McKinney v. American Security Life Insurance Co.

76 So. 2d 630, 1954 La. App. LEXIS 973
CourtLouisiana Court of Appeal
DecidedDecember 1, 1954
Docket8249
StatusPublished
Cited by34 cases

This text of 76 So. 2d 630 (McKinney v. American Security Life Insurance Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McKinney v. American Security Life Insurance Co., 76 So. 2d 630, 1954 La. App. LEXIS 973 (La. Ct. App. 1954).

Opinion

76 So.2d 630 (1954)

Noah W. McKINNEY, Plaintiff-Appellee,
v.
AMERICAN SECURITY LIFE INSURANCE COMPANY, Defendant-Appellant.

No. 8249.

Court of Appeal of Louisiana, Second Circuit.

December 1, 1954.
Rehearing Denied January 4, 1955.
Writ of Certiorari Denied February 14, 1955.

*631 Mecom, Scott & Despot, Shreveport, for appellant.

W. T. Holloway and D. T. Caldwell, Jonesboro, for appellee.

GLADNEY, Judge.

This is an action to recover indemnity for hospital confinement and other expenses resulting from sickness allegedly provided by the policy issued by the defendant to cover hospitalization and surgical expense.

After trial there was judgment in favor of plaintiff for the amount stipulated but with rejection of statutory penalties as claimed by plaintiff under the provisions of LSA-R.S. 22:657, including attorneys' fees of $250. From a judgment so rendered the defendant has perfected a suspensive and devolutive appeal and plaintiff has answered the appeal to secure the full amount of penalties denied by the trial court.

*632 Plaintiff is a resident of Jackson Parish, Louisiana, and obtained the policy effective as of April 25, 1953. The insured therein named includes plaintiff and his wife, for which a monthly premium of $10.80 or an annual payment of $121.80 is charged. It is alleged that from August 17, 1953, plaintiff was confined to the McDonald Clinic, a recognized hospital situated in Jonesboro, Louisiana, suffering from an acute skin eruption and because of a nervous condition or pain of the nerves. Upon demand being made for payment of the hospitalization, to which he thought he was entitled, his claim was rejected by the insurer, whereupon suit was instituted.

In lieu of the taking of testimony the parties stipulated the essential facts to a determination of the cause as follows:

"That plaintiff, Noah W. McKinney, was necessarily confined within the McDonald Clinic, Jonesboro, Louisiana, as a bed patient between the dates of August 17, 1953, and August 29, 1953, a total of twelve (12) days, said confinement being due to an acute skin eruption resulting from a nervous condition.
"That at the time there was in full force and effect one certain policy of hospitalization insurance issued by defendant, American Security Life Insurance Company, the original of which is attached to plaintiff's petition herein and incorporated herewith by reference, under which policy defendant agreed to pay to claimant the sum of Seven Dollars and Fifty Cents ($7.50) per day of hospital confinement, and certain other benefits, the grand total of which amounts to One Hundred Five and No/100 ($105.00) Dollars, which sum would be the sum due and payable plaintiff should it be determined by the court that said illness and resulting confinement was covered by said policy, plus statutory damages and attorneys' fees should the court further find that the failure to pay the claim when submitted was without just and reasonable grounds, such as would put a reasonable and prudent business man on his guard.
"That the place of confinement, the McDonald Clinic, did not have at the time of said confinement, X-ray equipment, although the same was readily available as hereinafter set forth, nor did it have a graduate registered nurse always on duty, but rather only during the day, while at night a practical nurse was on duty, and that the fact these things were absent was known to insurer at the time of refusal to pay said claim when submitted by claimant, but it was not known that X-ray equipment was available as set forth hereinabove and hereinafter.
"That other than the matters mentioned in (III) above, all of the requirements of a `hospital' under the policy are met by the McDonald Clinic.
"That notice and proofs of loss were furnished to defendant by plaintiff more than thirty days before suit was filed.
"That the person to whom the sum set forth hereinabove is due, if any be due at all, is the plaintiff, Noah W. McKinney.
"That Dr. C. S. McDonald has practiced medicine in Jackson Parish, Louisiana, for more than forty years, that he is now and at the time of the above mentioned confinement a registered and licensed practicing physician; that the McDonald Clinic can provide beds for approximately eight patients; that there are on the average five patients confined in the Clinic; that Dr. McDonald has an agreement with Dr. Robinson in Jonesboro and Dr. Green in Ruston for him to use their X-ray equipment; that approximately 150 babies are delivered at the Clinic per year; that the biggest portion of the revenue going to the Clinic is collected under health and accident policies.
"That more than twenty health and accident insurance companies pay *633 claims for confinement at the Clinic without question, including National Bankers Life Ins. Co., The Paul Revere Life Insurance Company, Reserve Life Insurance Company, Combined Insurance Company of America, Bankers Life and Casualty Co., Lumberman's Mutual Casualty Co., and the Pilot Life Insurance Company.
"That the failure of the McDonald Clinic to have a registered graduate nurse on duty all of the time plaintiff was confined, and the lack of X-ray equipment on the premises did not impede plaintiff's recovery.
"That the admissions made herein by both parties are admissions of fact only and do not necessarily admit the relevancy of said facts, this being reserved to the arguments and the briefs to be filed herein."

This court is confronted with the resolution of three principal issues: (1) Whether the McDonald Clinic can be considered a "hospital" within the definition of a hospital as prescribed in the policy; (2) Whether or not the cause of plaintiff's confining illness is excluded from a particular limitation contained in the policy which provides: "This policy does not cover * * * hospitalization or any other loss for nervous or mental disorders, rest cure or alcoholism * * *"; and (3) The entitlement to statutory penalties under LSA-R.S. 22:657.

An insurance policy is a contract to which rules for construction of written instruments apply. In resolving the meaning of a policy effect must be given to every part of the insurance policy if possible, and while all ambiguities in the policy must be construed in the insured's favor and against the insurer, the policy, from terms of which the parties' intent is evident, must be given a reasonable interpretation consonant with its apparent object and the parties' plain intent. Quinones v. Life & Casualty Insurance Company of Tennessee, 1945, 209 La. 76, 24 So.2d 270; Hemel v. State Farm Mutual Auto Ins. Co., 1947, 211 La. 95, 29 So.2d 483; Stanley v. Cryer Drilling Company, 1948, 213 La. 980, 36 So. 2d 9; Oil Well Supply Company v. New York Life Insurance Co., 1949, 214 La. 772, 38 So.2d 777; Moll v. Mutual Health Benefit & Accident Ass'n, 1953, 223 La. 511, 66 So.2d 320. The intention of the parties is of paramount importance and must be determined in accordance with plain, ordinary and popular sense of the language used in the agreement and by giving consideration on a practical, reasonable and fair basis to the instrument in its entirety. Beard v.

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Bluebook (online)
76 So. 2d 630, 1954 La. App. LEXIS 973, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mckinney-v-american-security-life-insurance-co-lactapp-1954.