Utterback v. American Security Life Insurance

165 So. 2d 39, 1964 La. App. LEXIS 1724
CourtLouisiana Court of Appeal
DecidedJune 1, 1964
DocketNo. 1472
StatusPublished
Cited by4 cases

This text of 165 So. 2d 39 (Utterback v. American Security Life Insurance) 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
Utterback v. American Security Life Insurance, 165 So. 2d 39, 1964 La. App. LEXIS 1724 (La. Ct. App. 1964).

Opinion

REGAN, Judge.

This suit was instituted by the plaintiffs, Anieta Utterback Cunniffe and Leonard A. Ferrell, as the sole heirs of the late Zella B. Utterback, endeavoring to recover the sum of $700.00 as reimbursement of expenditures incurred for hospitalization, laboratory tests, medicine, and oxygen in conformity with the provisions of two insurance policies issued to the decedent by the defendant, American Security Life Insurance Company. Plaintiffs also request the rendition of a judgment for penalties and [40]*40attorney’s fees for unreasonable refusal to pay the foregoing amount in accordance with the statutory law of this state.1

Defendant answered, basing its defense on the theory that the expenditures sued for were not encompassed by the terms of the policies since the disease which caused the insured’s hospitalization existed prior to the date of the issuance thereof. Defendant also reconvened to recover $95.00, which it had previously paid under the policies.

From a judgment in favor of the defendant, the plaintiffs have prosecuted this appeal.

The record reveals that on September 25, 1958, the defendant issued to Zella B. Utter-back a “Hospital and Surgical Expense Policy” and a “Hospital Room Expense Policy”, and that the premiums thereon were paid through December 19, 1961, when the policies were canceled by the defendant. When the contracts of insurance were issued, the insured had attained the age of seventy-four years.

On September 23, 1961, the insured was admitted to the Hotel Dieu, a hospital located in the City of New Orleans, and incurred therein the expenses which form the subject matter of this suit. She remained therein on this occasion until November 26, 1961. It is undisputed that if the defendant is liable under these policies, the amount due is $795.00, subject to a credit of $95.00 for part of the insured’s expenses paid by the defendant on November 14, 1961.

The clause of the policy upon which defendant predicates its defense provides that Mrs. Utterback is insured “from sickness the cause of which originates while this policy is in force and more than 15 days after the date hereof.” The defendant thus denies coverage on the ground that Mrs. Utterback’s hospitalization was brought about because of hypertension, heart disease, and related conditions which existed prior to the issuance of the policies.

Therefore, the question posed for our consideration is whether the insured was hospitalized solely as a result of a sickness the cause of which originated prior to the effective date of the contracts of insurance.

The defendant requested the appearance of two physicians as witnesses on the trial hereof in an effort to prove that the cause of the insured’s illness predated the policy. The first was her personal physician, Dr. Robert E. Gillaspie, who treated the insured at the time of her hospitalization and for several years prior thereto. The second was Dr. L. M. Redding, the Medical Director of the defendant insurer, who never examined the insured but testified solely from her medical and hospital records. A careful analysis of the testimony of these two physicians convinces us that there exists no doubt whatever that the insured suffered from high blood pressure and heart disease prior to the issuance of the policies by the defendant.

However, relative to the reason for the insured’s hospitalization on September 23, 1961, Dr. Gillaspie, the treating physician, very pertinently testified as follows:

“BY MR. RAINOLD:
“Q. You were in charge of the lady at the time she was in Hotel Dieu, the fatal illness? She was admitted September Twenty-third of 1961?
“A. That’s correct.
“Q. What did the lady die from?
“A. Well, at the time she was admitted I got the impression she had a cerebral thrombosis. She was admitted in the semi-comatose state. That was my diagnosis. This is a condition which is closely akin to a stroke. There was some slight difference, however, and we see it as a result of age. [41]*41By cerebral thrombosis I mean that the arteries, or some arteries in the brain become occluded and eventually a clot forms in the artery and any part of the brain that the artery is feeding oxygen does not get the blood and it regresses or dies, becomes dead tissue.
“Q. What significance does the hypertensive condition and high blood pressure have to the condition you have just described?
“A. I don’t see that it would go hand in hand. Again, I’d say that I have seen people with cerebral thrombosis who haven’t high blood pressure, never had it, and you see them with both situations. I don’t believe the two are related. We make a distinction now from a stroke or a cerebral vascular accident that goes hand in hand with pressure.
“Q. Did you have any evidence she had a cerebral accident?
“A. No, sir, I didn’t, and I have reasons for that. I’ll be glad to explain them.
“Q. I don’t know if that’s significant at this time.
“A. All right.
“Q. What was the condition of her heart when she was in the hospital, Doctor? Would you like to see the Hotel Dieu record? Do you have a copy of it there ?
“A. I don’t believe. I don’t have a copy of the record, no.
“Q. I hand you, Doctor, an exhibit known as Defendant D-Four, which is previously introduced and which is a copy of the Hotel Dieu record of admission, starting September Twenty-third of 1961?
“A. What was the question, please, sir?
“Q. The question was what was the condition of the heart at the time she was in the hospital then, Doctor?
“A. Well, I made a note, my own note, that she was again in this state of congestive heart failure she had been in, in 1956.
“Q. Uh huh?
“A. And, of course, that’s reasonable because here is a patient that is comatose. Naturally, it has quite an effect on the heart and that’s part of the diagnosis.
“Q. Doctor, did you have any note or recollection that the patient had suffered a stroke on April of 1961?
“A. No, sir, I certainly don’t because I saw her in March of 1961 and as far as I know, she didn’t have any stroke in April of 1961. I’m sure I would have known about it.
“Q. Did you at any time treat her for a stroke previous to the time she entered Hotel Dieu on September Twenty-third of 1961 ?
“A. Well, now, there seems to be— it seems like I visited her at home on several occasions and it could have been around that time. The dates — at which time again, I thought she was having this cerebral angio-spasm, or thrombosis, at which time this was my impression. Now that you recall that to my mind, that’s correct.
“Q. I show you the hospital record marked D-Four, and I call your [42]*42attention to Page Two, the opening note, and ask you to read it, Doctor.
(Document read silently by the witness.)

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Bluebook (online)
165 So. 2d 39, 1964 La. App. LEXIS 1724, Counsel Stack Legal Research, https://law.counselstack.com/opinion/utterback-v-american-security-life-insurance-lactapp-1964.