Jerger v. Commercial Ins. Co.

• Decision Date: 22 March 1965
• Docket Number: No. 41645,41645
• Citation: 4 Ohio Misc. 43,211 N.E.2d 99
• Parties: , 33 O.O.2d 24 JERGER v. COMMERCIAL INS. CO.
• Court: Ohio Court of Common Pleas

Page 43

4 Ohio Misc. 43

211 N.E.2d 99, 33 O.O.2d 24

JERGER v. COMMERCIAL INS. CO.

No. 41645.

Court of Common Pleas of Ohio, Richland County.

March 22, 1965.

Bayer & Jerger, Mansfield, for plaintiff.

Gongwer, Murray, Brown & Bemiller, Mansfield, for defendant.

MAYER, Judge.

This is an appeal on questions of law from the judgment of the Mansfield Municipal Court. Defendant, appellant herein, contends there was error prejudicial to appellant in the judgment, final order and pleadings of the trial court, in that the findings and judgment were contrary to law, contrary to the evidence, and that judgment should have been rendered for defendant.

This case was submitted to the trial court on December 3, 1964, upon the pleadings, stipulations of fact, arguments and briefs of counsel.

In consideration of $28.50 paid by plaintiff, appellee herein, on July 5, 1960, at Mansfield, Ohio, the defendant issued a policy of insurance, being No. GAT 5039, a copy of which is attached to the stipulations herein and made a part thereof.

Said policy covered plaintiff, his wife Catherine E., and his children, and provided as follows:

'This policy insures against loss due to medical expense incurred by the insured or the eligible members of the insured's family, if any, who are named in the application for this policy; resulting directly from accidental bodily injury occurring during any term of this policy, being hereinafter refered to as such 'injury,' or resulting from sickness commencing during any term of this policy, being hereinafter referred to as such sickness.'

This policy also provided 'no indemnity shall be payable under this policy with respect to such medical expense incurred: * * *

(J)--for pregnancy or any complications therefrom.'

Plaintiff kept, observed and performed all the requirements and conditions contained in said policy by him in accordance with the terms thereof. On January 2, 1961, plaintiff's wife, Catherine E., an eligible member of the insured's family under the policy, was hospitalized at People's Hospital, Mansfield, Ohio, by her family physician. Upon such hospitalization, emergency surgery was performed on January 2, 1961, disclosing a condition described as right tubal pregnancy, which had caused severe intra-abdominal hemorrhaging. Plaintiff's wife was confined to People's Hospital from January 2, 1961, until her discharge on January 14, 1961, all for such condition.

As a result of the illness, hospitalization and right tubal pregnancy of his wife, Catherine E., plaintiff was required to and did incur doctor bills for services in the amount of $380, a hospital bill in the amount of $339.57, and nursing services in the amount of $48, making a total of $767.57. Under the terms of the policy as hereinbefore set forth, plaintiff paid the deductible amount of $250 and 20% of the balance, or $103.49, for a total paid by plaintiff of $353.49. Defendant contracted to pay 80% of medical expenses in excess of the deductible amount of $250, or the sum of $414.08, and defendant did not, nor would not pay the sum of $414.08 although requested by the plaintiff to do so.

It was the finding and judgment of the Trial Court that plaintiff recover from defendant the sum of $414.08, and judgment was accordingly given. Findings of fact and conclusions of law were made and filed.

Is the condition or sickness of right tubal pregnancy among the exclusions of the policy for which plaintiff and the eligible members of his family are not covered by the exclusion 'for pregnancy or any complications therefrom'?

The Trial Court concluded and held that tubal pregnancy is caused by a diseased or a malfunctioning tube, that it never results in childbirth, and as it increases and advances, becomes a very dangerous illness.

Further, the conclusion was reached that pregnancy is a normal biological function usually resulting in childbirth; that the normal understanding and meaning given by ordinary people to the word, 'pregnancy,' is the normal biological function of childbirth and that the contracting parties herein did not intend to exclude tubular pregnancy from coverage in the insurance policy, and if the insurer intended to exclude tubular pregnancy it should have so stated in its policy.

This court can find no quarrel with the...