Reynolds v. Wabash Life Ins. Co.

• Citation: 161 S.E.2d 168,251 S.C. 165
• Decision Date: 29 April 1968
• Docket Number: No. 18784,18784
• Parties: Ralph REYNOLDS, Administrator of the Estate of Francis M. Arant, Respondent, v. WABASH LIFE INSURANCE COMPANY, Appellant.
• Court: United States State Supreme Court of South Carolina

Page 168

161 S.E.2d 168

251 S.C. 165

Ralph REYNOLDS, Administrator of the Estate of Francis M.

Arant, Respondent, v. WABASH LIFE INSURANCE COMPANY, Appellant.

No. 18784.

Supreme Court of South Carolina.

April 29, 1968.

Lightsey & Bowers, Columbia, for appellant

Herbert, Dial & Windham, Columbia, for respondent.

LITTLEJOHN, Justice:

Defendant issued its policy of hospital and surgical expense insurance to the plaintiff's intestate on September 11, 1964. On March 2, 1965, less than six months after its effective date, the insured died because of a ruptured abdominal aorta after one day of hospitalization.

This action was brought to enforce the policy. Defendant-insurer had refused to pay, alleging that because of the exceptions and limitations in the policy, no benefits were due and owing. The policy provides, under 'Exceptions and Limitations', that it does not cover 'hospitalization due to cardio-vascular disease, * * *, unless such cause occur after the policy has been maintained in continuous force for six (6) months from date of issue.'

The plaintiff maintains that the insured did not have 'cardio-vascular disease', but merely had vascular disease with no cardio disease whatever. The plaintiff thus maintains that the six months limitation does not bar recovery since the exception and limitation relate to cardio-vascular disease which must be present in combination. The policy makes no reference to disease of the cardiovascular system; the exact phrase used in the policy is 'cardio-vascular disease.'

The lower court found that the policy was in effect and found that the limitations did not apply. The first question which the insurer raises by this appeal is whether the lower court was correct in interpreting Cardio-vascular disease as though it were Cardio and vascular disease.

The plaintiff presented Dr. John R. Welsh of the faculty of the University of South Carolina who qualified as an expert in the field of English grammar. He testified that the hyphen is similar in effect to supplying the conjunction And and that the hyphen eliminates any suggestion of the conjunction Or. The hyphen between the two words, Cardio and Vascular, construed as And brings about the construction urged by the plaintiff.

There is abundant evidence from the surgeon who attended the insured prior to his death to warrant the conclusion that there was no cardio disease, and that the ruptured abdominal aneurysm was a vascular disease involving only the blood vessels.

There is also medical testimony of a practicing physician who testified that the term Cardio-vascular disease included an aortic aneurysm.

It becomes the duty of this court to construe the policy. In construing an insurance policy such as this, certain principles are well established. See Walker v. Commercial Casualty Insurance Co., 191 S.C. 187, 4 S.E.2d 248, where it is said that insurance contracts which are in any respect ambiguous or capable of two meanings must be construed in favor of the insured. Suffice it to say that this contract was capable of two meanings, and the lower court was justified in construing it in favor of the insured. We hold the insured bound to pay according to the terms of the policy.

After holding that the exceptions and limitations did not apply, the trial judge awarded the plaintiff $618.55.

By proper exceptions, the insurer challenges the trial court's determination of the benefits due under the policy provisions Part I of the policy is entitled 'Daily Hospital Benefits' and it reads:

Part I, Part II, and Part V. Part I and Part II are related and the relevant parts of each follow. Part V will be discussed separately.

'When by reason of such injury or such sickness as described in the Insuring Clause, herein, any member of the Family Group shall be necessarily confined in a licensed hospital, the Company will pay to the Insured the expense actually incurred, if any, not exceeding the rate per day as shown in the specified application herefor for the period the member of the Family Group shall necessarily be a resident patient * * *.' (The application shows a rate of Eight ($8.00) Dollars per day.)

Part II of the policy is entitled 'Additional Hospital Expense Benefits' and is quoted as follows:

'If the daily hospital confinement benefits are payable as provided in Part I...