denied the claim arguing that the amputation of the foot did not take place at or above the ankle joint.

Jefferson thereupon filed suit claiming that Monumental “arbitrarily and capriciously failed and refused to pay [the] claim.” Jefferson moved for and was granted a summary judgment by the 2nd Judicial District Court. The district judge found from Webster’s Dictionary, that the word “at” was "... a function word to indicate presence or occurrence in, on or near ...” The court reasoned that because the amputation was near the ankle joint, coverage existed under the policy. The Second Circuit Court of Appeal reversed plaintiff's favorable summary judgment and remanded the case to the trial court for full consideration of the facts and law. That court determined that a serious issue of material fact existed concerning the point at which the amputation actually occurred. Jefferson v. Monumental General Insurance Co., 577 So.2d 1184 (La. App. 2 Cir.1991).

On October 30, 1991, after a trial on the merits, the 2nd Judicial District Court once again rendered judgment in Jefferson’s favor against Monumental for $25,000. The district judge relied on the testimony of Jefferson’s treating physician and his own evaluation of Jefferson’s foot to arrive at his conclusion that Jefferson’s foot had been amputated at the ankle joint.2

Monumental appealed the judgment again. Jefferson v. Monumental General Insurance Co., 607 So.2d 851 (La.App. 2 Cir.1992). The court of appeal once more reversed the district court’s judgment, finding this time that the judgment was manifestly erroneous because “[t]he amputation clearly occurred below the ankle joint ...” Id. at 853. Moreover, the court noted that the insurance policy was not ambiguous, that “by its strict terms, any physical separation of the foot at a location below the ankle joint precludes recovery thereunder.” Id. at 852.

Jefferson then applied for this Writ of Certiorari which we granted in order to determine whether his injury was a covered loss within the terms of the policy. For on the following reasons, we find that the amputation of Jefferson’s foot occurred “at” the ankle joint. Therefore, the injury was covered by the policy and he is entitled to the compensation provided.

The Louisiana Civil Code provides the general rules for interpreting contracts and their provisions. According to C.C. art. 2047, “[t]he words of a contract or policy must be given their generally prevailing meaning”, and “[w]ords of art and technical terms must be given their technical meaning when the contract involves a technical matter.” Moreover, according to C.C. art. 2049, “[a] provision susceptible of different meanings must be interpreted with a meaning that renders it effective and not with one that renders it ineffective.”

The operative provision in question defines “loss ... with regard to foot, [as] [273] physical separation at or above the ankle joint.” However, the policy contains no definition or description as to what constitutes the ankle joint. Consequently, we must go beyond the four corners of the policy to establish the definition of an “ankle joint.”

The term “ankle joint” is not defined in the English dictionary. However, “ankle” and “joint” are individually defined. “Ankle”, according to Webster’s New Collegiate Dictionary is “the joint between the foot and the leg.” Webster’s defines “joint” as “the point of contact between elements of an animal skeleton with the parts that support and surround it.” Likewise, The Random House Dictionary of the English Language defines “ankle” as “the joint between the foot and the leg, in which movement occurs in two planes.” “Joint” is defined by the same dictionary as “the movable or fixed place or part where two bones or elements of a skeleton join.” Therefore, an extrapolated definition of “ankle joint” would seem to be the area of contact between the leg and the foot which includes the bones and elements that support and surround it, i.e., skin, bones, ligaments, muscles.

Although we have fashioned a definition of “ankle joint” based on individual definitions of “ankle” and “joint”, we note that the term is of a more technical nature, describing an anatomic location on the human body. Therefore, we are persuaded to refine our definition of “ankle joint” based on medical references.

According to Schmidt’s Attorneys’ Dictionary of Medicine,3 the ankle joint is a

... hinge joint between the lower end of the leg and the foot. The bones entering into the formation of the joint are the tibia (the inner of the two leg bones), the fibula (the outer of the two leg bones), and the talus (the highest of the
bones in the back of the foot) ... The chief ligaments holding the bones together are the deltoid, talofibular, and calcaneofibular ... (Emphasis added.)

The ankle joint is also defined in Legal Anatomy and Surgery,4 which states:

The Ankle Joint — The ankle is a perfect hinge joint, made up of the lower end and internal malleolus of the tibia, the external malleolus of the fibula, and the upper and lateral surfaces of the astragalus (heel bone) ... The ankle joint is a very powerful articulation, bound together by unyielding ligaments and many tendons ... Four important ligaments bind the ankle joint together: the anterior, posterior, internal lateral, and external lateral ... (Emphasis added.)

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Jefferson v. Monumental General Insurance Co., 620 So. 2d 271, 1993 La. LEXIS 2166, 1993 WL 239948 (La. 1993).

620 So. 2d 271 (Jefferson v. Monumental General Insurance Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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