Carr v. Maryland Cas. Co.

• Decision Date: 22 April 1976
• Citation: 88 Misc.2d 424,388 N.Y.S.2d 196
• Parties: Margaret McGill CARR, Plaintiff, v. MARYLAND CASUALTY CO., Defendant.
• Court: New York City Court

Page 196

388 N.Y.S.2d 196

88 Misc.2d 424

Margaret McGill CARR, Plaintiff, v. MARYLAND CASUALTY CO., Defendant.

Civil Court of the City of New York, Queens County.

April 22, 1976.

Bertram Herman, P.C., New York City, for plaintiff.

A. Alexander Pignato, Rockville Centre, for defendant; Paul Goodovitch, Island Park, of counsel.

DECISION

HERBERT POSNER, Judge.

This is an action in the amount of $2108.31 for alleged breach of contract between an insurer and its insured. The plaintiff carried a policy of automobile insurance with the defendant. The policy carried statutory no fault benefits (as required under Article 18 of the Insurance Law). In addition, for an extra premium (exact amount of the premium not being contained in the submitted set of facts stipulated by the parties), the defendant also sold to the plaintiff automobile medical payments coverage in the principal sum of $5,000.

The medical expense part of the policy stated as follows: 'To pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical, X-ray and dental services including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services.'

Section 2 of the no fault part of the policy stated the following: 'If automobile medical payments or any disability coverages are afforded under this policy, such coverages shall be excess insurance over any mandatory or additional personal injury protection benefit paid or payable or which would be paid or payable but for the application of a deductible under this or any other automobile No Fault insurance policy.'

On August 13, 1974 the plaintiff was involved in an automobile accident in Queens County wherein she suffered severe permanent injuries. As a result of the hospitalization and other medical treatment which she received, she exhausted the maximum benefits under the mandatory No Fault coverage in her policy of automobile liability insurance with the defendant. However, the exhaustion of her benefits under the no fault coverage was subsequent to one year following August 13, 1974.

Plaintiff was confined to Mary Immaculate Hospital of Jamaica from August 16, 1975 through October 1, 1975, a period of time that was clearly more than one year after the accident. The hospital bill for this period of time was originally in the sum of $7,164.80 and the defendant, under the no fault coverage portion of the policy, paid all but $2,108.31. The defendant refused to pay the balance of the hospital bill on the following grounds: 1) The plaintiff had used up her entire $50,000 benefits under the no fault coverage and; 2) the medical expense part of the policy was no longer in effect because the remaining expenses were not incurred within one year from the date of the accident.

There is no issue presented to the court concerning the fair and reasonable value of the balance of the bill that is being sued hereon. The only issue presented to the court is whether or not the medical payments portion of the policy afforded coverage for the balance of the bill.

To clarify the issues of law involved in this case, the plaintiff narrows the facts down to three basic issues: 1) Does the suspension paragraph in the no fault policy suspend the one-year limitation provision in the medical payments policy? 2) If the answer to the first question is no, then would the plaintiff be entitled to recover for medical payments benefits simultaneously with no fault benefits? 3) Do the words 'incurred within one year from the date of the accident' mean that the covered service must have actually been expended, or does it mean that the covered service could be reasonably expected to be expended within the one year period although actually charged subsequent to the one year period?

The well settled doctrine of 'contra proferentum' holds that ambiguity in nonnegotiated or adhesion contracts are to be construed against the profferer, here the insurer. (Sincoff v. Liberty Mutual Fire Insurance Co., 11 N.Y.2d 386, 230 N.Y.S.2d 13, 183 N.E.2d 899; Hartol Products Corp. v. Prudential Insurance Co., 290 N.Y. 44, 47 N.E.2d 687; Ore & Chemical Corp. v. Eagle Star Insurance Co. Ltd., 2 Cir., 489 F.2d 455; Citron v. Hartford Accident & Indemnity Co., 86 Misc.2d 26, 381 N.Y.S.2d 650, 1976). Accordingly, the answers to the three issues cited above will hinge upon the resolution of whether the...