Feit v. St. Paul Fire & Marine Ins. Co.

• Decision Date: 28 September 1962
• Docket Number: No. 2744,2744
• Citation: 27 Cal.Rptr. 870,209 Cal.App.2d Supp. 825
• Court: California Superior Court
• Parties: 209 Cal.App.2d Supp. 825 Abe FEIT, Plaintiff and Appellant, v. ST. PAUL FIRE & MARINE INSURANCE CO. et al., Defendants and Respondents. Appellate Department, Superior Court, San Francisco County, California

Page 870

27 Cal.Rptr. 870

209 Cal.App.2d Supp. 825

Abe FEIT, Plaintiff and Appellant, v. ST. PAUL FIRE & MARINE INSURANCE CO. et al., Defendants and Respondents.

No. 2744.

Appellate Department, Superior Court, San Francisco County, California.

Sept. 28, 1962.

Albert E. Polonsky, San Francisco, for appellant.

James Shovlin, Jr., San Francisco, for respondents.

WEINBERGER, Judge.

The plaintiff was involved in an automobile accident in which he sustained injuries which were treated at the Kaiser Foundation Hospital by doctor-members of the Permanente Group. Because he was a prepaying member of Kaiser Foundation Health Plan the plaintiff was not required to, and did not pay for these services valued at $551.49. He nevertheless sought to recover the stated amount from the defendant on the ground that such expenses were covered under the Medical Payments clause of an automobile policy issued to him by the defendant insurer. To support his claim the plaintiff obtained statements from the Hospital and Medical Group which itemized the services rendered and contained the following: 'This is what the patient would have paid had he not been a pre-paying member of the Kaiser Foundation Health Plan. Make Check Payable to Patient Only.' The claim was declined, suit was filed and this appeal is from the trial court's decision in favor of the defendant.

The complaint alleged, among other things, that the defendant had issued its policy 'insuring the plaintiff for all medical expenses incurred by said driver or passenger.' The answer alleged that the policy 'contained a medical payment clause whereby defendant agreed to pay [to plaintiff] all reasonable expenses incurred'; that 'bills of $551.49 were not, in fact incurred by plaintiff, therefore there is nothing due and owing him'. We have italicized portions of each pleading to show that both parties assumed incorrectly that the insuring clause limited recovery to expenses incurred by the insured.

The insuring clause in question is 'Coverage C--Automobile Medical Payments', and reads as follows:

'The St. Paul Fire and Marine Insurance Company agrees with the Insured to pay all reasonable expenses incurred within one year from the date of accident for all necessary medical, surgical and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services--to or for each insured who sustains bodily injury, etc.'

We have been unable to find a California case interpreting this precise language, but courts of other states have been called upon to do so. (Gordon v. Fidelity and Casualty Co. of N. Y., 238 S.C. 438, 120 S.E.2d 509; State Farm Mutual Automobile Ins. Co. v. Fuller, 232 Ark. 329, 336 S.W.2d 60; Kopp v. Home Mutual Ins. Co., 6 Wis.2d 53, 94 N.W.2d 224.) The identical language has been referred to in several additional decisions, so it would appear that the clause in question is part of the standard form of automobile insurance policy in general use throughout the nation. We agree with the interpretation of the Supreme Court of Wisconsin in the Kopp case, supra, cited with approval by the Supreme Court of Arkansas in the State Farm case, supra, as follows:

'The defendant contends that, under the above quoted policy provisions, it is a condition precedent to the insured's right of recovery upon the policy for his hospitalization that he shall first have incurred a debt for the same. It is clear from the undisputed facts that no such debt was incurred by the plaintiff to pay for such hospitalization. However, a debt was incurred on the part of Blue Cross to pay such expense to Luther Hospital, and the plaintiff has paid quarterly ...