Hughes v. American Universal Ins. Co., 79-506-A

• Decision Date: 23 December 1980
• Docket Number: No. 79-506-A,79-506-A
• Citation: 423 A.2d 1171
• Parties: Doris R. HUGHES et al. v. AMERICAN UNIVERSAL INSURANCE CO. ppeal.
• Court: Rhode Island Supreme Court

Page 1171

423 A.2d 1171

Doris R. HUGHES et al. v. AMERICAN UNIVERSAL INSURANCE CO.

No. 79-506-Appeal.

Supreme Court of Rhode Island.

Dec. 23, 1980.

Almonte, Lisa & Pisano, Stephen C. Mackie, Thomas L. McDonald, Providence, for plaintiffs.

Higgins & Slattery, Robert J. Dumouchel, Providence, for defendant.

OPINION

KELLEHER, Justice.

This is a dispute between an insurer and its insureds who are the plaintiffs, Doris R. Hughes and her husband Francis. ¹ The controversy centers on the amount of money due the Hugheses under the medical-payments provision of a so-called Family Combination Automobile Policy that apparently was first issued by the insurer to the Hugheses in November 1958 and regularly renewed since that time.

On September 17, 1975, Mr. Hughes received serious injuries when an automobile in which he was a passenger was involved in a collision with an uninsured motor vehicle. He and his wife sought payment of medical expenses that are in excess of $21,000, but the insurer insisted that its liability for the medical expenses incurred by their insureds is limited by the terms of the policy to $500. Both the insureds and the insurer sought to vindicate their respective positions by way of the summary-judgment route. A Superior Court justice, after first finding that the policy was ambiguous, granted the insureds' motion for a summary judgment and denied the insurer's motion.

When the insureds originally purchased their policy, the coverage for medical expenses read as follows:

"Part II Expenses For Medical Services Coverage C Medical Payments: To pay all reasonable expenses incurred within one year from date of accident for necessary medical, surgical, X-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services:

"Division 1. To or for the named insured and each relative who sustains bodily injury, sickness, or disease, including death resulting therefrom, hereinafter called 'bodily injury', caused by accident * * *.

"Limit of Liability: The limit of liability for medical payments stated in the declarations as applicable to 'each person' is the limit of the company's liability for all expenses incurred by or on behalf of each person who sustains bodily injury as the result of any one accident."

The policy's declaration page, which is referred to in the limit-of-liability clause, in its pertinent part states:

"Item 3: The insurance offered is only with respect to such of the following coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such coverage shall be as stated herein, subject to all the terms of this policy having reference thereto.

Later, on November 11, 1972, the policy was amended by the addition of an endorsement that is identified as form No. 645. The endorsement was entitled "Voluntary No-Fault Loss of Income Endorsement" and provided in pertinent part:

"AMERICAN UNIVERSAL INSURANCE COMPANY VOLUNTARY NO-FAULT LOSS OF INCOME ENDORSEMENT

PART II EXPENSES FOR MEDICAL SERVICES IS AMENDED TO READ AS FOLLOWS:

PART II PERSONAL PROTECTION AGAINST MEDICAL EXPENSE AND LOSS OF INCOME TO PAY:

1) MEDICAL EXPENSE BENEFITS

All reasonable expenses resulting from bodily injury, sickness or disease, including death resulting therefrom, caused by accident and 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, subject to the limits stated below under Limits of Liability.

2) LOSS OF INCOME BENEFITS

Eighty-five (85) percent of loss of income resulting from bodily injury, sickness or disease, caused by accident, for the period of continuous total disability beginning the fifteenth day after the accident and terminating one year and fourteen days from the date of the accident, or at death, whichever occurs first, not in excess of $750.00 per month.

LIMITS OF LIABILITY: The limit of liability stated in the Declarations under Part II Medical Expense shall be the limit of the company's liability for all expenses incurred by or on behalf of each person who sustains...