Zimmerman Ex Rel. Zimmerman v. National Home Life Assurance Co.

517 S.W.2d 842, 1974 Tex. App. LEXIS 2857
CourtCourt of Appeals of Texas
DecidedDecember 19, 1974
Docket5390
StatusPublished
Cited by2 cases

This text of 517 S.W.2d 842 (Zimmerman Ex Rel. Zimmerman v. National Home Life Assurance 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
Zimmerman Ex Rel. Zimmerman v. National Home Life Assurance Co., 517 S.W.2d 842, 1974 Tex. App. LEXIS 2857 (Tex. Ct. App. 1974).

Opinion

OPINION

McDONALD, Chief Justice.

This is an appeal by appellant (plaintiff) Zimmerman from take nothing judgment against appellee (defendant) Insurance Company in a suit on a hospitalization indemnity policy.

Plaintiff alleged his wife the insured was entitled to $500. per month benefits while confined in a hospital, that she has been confined in a hospital since January 5, 1972; that defendant paid the benefits to September 5, 1972, but has refused to pay since that date.

Defendant denied plaintiff’s wife is confined to a “hospital” as defined by the policy, and denied she was a “resident patient” as defined by the policy.

Trial was before the court which rendered judgment plaintiff take nothing, and *843 filed Findings of Fact and Conclusions of Law pertinent of which are summarized as follows:

Findings of Fact
1) Defendant had issued plaintiff its hospitalization indemnity policy which provided in material part:
“Monthly Hospital Benefit: When injury or sickness * * necessitates hospital confinement of a covered member as a resident patient and under the care of a physician * * * we will pay * * * $500. per month subject to the following:
“ ‘Hospital’ means an institution whose principal purpose is providing medical care and treatment for injured and sick persons on a resident patient basis; and which maintains facilities for medical diagnosis and treatment of such persons; by or under the supervision of a staff of physicians; and which provides 24 hour a day nursing service by and under the supervision of registered nurses; and which provides facilities for major surgery; and which is not 1 other than incidentally, a place of rest, a place for the aged, a place for drug addicts, a place for alcoholics, a mental institution, a tuberculosis sanitarium and/or hospital, or a nursing, convalescent 1 rehabilitation or extended care facility. 1 * * *
“ ‘Resident Patient’ means one who is confined to a hospital and for whom a charge is made by the hospital for each day so confined. This does not 1 include one whose confinement is not necessary for medical treatment or who is occupying any form of rest, nursing, convalescent, rehabilitation or extended care facility.” 1
2) Brookhaven Medical Center is designed to provide a complete line of services. It consists of 3 buildings, each separated, by a walkway; the west building is the “Medical Office Building”; the center building is the “Skilled Nursing Facility”; and the east building is the “General Hospital”. The 3 facilities are owned by R & D Medical Corporation.
3) The Skilled Nursing Facility in the .Brookhaven Medical Center is primarily a nursing facility providing 24 — hour skilled nursing care. It has no x-ray or major surgery facilities, such facilities being situated within the General Hospital.
4) The Skilled Nursing Facility of Brookhaven Medical Center maintains records on its patients separate and apart from the records maintained by the General Hospital on its patients.
5) When a patient moves from the General Hospital to the Skilled Nursing Facility, records of the Hospital will reflect the patient was discharged from the hospital, and records of the Skilled Nursing Facility will reflect the patient was admitted to the Skill Nursing Facility; and vice versa.
6) Skilled Nursing Facility provides nursing care to patients who have been discharged from hospitals other than the General Hospital at Brookhaven Medical Center.
7) On January 5, 1972 plaintiff’s wife entered the General Hospital facility of Brookhaven Medical Center for fracture of her elbow. While in surgery for the fracture she suffered cardiac arrest resulting in a neurologically serious condition.
8) As a result she was on January 20, 1972 discharged from Brookhaven General Hospital and admitted to Baylor University Medical Center. She remained in Baylor through September 5, 1972 for evaluation and treatment of her neurological condition.
*844 9) On September 5, 1972 she was discharged from Baylor Hospital and admitted to the Skilled Nursing Facility of the Brookhaven Medical Center because her doctor “felt at that time that she had received the maximum benefit from a hospital, as far as improvements. She was transferred to the Nursing Care Center for continued nursing care.” Patients are transferred from á hospital to a nursing home such as the Skilled Nursing Facility of the Brookhaven Medical Center'when the patient appears to have received all the hospital care that might help them at the time.
10) If Mrs. Zimmerman needed hospital care and treatment Dr. Jenike would remove her from the Skilled Nursing Facility to Baylor Hospital. He would not allow her to stay in the nursing home.
11) Since September 5, 1972 Mrs. Zimmerman has been in the Skilled Nursing Facility of the Brookhaven Medical Center receiving 24-hour skilled nursing care.
12) Defendant paid plaintiff for the time Mrs. Zimmerman spent in General Hospital of Brookhaven Medical Center and Baylor Hospital.
13) The Skilled Nursing Facility in which Mrs. Zimmerman has been confined since September 5, 1972 is a “nursing, convalescent, rehabilitation or extended care facility” and therefore does not constitute a “hospital” within the meaning of the policy.
14) Mrs. Zimmerman since September 5, 1972 has not been a “resident patient” within the meaning of the policy because she is occupying a “form of rest, nursing, convalescent, rehabilitation or extended care facility”.
Conclusions of Law
1)Because the institution in which Mrs. Zimmerman has been confined since September 5, 1972 is not a “hospital” within the meaning of the policy, and because since September 5, 1972 Mrs. Zimmerman has not been a “resident patient” as defined by the policy, no benefits are payable.

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Related

National Family Care Life Insurance Co. v. Kuykandall
705 S.W.2d 267 (Court of Appeals of Texas, 1986)
Hrebec v. Aetna Life Insurance Co.
603 S.W.2d 666 (Missouri Court of Appeals, 1980)

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Bluebook (online)
517 S.W.2d 842, 1974 Tex. App. LEXIS 2857, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zimmerman-ex-rel-zimmerman-v-national-home-life-assurance-co-texapp-1974.