Old Southern Life Insurance Company v. Moore

204 So. 2d 828, 44 Ala. App. 183, 1967 Ala. App. LEXIS 454
CourtAlabama Court of Appeals
DecidedApril 18, 1967
Docket4 Div. 587
StatusPublished
Cited by2 cases

This text of 204 So. 2d 828 (Old Southern Life Insurance Company v. Moore) is published on Counsel Stack Legal Research, covering Alabama Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Old Southern Life Insurance Company v. Moore, 204 So. 2d 828, 44 Ala. App. 183, 1967 Ala. App. LEXIS 454 (Ala. Ct. App. 1967).

Opinions

JOHNSON, Judge.

This is an appeal from a judgment of the Circuit Court of Covington County, Alabama, awarding appellee, Lois N. Moore, $716.00 damages on a health and accident insurance policy. On July 13, 1965, the policy in question was sold by Old Southern Life Insurance Company to appellee, a twenty-eight year old widow, and her minor son. The policy was actually issued to appellee on July 15, 1965, and enumerated certain specific hospital and surgical benefits to appellant and her son, which included hospital room and board, necessary miscellaneous hospital expenses, and doctor’s fee while in the hospital. More specifically, the policy stated in part:

“(a) Hospital Room and Board, at the rate of the Daily Room Benefits stated in the hospital Schedule for the number of days of hospital confinement, but not exceeding 120 days as a result of any one sickness or any one accident.
“(b) Necessary Miscellaneous Hospital Expense at an amount each day not to exceed the daily room benefit, incurred by utilization of X-ray, Anesthesia, Laboratory, Operating room, Drugs and Medicine, use of Oxygen, Surgical Dressings, and Ambulance Service. These benefits are specifically limited to a total which shall not exceed ten times the daily room benefit of this policy.”

A sixty day waiting period was contained in the policy. This was waived by the Company and the benefits could take immediate effect except for pregnancy of the insured. The daily hospital indemnity as stipulated in the policy was $15.00 per day.

The policy contained the following provision with reference to surgical benefits:

“Payment shall be made for any cutting operation not named above, but otherwise complying with the conditions of this policy, in proportion to benefits provided for comparable operations, the amount to be determined by the Company. No benefits will be paid for dentistry.”

There is listed in the policy a procedure for notice by the claimant to the Company of claim. This required written notice within thirty days after the occurrence to the insuror was here complied with by appellee in full.

On August 11, 1965, appellee was hospitalized for two days because of a kidney stone. She was again hospitalized on August 23, 1965, for the same illness, and again on September 16, 1965, at which time she underwent an operation for removal of the kidney stone.

Appellant contends that the possible existence of the kidney stone at the issuance date of the policy was, in effect, an illness of appellee at the time of its issuance, thereby voiding the contract of insurance— even if without Mrs. Moore’s knowledge of her possible illness.

Mrs. Moore testified that she had never had any trouble with her kidneys prior to August 11, 1965, and no evidence was introduced to the contrary. The record states the following:

“Q. Was the hospitalization, all three of these that we are talking about, was it for the kidney trouble?
“A. Yes, it was.
“Q. Did that ultimately result in an operation during your last confinement?
“A. Yes, it did.
“Q. To remove a kidney stone?
“A. That’s right.
“Q. Now Mrs. Moore, before this policy was issued had you ever had any kidney trouble that you know about?
“A. No, sir.
[185]*185“Q. I believe the hospital records that will later be introduced shows that you went to Dr. Gunnels the first time about August 11. Did he put you right in the hospital then?
“A. Yes, he did.
“Q. Had you had any trouble prior to going to Dr. Gunnels ?
“A. No.
“Q. What was the very first knowledge that you had of any trouble with regard to your kidneys ? How long before you went to the doctor was it before you first noticed anything at all pertaining to it or any other symptoms?
“A. It was about a week and four days before I went to see the doctor. I saw blood coming through the kidneys.
“Q. Was that the first symptom or knowledge of any kind that you had any trouble of this nature?
“A. It was.
“Q. Had you had any past history of anything of this type?
“A. No, sir.
‡ * * * *
“Q. At the time she sold you this policy did she also sell you a rider, or as it is styled here ‘Policy Amendment’, which said the waiting period for sickness and surgery, except for pregnancy, that may be shown on this policy is hereby waived to as to extend to and cover sickness and/or surgery resulting from sickness which originates after the effective date of this policy?
“A. She did.
“Q. She charged a premium for that?
“A. Yes.
“Q. Now at the time she sold you this policy had you had any trouble about your kidney, any symptoms or anything like that?
“A. No, sir.
“Q. If it was four days to a week before you went in the hospital it would have been early in August?
“A. In August.
“Q. Before you knew anything about it?
“A. That’s right.
“Q. Now did the agent, Mrs. Gentry, she asked you, I assume, some questions on this application about past medical history, did she not?
“A. Yes, she did.
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“Q. You had never had any kidney treatment or any doctor to diagnose that you had any kind of kidney trouble prior to this going to Dr. Gunnels in August, is that right?
“A. That’s right.”

Appellee claimed in her original complaint the sum of $561.00 plus interest and costs for her loss as a result of expenses for hospitalization and surgery, and failure of Old Southern Life Insurance Company to pay her claim. After the Company’s demurrer and answer appellee amended her complaint and added two additional counts — Count 2, $62.00 plus interest and costs for the hospitalization of August 11-13, 1965; and Count 3, $93.00 plus interest and costs for the hospitalization of August 23-27, 1965. Appellant withdrew his answer and filed his plea. The verdict was for appellee for $716.00.

Appellant lumped for argument Assignments of Error 1-5, 7-9, and 12-17, all of which relate to various aspects of when the kidney disease was chargeable to plaintiff’s knowledge.

Appellant’s second argument rests on a claimed misrepresentation at inception of the policy.

Appellant introduced as Defendant’s Exhibit No. 1, as agreed by the attorneys, the August 11, 1965, hospital report on Mrs. [186]*186Moore as prepared by Dr. W. A. Gunnels, the attending physician. This stated in part as follows:

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204 So. 2d 828, 44 Ala. App. 183, 1967 Ala. App. LEXIS 454, Counsel Stack Legal Research, https://law.counselstack.com/opinion/old-southern-life-insurance-company-v-moore-alactapp-1967.