McManus v. Equitable Life Assur. Soc. of U.S.

• Decision Date: 11 June 1979
• Docket Number: No. KCD,KCD
• Citation: 583 S.W.2d 271
• Parties: Anne M. McMANUS, Plaintiff-Respondent, v. The EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Defendant-Appellant. 30244.
• Court: Missouri Court of Appeals

Page 271

583 S.W.2d 271

Anne M. McMANUS, Plaintiff-Respondent, v. The EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES Defendant-Appellant.

No. KCD 30244.

Missouri Court of Appeals, Western District.

June 11, 1979.

Michael H. Maher, Kansas City, for defendant-appellant.

Eileen S. Sullivan, Kansas City, for plaintiff-respondent.

Before DIXON, P. J., and TURNAGE and KENNEDY, JJ.

KENNEDY, Judge.

We reverse the trial court's judgment for $3,036 in favor of plaintiff's claim upon a group medical policy issued by defendant The Equitable Life Assurance Society of the United States. The judgment was for an amount paid or incurred for services rendered to plaintiff's deceased husband by Brothers of Mercy Extended Care Facility during a period beginning April 3, 1972, and (with one intermission of 27 days) ending with his death on November 30, 1972.

The case turns upon whether the Brothers of Mercy Extended Care Facility was a "hospital" within the meaning of the policy. If it was a "hospital", the expenses were covered by the policy and Equitable is liable for the amount of the judgment; if it was not, then the expenses were not covered and Equitable is not liable. Since the term "hospital" is defined in the policy, we must look there and nowhere else for the definition, for the definition is a part of the contract. 44 Am.Jur.2d Insurance S 1624 (1969). It is there defined as follows:

The term "hospital" means only a legally constituted and operated institution Having, on the premises, organized facilities (including organized diagnostic and Major surgical facilities ) for the care and treatment of sick and injured persons by or under the supervision of the staff of legally qualified physicians with a registered professional nurse (R.N.) on duty, or on call, at all times. In no event, however, will the term "hospital" include any charges incurred in connection with confinement to, any institution or part thereof which is used Principally as a Rest or Nursing facility or a Facility for the aged, chronically ill, Convalescents, drug addicts or alcoholics, or as a Facility providing primarily custodial, educational or Rehabilitory care. (Emphasis supplied.)

There are at least two points at which Brothers of Mercy Extended Care Facility does not qualify as a hospital under this definition. It did not have "organized . . . major surgery facilities", and it was "used principally . . . as a facility for . . . convalescents . . . or as a facility providing primarily . . . rehabilitory care." This is clearly established by the evidence and there is no evidence to the contrary.

The evidence of the character of Brothers of Mercy, as we shall hereafter call the facility, is contained in a written questionnaire submitted by Equitable and answered in behalf of Brothers of Mercy by its personnel chief, Kathleen Allen; in the deposition of its administrator, Mr. Ainsworth; and in a Stipulation of Facts entered into by the parties. From these sources, we learn that the facility was licensed by the State of Missouri as a professional nursing home under Chapter 198, RSMo 1969. In the questionnaire, it describes its "type" as "extended care facility", and its "type of license" as "skilled nursing facility". ¹ It has facilities for "Rehabilitation and some ambulatory care," and is "For recovery following acute condition," rather than for "short-term confinement for acute care," according to the questionnaire.

Mr. Ainsworth, the administrator, said that the following statement, contained in a brochure published by the facility, accurately stated its basic purpose: "Through our restorative services the post-hospital patient may receive the rehabilitative care needed prior to his transfer to his...