Cassidy v. Springfield Life Ins. Co.
| Citation | 262 A.2d 378,106 R.I. 615 |
| Decision Date | 23 February 1970 |
| Docket Number | No. 729-A,729-A |
| Parties | Joseph F. CASSIDY v. SPRINGFIELD LIFE INSURANCE COMPANY, Incorporated. ppeal. |
| Court | Rhode Island Supreme Court |
This civil action was brought on a major medical insurance policy issued by the defendant corporation to the plaintiff, who seeks to recover for medical expenses incurred during the illness of his minor son Michael. The matter was heard by a justice of the Superior Court on motions for summary judgment by both the defendant and the plaintiff. After hearing on the motions, the justice on March 19, 1969, denied the plaintiff's motion for summary judgment and granted that of the defendant, and entered judgment accordingly. The plaintiff thereupon prosecuted an appeal from that judgment to this court.
The policy insured plaintiff and his dependents for major medical expenses as provided therein, and it is not disputed that plaintiff's son Michael was covered by the terms of the policy and is an insured thereunder. It is further conceded that the policy was in full force and effect after September 17, 1964, the effective date thereof, and during that period plaintiff incurred medical expenses resulting from the treatment and hospitalization of his son Michael.
The record discloses that on May 8, 1964, it was determined by diagnosis that Michael was suffering from ulcerative colitis and that on May 19, 1964, he was admitted to a hospital. He was discharged therefrom on July 3, 1964, and from then until September 17, 1964, the effective date of the policy, Michael continued to receive treatment from time to time from duly licensed physicians. This treatment and further hospitalization continued after the effective date of the policy until October 21, 1966.
The plaintiff seeks to be reimbursed only for expenditures made in providing treatment and hospitalization for his son Michael after the effective date of the policy, September 17, 1964. That Michael had been ill for some time prior to the effective date of the policy and that the illness continued thereafter is not disputed. The plaintiff argues, however, that the expenses incurred for treatment and hospitalization after the effective date of the policy were 'Eligible Expenses' incurred during a 'Period of Treatment' as defined in the policy and are, therefore, payable under sec. 2 of the policy.
The insuring clause in the policy, sec. 2, provides: 'Upon receipt by the Company of notice and satisfactory proof that any insured person or dependent has incurred Eligible Expenses during a Period of Treatment commencing while the insured person or dependent is insured for Composite Major Medical Expense Benefits under this contract, the Company will * * * pay the insured person benefits on account of such Eligible Expenses * * *.' It is clear from the above-quoted provisions of the policy that defendant basically has agreed to pay to a person insured under the policy the 'Eligible Expenses' incurred by him during a 'Period of Treatment' which begins while the insured person is within the coverage of the policy. In our opinion, the meaning of sec. 2 of the policy is clear and unambiguous.
The policy in sec. 6 defines 'Eligible Expenses' as follows: 'Eligible Expenses shall include the usual and customary charges incurred for necessary services and supplies of the following types which are performed or prescribed by a licensed physician or surgeon * * *.' Section 6 further provides that 'Eligible Expenses shall not include * * * (2) any charges which are set forth in Section 9 of these Composite Major Medical Expense Provisions.' 'Period of Treatment' is defined in sec. 7 of the policy as follows: 'A period of Treatment means that period of time during which the insured person or dependent, as a result of one sickness or one accidental injury or as a result of two or more concurrent sicknesses or accidental injuries, is incurring Eligible Expenses.'
The defendant denies any...
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