King v. Public Savings Life Insurance Company, 63681
| Decision Date | 06 April 1982 |
| Docket Number | No. 63681,63681 |
| Citation | 290 S.E.2d 134,162 Ga.App. 49 |
| Parties | KING v. PUBLIC SAVINGS LIFE INSURANCE COMPANY. |
| Court | Georgia Court of Appeals |
Wallace H. Pilcher, Wrens, for appellant.
Millard B. Shepherd, Jr., Swainsboro, for appellee.
The appellant received an injury compensable under the Worker's Compensation Act for which he was hospitalized from August 4, 1980, until October 2, 1980. All expenses incident to his hospitalization were paid by the workers' compensation carrier. The appellant was also covered under a medical insurance policy issued by the appellee, which contains the following exclusion: "This policy does not provide any benefits for any loss ... for which no charge is made that the insured is required to pay." Relying solely on this exclusion, the appellee denied the appellant's claim for $1,230 in benefits under the policy. The appellant filed suit on the claim, seeking a bad faith penalty and attorney fees in addition to the benefits allegedly due, and the trial court granted the appellee's motion for summary judgment based on the policy exclusion. This appeal followed. Held :
It is undisputed that the hospital in fact charged for the appellant's hospitalization. The only question is whether the appellant was "required to pay" those charges within the meaning of the policy exclusion. He was obviously not required actually to make payment since payment was ultimately made by the workers' compensation carrier. However, he was certainly required to pay in the sense that he was primarily liable for the charges, i.e., if the workers' compensation carrier had not paid them, the hospital would have held him responsible.
If a policy of insurance is capable of two different constructions, that interpretation must be placed on it which is the most favorable to the insured. Johnson v. Mutual Life Ins. Co. &c., 154 Ga. 653(1, 2), 115 S.E. 14 (1922); Davis v. United American Life Ins. Co., 215 Ga. 521, 527, 111 S.E.2d 488 (1959); Marsh v. Zurich Ins. Co., 118 Ga.App. 409(1), 163 S.E.2d 867 (1968). The policy exclusion at issue in this case is capable of a construction favorable to the insured; and, consequently, that is the construction which we must adopt. Had the appellee wished to exclude coverage for injuries for which benefits were payable under workers' compensation or other insurance, it could easily have drafted an exclusion to that effect in unambiguous language. See, e.g., Wise v. American Cas. Co., etc., 117...
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...worker's compensation law." We affirmed summary judgment for appellee. In a recent case cited in Cantrell, King v. Public Savings Life Ins. Co., 162 Ga.App. 49, 290 S.E.2d 134 (1982), the appellant received an injury that was clearly compensable under workers' compensation, which paid all e......
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...Ga. 521, 527, 111 S.E.2d 488." Welch v. Gulf Life Ins. Co., 126 Ga.App. 115, 117, 190 S.E.2d 101 (1972). See King v. Public Savings etc. Co., 162 Ga.App. 49, 290 S.E.2d 134 (1982); Cotton States Mut. Ins. Co. v. Crosby, 149 Ga.App. 450, 451(1B), 254 S.E.2d 485 (1979), rev'd in part on other......
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Cantrell v. Home Sec. Life Ins. Co., 65198
...of whether or not there is an adjudication on the merits of compensability by the Board. Id. Compare King v. Public Savings etc. Ins. Co., 162 Ga.App. 49, 290 S.E.2d 134. The trial court correctly granted appellee's motion for summary Judgment affirmed. QUILLIAN, P.J., and CARLEY, J., concur. ...