MacArthur v. Massachusetts Hospital Service, Inc.

• Decision Date: 23 February 1962
• Parties: Harold MacARTHUR v. MASSACHUSETTS HOSPITAL SERVICE, INC.
• Court: United States State Supreme Judicial Court of Massachusetts Supreme Court

Page 449

180 N.E.2d 449

343 Mass. 670

Harold MacARTHUR v. MASSACHUSETTS HOSPITAL SERVICE, INC.

Supreme Judicial Court of Massachusetts, Suffolk.

Argued Dec. 7, 1961.

Decided Feb. 23, 1962.

Earle C. Parks, Boston (Owen P. Maher, Boston, with him), for plaintiff.

James O. Smith, Boston, for defendant.

Before WILKINS, C. J., and SPALDING, WILLIAMS, WHITTEMORE, and SPIEGEL, JJ.

SPIEGEL, Justice.

The plaintiff seeks a declaration under G.L. c. 231A determining his right to payment for hospital expenses under a contract with the defendant. The case was reserved and reported by a single justice upon the pleadings and a statement of agreed facts.

In 1939 the plaintiff subscribed to the services offered by the defendant, Massachusetts Hospital Service, Inc., better known as the 'Blue Cross,' and received a 'Subscriber Certificate.' In February, 1961, the plaintiff, a fireman, employed by the City of Gloucester, suffered personal injuries at a fire while performing his duties under the direction of the chief of the fire department. By reason of his injuries the plaintiff was hospitalized and incurred hospital expenses in the amount of $246.89. The parties have agreed that, if the plaintiff is entitled to payment under the subscriber's certificate, he is entitled to payment of his hospital expenses to the extent of $144.89.

The subscriber's certificate provides in art. II, paragraph C, § 2, as follows: 'No credits shall be provided for services, care, or treatment for personal injuries or illness arising out of or in the course of employment or incurred in line of duty, or for admissions to a hospital operated by any agency of the United States Government, or for any other services, when the member would be entitled to full or partial benefits under any municipal, state, or Federal law, regulations, or agency, if this contract were not in effect.'

The defendant asserts that art. II, paragraph C, § 2, of the certificate sets forth three distinct situations for which credits will not be provided, namely, (1) for services, care or treatment for personal injuries or illness arising out of or in the course of employment, or incurred in the line of duty; (2) for admissions to a hospital operated by any agency of the United States Government; (3) for any other services when the member would be entitled to full or partial benefits under any municipal, State or Federal law, regulation or agency if this contract were not in effect.

The defendant contends (a) that under this construction of the certificate the plaintiff 'is not entitled to credit because he was injured in the line of duty,' and (b) that the plaintiff 'is entitled to full or partial benefits under the state law as set forth in' G.L. c. 41, § 100.

The provisions of the contract are to be construed '* * * according to the fair and reasonable meaning of the words in which the agreement of the parties is expressed.' Koshland v. Columbia Inc. Co., 237 Mass. 467, 471, 130 N.E. 41, 43. Lustenberger v. Boston Cas. Co., 300 Mass. 130, 135, 14 N.E.2d 148, 115 A.L.R. 1055. We are of opinion that the clause in the aforementioned § 2 of the subscriber's certificate beginning with the word 'when' relates to each of the situations set forth in that section. If, as the defendant argues, that clause was intended to apply only to the phrase 'for any other services,' no comma would be necessary after the word 'services.'

We think there is no doubt as to the meaning of this section. However, even if we should assume that there is some difficulty in ascertaining its meaning, any ambiguity must be resolved against the defendant. The contract was drawn by the defendant and it would have been an easy matter to state the provisions of the section in dispute in form and words which would leave no doubt as to its intent.

We see no reason why an exclusionary clause should not be written free from any ambiguity and in such simple language so as to be readily understood by a person not versed in legal technicalities or nuances of phraseology. If an insurer chooses to use language in a policy which permits two rational interpretations, we choose the one more favorable to the insured. Koshland v. Columbia Inc. Co., 237 Mass. 467, 471-472, 130 N.E. 41. Rezendes v. Prudential Ins. Co., 285 Mass. 505, 511, 189 N.E. 826. Woogmaster v. Liverpool & London & Globe Ins. Co., Ltd., 312 Mass. 479, 481, 45 N.E.2d 394. Fuller v. Home Indem. Co., 318 Mass. 37, 42, 60 N.E.2d 1. August A. Busch & Co. of Mass., Inc. v. Liberty Mut. Inc. Co., 339 Mass. 239, 243, 158 N.E.2d 351.

The plaintiff is not deprived of benefits under his contract with the defendant solely because he was injured 'in line of duty.' It remains to be determined, however, whether the plaintiff is 'entitled to full or partial benefits' under G.L. c. 41, § 100 (as amended through St.1958, c. 267).

Section 100 of G.L. c. 41 provides that a city 'shall indemnify a * * * fireman or a member of the fire department * * * to an amount not more than the amount recommended by the board or officer authorized to appoint * * * firemen or members of...