Health Maintenance Group of Birmingham v. Rutledge
| Decision Date | 27 June 1984 |
| Citation | 459 So.2d 889 |
| Parties | HEALTH MAINTENANCE GROUP OF BIRMINGHAM v. Lynneice Taylor RUTLEDGE. Civ. 4074. |
| Court | Alabama Court of Civil Appeals |
Lawrence B. Clark, L. Burton Barnes, III, and Sally A. Sharp of Lange, Simpson, Robinson & Somerville, Birmingham, for appellant.
Grover S. McLeod, Birmingham, for appellee.
This is a breach of contract action.
On February 5, 1981 Lynneice Taylor Rutledge filed suit against Health Maintenance Group of Birmingham (HMG) to recover expenses incurred when her son, Paris, received surgery and treatment at Children's Hospital in Birmingham, Alabama.
A jury trial was held on July 25, 1983. At the close of plaintiff's case, HMG filed a motion for a directed verdict and reasserted its motion for directed verdict at the close of all the evidence in the case. The trial court denied both motions and refused to grant any of HMG's requested jury instructions.
The jury returned a verdict in favor of plaintiff and against defendant in the amount of $6,457.06. HMG filed a motion for judgment notwithstanding the verdict or, in the alternative, for a new trial. Denied. HMG appeals.
HMG argues here that the trial court erred in denying its motions for directed verdict and in refusing to grant its requested jury charges. We consider the failure to properly charge the jury dispositive of this appeal and we will focus on that aspect of the case.
The evidence shows that plaintiff was employed at Eastside Mental Health Center in Birmingham. She was enrolled in a prepaid group health insurance program offered by HMG that provided for medical, surgical, and hospital care to insureds and members of their family at Lloyd Noland Hospital (LNF). Under certain limited circumstances HMG provides its members with reimbursement and payment for services rendered at a medical facility other than Lloyd Noland Hospital. One such circumstance concerns "emergency service." Specifically, the HMG contract (policy) provides that:
The HMG contract defines "Emergency Service" as follows:
(Emphasis added.)
On June 6, 1980 Paris Taylor, plaintiff's two year old son, was severely burned when the stove in plaintiff's apartment collapsed, spilling boiling water on his back. Plaintiff took Paris to the emergency room at Baptist Hospital-Princeton in Birmingham, but was referred to the emergency room at Children's Hospital in Birmingham. Paris was treated by Dr. Pitts in the children's burn unit for second degree burns and was released from the hospital on June 24, 1980.
Plaintiff subsequently filed a claim with HMG for Paris's hospitalization and attendant services. HMG paid the claim.
Following Paris's discharge from the hospital, plaintiff returned to Children's Hospital every two days with Paris so that the burn could be scrubbed down, soaked, and rebandaged. She was informed by an HMG employee that "follow-up [care] should be handled by LNF," and that HMG would not guarantee coverage for the care at Children's Hospital unless it was established that LNF could not furnish the same care. On July 7, 1980 plaintiff took Paris to LNF for follow-up treatment. The examining physician changed Paris's bandage and they left.
On July 9, 1980 plaintiff returned with Paris to Children's Hospital. Paris was sick, whining, and not eating. He was restless and his bandages were soiled. There was a ten by ten centimeter area on Paris's back where he had scratched and rubbed the skin healing over the burned area. He was admitted to the hospital and was scrubbed down and rebandaged. His arms were put in slings so that he could not scratch his back.
There was testimony that Paris could have been moved to another hospital and that "a few hours wouldn't make much difference." There was also evidence that LNF could have rendered the care to Paris.
On July 14, 1980 a skin graft was performed on Paris at Children's Hospital. He was subsequently released from the hospital on July 30, 1980.
Plaintiff sent HMG a claim for Paris's second hospitalization and surgery. HMG refused to pay the claim...
To continue reading
Request your trial
-
Etienne v. Wolverine Tube, Inc.
...v. Cornett, 368 So.2d 272, 274-75 (Ala.1979) (claim of dissatisfaction must be made in good faith); Health Maintenance Group of Birmingham v. Rutledge, 459 So.2d 889, 892 (Ala.Civ.App.1984) ("[I]t is a rule of law in satisfaction contracts that a promissor must exercise good faith in its de......
-
Alabama Power Co. v. Cantrell
...Life Ins. Co. v. Smith, 356 So.2d 646 (Ala.1978); Jones v. Blackman, 284 Ala. 684, 228 So.2d 1 (1969); Health Maintenance Group of B'ham v. Rutledge, 459 So.2d 889 (Ala.Civ.App.1984); Great Northern Land & Cattle, Inc. v. Firestone, 337 So.2d 1323 (Ala.1976). APCo claims that this obligatio......
-
Grayco Resources, Inc. v. Poole
...trial judge to educate the jury on the law of the case. Raines v. Williams, 397 So.2d 86 (Ala.1981), Health Maintenance Group of Birmingham v. Rutledge, 459 So.2d 889 (Ala.Civ.App.1984). We agree with the Fifth Circuit Court of "It is the inescapable duty of the trial judge to instruct the ......
-
Alewine v. Southern Ry. Co.
...trial judge to educate the jury on the trial of the case. Raines v. Williams, 397 So.2d 86 (Ala.1981), Health Maintenance Group of Birmingham v. Rutledge, 459 So.2d 889 (Ala.Civ.App.1984). We agree with the Fifth Circuit Court of Appeals: 'It is the inescapable duty of the trial judge to in......