UNITED AMERICAN INSURANCE COMPANY v. Pittillo

308 S.W.2d 241, 1957 Tex. App. LEXIS 2258
CourtCourt of Appeals of Texas
DecidedNovember 7, 1957
Docket3484
StatusPublished
Cited by10 cases

This text of 308 S.W.2d 241 (UNITED AMERICAN INSURANCE COMPANY v. Pittillo) 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
UNITED AMERICAN INSURANCE COMPANY v. Pittillo, 308 S.W.2d 241, 1957 Tex. App. LEXIS 2258 (Tex. Ct. App. 1957).

Opinion

TIREY, Justice.

This suit (non-jury) was brought to recover on a hospital and surgical benefit insurance policy. In the decree we find this recital: “ * * * a jury being waived, all matters of fact as well as of law were submitted to the Court, who, after hearing the pleadings read, the evidence adduced and the argument of counsel, is of the opinion and so finds that the plaintiff is entitled to recover of and from the defendant on the policy sued upon the sum of $154.30, together with twelve per cent penalty amounting to the sum of $18.52 and an attorney’s fee in the sum of $150 to be taxed as a part of the costs in this cause” and the court decreed accordingly.

The insurance company in open court duly excepted to the judgment and gave notice of appeal to this court and perfected its appeal. There was no request for findings of fact and conclusions of law and none filed.

The decree entered is assailed on one point. It is to the effect that the court erred in granting judgment to appellee for hospital and surgical benefits under a hospital and surgical expense policy where the illness and loss resulted in a surgical operation before said policy had been in force for six months, such benefits being expressly excluded by the terms of the policy.

A statement is necessary.

It is admitted by appellee that the law suit for hospital and surgical expenses incurred resulted from a surgical operation occurring within six months of the date of the policy. The amount of the judgment was stipulated by the parties. Appellee went to trial on his original petition. He alleged substantially that on February 1, 1956, the defendant, for a valuable consideration to it in hand paid by him, issued its certain policy of health, accident, medical and sickness insurance wherein defendant agreed to and did insure him against loss and agreed to pay him against loss for hospital confinement, including doctor’s and surgeon’s fees resulting from sickness, which originated while the policy was in effect and after the date thereof, according to the terms of said policy here referred to and made a part thereof for all purposes; that thereafter on or about July 9, 1956, and while said policy and contract of insurance was in full force and effect and while all the premiums due thereon were fully paid, plaintiff became ill and consulted a physician on July 9, 1956, and was thereafter taken to Providence Hospital on July 19, 1956, and on July 20, 1956 was operated upon and incurred certain doctor’s bills and hospital bills, the amount of which are not here in dispute; that plaintiff seasonably filed proof of loss and that his claim was denied. He further sued for attorney’s fees by reason of the failure of the insurance company to pay his claim, and the amount of attorney’s fees found by the court is not questioned, except as to liability under the terms of the policy.

Appellee went to trial on its original answer and pertinent to this discussion entered a general denial and specially answered in effect that there was no liability under the terms of the policy and set out a clause in the policy denominated “limitations and exclusions,” being Part 10, Paragraph 2, which reads as follows:

“ * * * any loss, sickness or disability (except in connection with accidental bodily injury) which results in a surgical operation, shall be covered only if the cause thereof originates after this policy has been in continuous force for the preceding six months.”

*243 Appellant further specially pleaded that Policy H-236,409, upon which plaintiff sued, was issued to him February 1, 1956, and that the loss plaintiff incurred and for which he sued resulted from a surgical operation performed on July 20, 1956, namely a fissurectomy and pectinotomy, and that since said operation was performed less than six months from the effective date of said policy defendant is not liable for the loss incurred and for which plaintiff sues under the terms and provisions of the policy.

Appellee in his brief urges four counter points. They are substantially: (1) Where the language of a policy of insurance is unambiguous and susceptible of but one reasonable construction, the court will interpret it as made, and the policy sued on providing without qualification that appellant will pay the benefits provided therein for hospital confinement and other specified expense (b) resulting from sickness which originates while the policy is in effect and after the date hereof, the court therefore did not err in rendering judgment thereon in favor of appellee. (2) Where the language of an insurance policy is susceptible of more than one construction, it will be interpreted strictly against the insurer and liberally in favor of the insured, and since the policy sued on is susceptible of more than one construction, the trial court therefore did not err in interpreting the same strictly against the insurer and in favor of the insured and in rendering judgment in favor of appellee. (3) The law is well settled that a general exception which renders nugatory a prior specific provision, the general exception must yield to such prior specific provision, and since the policy provides in the insuring clause that the appellant will pay the benefits provided therein for hospital confinement and other specified expense resulting from sickness which originates while the policy is in effect and after the date hereof and thereafter provides that it will not pay any loss, sickness or disability unless the cause thereof originates after the policy has been in continuous force for the preceding six months, the latter provision is therefore repugnant to the prior specific provision, the prior specific provision will therefore prevail, and the trial court did not err in so holding. (4) Any ambiguity in an insurance contract which was drafted by the insurer will be resolved in favor of the insured against the insurer, and if the provision in the policy “that any loss, sickness or disability * * * which results in a surgical operation shall be covered only if the cause thereof originates after this policy has been in continuous force for the preceding six months” conflicts with the prior provision that appellant “will pay the benefits provided herein for hospital confinement and other specified expense (b) resulting from sickness, which originates while this policy is in effect and after the date hereof,” then the court properly resolved such conflict in favor of appellee and correctly rendered judgment against appellant.

Appellee relies on and cites the following authorities to sustain him in his counter points: 10 C.J.S. p. 338; Fidelity Union Cas. Co. v. Wilkinson, Tex.Civ.App., 94 S.W.2d 763 (aff. by S.Ct.); Franklin Life Ins. Co. v. Woodyard, Tex.Civ.App., 206 S.W.2d 93 (no writ history); Home Ins. Co., N. Y. v. Rose, 152 Tex. 222, 255 S.W.2d 861; Lloyds Casualty Insurer v. McCrary, 149 Tex. 172, 229 S.W.2d 605; Provident Life & Acc. Ins. Co. v. Deckard, Tex.Civ.App., 179 S.W.2d 828; Provident Life Ins. Co. v.

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Cite This Page — Counsel Stack

Bluebook (online)
308 S.W.2d 241, 1957 Tex. App. LEXIS 2258, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-american-insurance-company-v-pittillo-texapp-1957.