Keffer v. Prudential Ins. Co. of America
| Decision Date | 10 March 1970 |
| Docket Number | No. 12832,12832 |
| Citation | 172 S.E.2d 714,153 W.Va. 813 |
| Court | West Virginia Supreme Court |
| Parties | Joseph W. KEFFER v. The PRUDENTIAL INSURANCE COMPANY OF AMERICA. |
Syllabus by the Court
Where the provisions of an insurance policy contract are clear and unambiguous they are not subject to judicial construction or interpretation, but full effect will be given to the plain meaning intended.
W. T. O'Farrell, Jackson, Kelly, Holt & O'Farrell, Charleston, Robert J. Thrift, Mahan, Higgins, Thrift & Graney, Fayetteville, for appellant.
Samuel W. Price, Oak Hill, for appellee.
This is a civil action instituted in the Circuit Court of Fayette County, West Virginia, in which the plaintiff, Joseph W. Keffer, seeks to recover from the defendant, The Prudential Insurance Company of America, certain hospital expenses and medical costs in connection with the treatment of an injury which he sustained on May 7, 1965, under a policy of insurance dated March 15, 1965, issued by the defendant, which provided for a maximum daily hospital benefit of $15.00 per day, not to exceed 365 days, for all confinements, and a schedule of surgical procedure.
The defendant moved the circuit court for judgment on the complaint under Rule 12(b)(6) of the Rules of Civil Procedure and assigned grounds in support of its motion. By its order entered January 4, 1968 the circuit court overruled the motion and on January 5, 1968 the defendant filed its answer, in which it alleged, in addition to other defenses, that the plaintiff was injured while working; that he was covered as to such injury by the Workmen's Compensation law of this State; that he was paid by Workmen's Compensation, as compensation for his injury, the sum of $4400.00 for hospital, medical and like attention; that the fund available for the payment of workmen's compensation benefits was exhausted under the terms of the applicable statute; that the plaintiff incurred further and additional expenses for the treatment of his injury; and that by reason of an exception in the policy of insurance such policy does not provide benefits with respect to sickness or injury covered by any workmen's compensation act or occupational disease law.
On October 21, 1968 the case was heard by the circuit court in lieu of a jury and at the conclusion of the evidence introduced by the plaintiff, which consisted of his testimony concerning his hospitalization and medical treatment and certain bills for those services and checks by which some of those bills were paid by the plaintiff and the policy of insurance on which this action is based, the circuit court overruled a motion of the defendant to direct a verdict in its favor. The defendant introduced no evidence and after having rested moved the court to enter judgment in its favor. This motion the circuit court overruled and entered judgment in favor of the plaintiff for $890.00, with interest and costs. On October 25, 1968, the circuit court overruled the motion of the defendant to set aside the judgment rendered October 21, 1968. From the judgment this Court granted this appeal upon the application of the defendant.
The undisputed evidence shows that in addition to the payment of $4400.00 of workmen's compensation benefits for hospital expenses and medical costs, the plaintiff, after the compensation benefits were exhausted by the payment of the sum of $4400.00, paid additional hospital expenses and medical costs in the amount of $890.00.
The plaintiff contends, and the circuit court held, that the exception in the policy of insurance that: 'This policy does not provide benefits with respect to: (1) Sickness or injury covered by any workmen's compensation act or occupational disease law;' was ambiguous and should be construed liberally in...
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...construction or interpretation, but full effect will be given to the plain meaning intended." Syllabus, Keffer v. Prudential Ins. Co. of America, 153 W.Va. 813, 172 S.E.2d 714 (1970). However, "[w]henever the language of an insurance policy provision is reasonably susceptible of two differe......
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