Van Deusen v. Connecticut General Life Insurance Co.

514 S.W.2d 951, 1974 Tex. App. LEXIS 2671
CourtCourt of Appeals of Texas
DecidedOctober 11, 1974
Docket17536
StatusPublished
Cited by12 cases

This text of 514 S.W.2d 951 (Van Deusen v. Connecticut General Life Insurance Co.) 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
Van Deusen v. Connecticut General Life Insurance Co., 514 S.W.2d 951, 1974 Tex. App. LEXIS 2671 (Tex. Ct. App. 1974).

Opinion

OPINION

BREWSTER, Justice.

The plaintiff, Roland C. Van Deusen, individually and as administrator of the estate of his deceased wife, Merle Van Deu-sen, filed this suit against the defendant, Connecticut General Life Insurance Company, seeking to recover on a group health insurance policy that provided coverage for the plaintiff and his wife should they become ill and require hospitalization and medical care. The defendant, insurance company, filed a cross-action against plaintiff alleging that prior to the occasion when the illness involved occurred that as a result of a mutual mistake of the parties it had paid to the plaintiff and his wife benefits under the same policy that it did not actually owe to them. The defendant prayed that plaintiff take nothing or in the alternative that this sum that it paid by mistake to plaintiff and his wife be set off against the sums that it did owe to plaintiff under the policy sued upon.

Following a jury trial a judgment was rendered decreeing that plaintiff take nothing by his suit and plaintiff is here appealing from that decree.

We affirm.

The following facts were either undisputed or were stipulated by the parties: on March 18, 1970, the plaintiffs wife, Merle Van Deusen, was an employee of Harris Costumes; Harris Costumes then had in force a policy of workmen’s compensation insurance issued to it by United States Fidelity and Guaranty Insurance Company; on March 18, 1970, while she was on the job working for her employer, Harris Costumes, the plaintiff’s wife, Merle Van Deusen, suffered a heart attack by reason of which she was hospitalized for three weeks; and on April 30, 1970 she was hospitalized for another period of time; as a result of those illnesses Merle Van Deusen incurred $3,274.01 in doctor and hospital bills; at all times material here the group insurance policy that was here sued on by plaintiff was also in full force and effect; this group policy had been issued by the defendant to Jerome Tailors, the employer of plaintiff, Roland C. Van Deusen, and it provided coverage for the plaintiff and his wife, Merle Van Deusen, in the event they became ill and required hospitalization, *953 surgery, etc.; on March 23, 1971, Merle Van Deusen had cancer and by reason thereof she entered a hospital and remained there until she died on May 7, 1971; by reason of this last illness she reasonably and necessarily incurred a doctor’s bill of $429.00 and a hospital bill of $2,675.45; these two items are the ones plaintiff seeks to recover in the suit he here brought against the defendant on the group policy.

The group insurance policy involved here contained the following clause:

“No payment will be made under this policy for expenses incurred by an Employee or a Dependent

“2. for or in connection with a sickness for which the Employee or Dependent is entitled to benefits under any workmen’s compensation or similar law.”

After Merle Van Deusen incurred the $3,274.01 in expenses in connection with the heart attack in 1970, she did on June 12, 1970 execute a notice of injury and a claim for compensation and filed them with the Industrial Accident Board. Therein she made a claim that the heart attack was an injury that she sustained in the course of her employment for her employer and that she was hospitalized from March 18, 1970 to April 8, 1970, and again from April 30, 1970 to May 17, 1970 as a result thereof. United States Fidelity and Guaranty Insurance Company advised plaintiff that they would not pay workmen’s compensation insurance on this claim. The Van Deusens then advised the defendant, insurance company, that the compensation carrier had refused to pay the claim for workmen’s compensation insurance and they then filled out a claim with defendant under the group policy for all the expenses they had incurred between March 18, and May 17, 1970, in connection with the 1970 heart attack. When this defendant was advised from several sources that the compensation claim plaintiff had made in connection with the 1970 heart attack and the two 1970 periods of hospitalization had been denied by that compensation carrier, this defendant issued checks totaling $3,274.01 in payment of hospital bills and doctor bills that the Van Deusens had incurred by reason of Merle Van Deu-sen’s March 18, 1970, heart attack and the two periods of hospitalization that followed between March 18, 1970 and May 17, 1970.

These payments were made by the defendant about August 7, 1970, on the assumption that the Van Deusens were not entitled to workmen’s compensation benefits by reason of the 1970 heart attack, and by reason of the two periods of hospitalization she had in 1970. The group policy provisions clearly excluded coverage if the loss was covered by workmen’s compensation insurance.

On August 19, 1970, after defendant had paid these bills for the Van Deusens, the Van Deusens employed an attorney to further prosecute the compensation claim for them. This claim reached the courts and while the case was being tried a settlement agreement was reached whereby a judgment for $5,300.00 was rendered on April 7, 1971, in favor of the Van Deusens and against United States Fidelity and Guaranty Company. This judgment awarded plaintiff workmen’s compensation insurance on the theory that the heart attack was an injury sustained in the course of Merle Van Deusen’s employment.

In this case in response to special issues the jury found that the defendant paid for the Van Deusens the $3,274.01 in medical expenses that they had incurred for the 1970 heart attack as a result of a mutual mistake of facts in which both plaintiff and defendant believed that Mrs. Van Deu-sen’s heart attack on March 18, 1970, did not arise from her employment.

The trial court concluded that the defendant owed to plaintiff under the group policy the sums that plaintiff sued for arising out of Merle Van Deusen’s hospitalization for cancer from March 23, 1971 to May 7, 1971. These sums totaled $3,104.45. Since the jury found that it was as a result of a mutual mistake that defendant had *954 paid for plaintiff $3,274.01 in benefits to cover the expenses plaintiff incurred in 1970 in connection with the heart attack and the two periods of hospitalization, the trial court set that sum off against the $3,104.45 that defendant owed to plaintiff and rendered judgment that plaintiff take nothing by his suit.

In plaintiff’s first point of error he contends that the trial court erred in allowing the counterclaim and setoff to defendant, Connecticut General Life Insurance Company. He says that this allowance was erroneous and void because the setoff was made against workmen’s compensation benefits that had been paid to the Van Deusens for Merle Van Deusen’s alleged injury of March 18, 1970. He contends that the setoff is in violation of Art. 8306, Sec. 3 of the Texas Workmen’s Compensation Act.

We overrule this point.

Article 8306, Sec. 3, Vernon’s Ann.Texas Civ.St., provides in part as follows:

“All compensation allowed under the succeeding sections herein shall be exempt from garnishment, attachment, judgment and all other suits or claims, and no such right of action and no such compensation and no part thereof or of either shall be assignable, except as otherwise herein provided, and any attempt to assign the same shall be void. . . . ”

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Cite This Page — Counsel Stack

Bluebook (online)
514 S.W.2d 951, 1974 Tex. App. LEXIS 2671, Counsel Stack Legal Research, https://law.counselstack.com/opinion/van-deusen-v-connecticut-general-life-insurance-co-texapp-1974.