Simmons v. Provident Mut. Life Ins. Co. of Philadelphia, Pennsylvania

• Decision Date: 28 October 1986
• Docket Number: No. 86-634,86-634
• Citation: 496 So.2d 243,11 Fla. L. Weekly 2267
• Parties: 11 Fla. L. Weekly 2267 Betty Jo SIMMONS, Appellant, v. PROVIDENT MUTUAL LIFE INSURANCE COMPANY OF PHILADELPHIA, PENNSYLVANIA, a foreign corporation, Appellee.
• Court: Florida District Court of Appeals

Page 243

496 So.2d 243

11 Fla. L. Weekly 2267

Betty Jo SIMMONS, Appellant, v. PROVIDENT MUTUAL LIFE INSURANCE COMPANY OF PHILADELPHIA, PENNSYLVANIA, a foreign corporation, Appellee.

No. 86-634.

District Court of Appeal of Florida,

Third District.

Oct. 28, 1986.

Gerald E. Rosser, Miami, for appellant.

Shutts & Bowen and Robert A. Wainger, Miami, for appellee.

Before SCHWARTZ, C.J., and HUBBART and BASKIN, JJ.

SCHWARTZ, Chief Judge.

Ms. Simmons was admitted to the hospital suffering from extreme high blood pressure. In order to determine whether a kidney problem was contributing to the ailment, her physician performed a renal arteriogram, an invasive x-ray procedure in which a catheter was introduced through the femoral artery and aorta to the renal arteries. After the procedure was completed apparently without incident, Ms. Simmons developed dry gangrene in both feet which required their amputation. It was later determined that, although the arteriogram had been properly performed, the catheter had dislodged cholesterol plaques--caused by previously undiagnosed arteriosclerosis--from the surface of the aorta; the plaques then formed emboli in the feet which ultimately resulted in the loss. This series of events was a not unprecedented consequence of an operation of this kind.

The present case arose when Ms. Simmons sued Provident under a policy which provided benefits for the loss of extremities which were

directly and solely as a result of accidental bodily injuries.

The policy provides an exception which states:

No payment will be made for any loss contributed to or caused by:

* * *

* * *

(b) disease or bodily or mental infirmity, or medical or surgical treatment thereof....

Upon the undisputed facts which have been outlined, both sides moved for summary judgment. The trial judge granted Provident's motion and Ms. Simmons appeals.

We conclude that the arteriogram which indisputably caused the loss was "medical or surgical treatment" of Ms. Simmons's hypertension and that this aspect of the exclusion therefore precluded recovery. ¹ The appellant's contrary contention is based solely upon the imaginative claim that the procedure involved only "diagnosis" which is to be differentiated from and is not included within the term "treatment." We do not agree.

The general doctrine that policy exceptions and exclusions are to be restrictively read, Firemans Fund Ins. Co. v. Boyd, 45 So.2d 499 (Fla.1950); Palatine Ins. Co. v. Whitfield, 73 Fla. 716, 74 So. 869 (1917), is of course tempered by the rule of reason and the principle that even insurance policies must be given practical, sensible interpretations in accordance with the natural meaning of the words employed. Hess v. Liberty Mutual Ins. Co., 458 So.2d 71 (Fla. 3d DCA 1984); New Hampshire Ins. Co. v. Carter, 359 So.2d 52 (Fla. 1st DCA 1978). In our view, there is simply no question that medical "treatment" generally includes the means used to find out what is wrong and specifically includes the arteriogram performed on Ms. Simmons. Diagnosis, that is, determining the medical cause of the patient's problems--as in the present case in which the operation was performed to find the precise etiology of the plaintiff's hypertension--is an obviously indispensable element of the entire process of trying to alleviate the symptoms and get the patient well. This point was effectively made in Provident Life & Accident Ins. Co. v. Hutson, 305 S.W.2d 837, 839-40 (Tex.Civ.App.1957), which explicitly rejects the appellant's present position:

"The meaning of the word 'treatment' as used in the policy must be given a reasonable scope. It includes not merely the actual operation in a surgical case or the giving of a prescription in a nonsurgical case, but also the preliminary examination, including sometimes an exploratory operation or an exploratory examination. The treatment may, and generally does, include three stages: Preliminary, main, and final. Whatever is usually done to the patient or administered to him by a skilled physician or surgeon in any one of these stages is properly included under the term 'treatment,' even though it may not be an indispensable prerequisite." Order of United Commercial Travelers v. Shane, 8 Cir. [1933], 64 F.2d 55, 59.... Within [the] legal meaning must be included not only what...