Vidrine v. Reserve Life Ins.

58 So. 2d 251, 1952 La. App. LEXIS 547
CourtLouisiana Court of Appeal
DecidedApril 9, 1952
DocketNo. 3538
StatusPublished
Cited by3 cases

This text of 58 So. 2d 251 (Vidrine v. Reserve Life Ins.) 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
Vidrine v. Reserve Life Ins., 58 So. 2d 251, 1952 La. App. LEXIS 547 (La. Ct. App. 1952).

Opinion

DORÉ, Judge.

This appeal is from a decision of the lower court rejecting plaintiff’s claim for hospital and medical expenses alleged to be due under the terms of a hospital and surgical expense policy written by the Reserve Life Insurance Company of Dallas, Texas. Plaintiff seeks to recover $84, plus a penalty of $168 (or double the sum due under the policy) and reasonable attorney fees of $150 alleged to be due because defendant, without just and reasonable ground, refused to pay plaintiff’s claim within thirty days from submission of proof of claim, as is required by LSA-R.S. 22:-657.

In this court defendant-appellee filed a motion to dismiss the appeal for want of jurisdiction ratione materiae in that the main demand is less than $100. We do not find the motion well founded. The prayer of the petition is for judgment in the total sum of $402, an amount within our jurisdiction. The appeal is sustained.

Plaintiff alleged that the policy was issued to her on or about January 18, 1951 and that on or about May 1, 1951 she was hospitalized due to illness and incurred certain expenses for which defendant was liable under its policy up to the sum of $84; that the hospitalization occurred after the policy had been in force for more than 15 days; and that more than 30 days have [252]*252elapsed since proof of claim was submitted to defendant, yet defendant has failed to pay the sum due. The answer of defendant was in substance a general denial.

The insuring clause of the policy states that the company insures the applicant and agrees to pay “subject to all provisions and limitations herein contained, the benefits provided herein for hospital confinement and other specified expense * * * (b) resulting from sickness which originates while this policy is in effect and more than fifteen days after the date hereof * * Under a section headed “Hospital Expense Benefits” the policy lists several specific expense items for which the company will pay, and it was five of these, making up a total of $84 for which plaintiff sued. Another section of the policy is headed “Standard Provisions”, and contains inter alia the following:

1. “This policy includes the endorsements and attached papers, if any, and contains the entire contract of insurance. * * *
2. “No statement made by the applicant for insurance not included herein shall avoid the policy or be used in any legal proceeding hereunder. No agent has authority to change the policy or to waive anyof its provisions. No change in this policy shall be valid unless approved by an executive officer of the Company and such approval endorsed hereon.”

There were no endorsements or papers attached to the. policy, nor was the application attached.

The only testimony taken at the trial was that of plaintiff; but by stipulations counsel entered what would have been the testimony of Dr. R. E. Dupre and Dr. R. B. Thompson if they had been called in as witnesses. In addition tó 'this, counsel by agreement placed in evidence'th'e Claimant’s Hospitalization Statement and' the Physician’s Hospitalization ' Statement, both of which were prepared in connection with or as a result of the hospital confinement that gave rise to this claim. The stipulation giving Dr. Dupre’s testimony was brief and can be summarized by saying that he operated on Mrs. Vidrine in 1947 or early 1948 and removed ovaries; that the uterus (womb) was then inflamed, but in his opinion its removal was not necessary at that time; and that he did not treat her during approximately one and one-half years prior to her operation in May, 1951.

The pertinent part of the stipulation giving Dr. Thompson’s testimony was as follows :

“Upon examination of Mrs. Vidrine his impression was that there was probably a mass between the rectum and the posterior uterine wall and numerous cysts of the cervix uteri. He recommended X-ray irradiation of the uterus in an attempt to postpone or eliminate the necessity of surgical removal of the uterus.”

The stipulation said further that Mrs. Vid-rine visited Dr. Thompson in reference toiler condition twenty-eight times between her initial visit and the operation in May, 1951.

Mrs. Vidrine testified on direct examination:

“Q. Now, Mrs. Vidrine, at the time that you applied for and was issued this policy by the Reserve Life Insurance Company, were you given any physical examination by the Reserve Life Insurance Company? A. No sir.”

On cross-examination she testified:

“Q. Now, Mrs. Vidrine, do you recollect just*what the operation entailed? (meaning the operation in 1948) A. What it was ?
“Q. Yes madam. As I understood it, at that date, he removed your ovaries and tubes? A. Yes sir.
"Q. Do you know why he didn’t remove your uterus at that time? A. Yes, because the job was too big, it was worse than he expected, so he left it and thought that it would gradually dry lip like a woman in the change of age.
* * * * * * •
“Q. Mrs. Vidrine,.Didn’t Dr. Dupre tell you after the operation that the reason he did not remove your uterus was because of adhesions and offered [253]*253you to call upon him anytime to perform that operation and that he would call a specialist in? A. Yes, he didn’t tell me of adhesions, but he told me it was stuck to my rectum, and it would take too long that date, but I might never suffer anymore, it would just dry up, and if it didn’t do, that I would have to have an operation to be done; he would do it for nothing, that he had made a big mistake, he did not think I was that bad off.”

In the light of the testimony quoted above there is no room for doubt but that the uterus of plaintiff was in an unhealthy condition prior to the time her insurance policy was issued in January, 1951, that she had knowledge of this condition and was treated for it, and that it was this unhealthy condition of the uterus that caused her hospitalization and operation in May, 1951. So it must be concuded that there is no liability resting on defendant unless it arises in some way other than under the insuring clause quoted hereinabove.

But plaintiff has sought in argument and brief to fasten liability on defendant in spite of the fact that plaintiff’s hospitalization resulted from an illness or unhealthy condition that existed prior to issuance of the policy. Counsel for plaintiff state in brief that the issues in the case are these: 1. Was the hospitalization of plaintiff a “sickness” originating while the policy was in effect? and 2. Is defendant bound by the construction of “sickness” as represented to plaintiff at the time she purchased ■ the policy? And plaintiff answers both of these questions in the affirmative.

On the first issue plaintiff’s position seems to be that a diseased condition in an acute stage that requires hospitalization and operation constitutes a separate and distinct sickness from a diseased condition in a mild stage which does not yet require hospitalization or surgery. Counsel cite two cases which admittedly might provide some slight comfort to one in plaintiff’s position, these being Dance v. Southern Surety Company of New York, 1931, 2d Cir., 16 La.App. 373, 134 So. 725, 726, and National Casualty Company v. Hudson, 32 Ala.App. 69, 21 So.2d 568, an Alabama case decided in 1945.

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Related

Galloway v. Standard Life and Accident Ins. Co.
289 So. 2d 176 (Louisiana Court of Appeal, 1973)

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Bluebook (online)
58 So. 2d 251, 1952 La. App. LEXIS 547, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vidrine-v-reserve-life-ins-lactapp-1952.