State Farm Mut. Auto. Ins. Co. v. Gregg

• Citation: 526 So.2d 554
• Decision Date: 03 June 1988
• Docket Number: No. 57656,57656
• Parties: STATE FARM MUTUAL AUTOMOBILE INSURANCE CO. v. Dorothy L. GREGG.
• Court: Mississippi Supreme Court

Page 554

526 So.2d 554

STATE FARM MUTUAL AUTOMOBILE INSURANCE CO. v. Dorothy L. GREGG.

No. 57656.

Supreme Court of Mississippi.

June 3, 1988.

Jack F. Dunbar, John H. Dunbar, Holcomb, Dunbar, Connell, Chaffin & Willard, Oxford, for appellant.

Preston Davis Rideout, Jr., Fraiser, Burgoon & Abraham, Greenwood, Lon Stallings, Calhoun City, for appellee.

Before DAN M. LEE, ROBERTSON and ZUCCARO, JJ.

DAN M. LEE, Presiding Justice, for the court:

This case presents the question whether chiropractic expenses are included within the coverage of an insurance policy "med pay" provision.

Dorothy L. Gregg received a judgment against appellee State Farm Mutual Automobile Insurance Co. (State Farm) in the amount of $780 on the basis of the trial court's affirmative answer to the question posed above.

The facts are virtually without dispute, and the trial court decided liability based on interpretation of Mrs. Gregg's "med pay" policy provision and our statutory "freedom of choice" provision, Miss.Code Ann. Sec. 83-41-215 (Supp.1987) (effective from and after April 24, 1980).

State Farm appeals, assigning as its lone error that the trial court erred in granting summary judgment on behalf of Mrs. Gregg.

FACTS

Based on stipulations, the facts are these:

Dorothy Gregg injured her back in an automobile collision on April 27, 1985. At the time of the collision, Mrs. Gregg was driving her four-door Mercury Marquis, for which State Farm provided liability insurance. This policy included coverage for medical payments of up to $5,000 per injured person.

Following the accident, Mrs. Gregg received chiropractic care from M. Ray Teas, a licensed chiropractor who practices in Calhoun City, Mississippi. These treatments began April 29, 1985 and continued through September 27, 1985. Admittedly, the treatments and services rendered by Teas were within the scope of lawful chiropractic practice as defined in Miss.Code Ann. Sec. 73-6-1 (1972).

Teas had no right to practice medicine or surgery, nor did he have the right as a physician or to prescribe drugs or to advise patients not to use a prescribed drug, but he could make x-rays.

Mrs. Gregg's total bill for chiropractic services came to $920, $140 of which covered the cost of x-rays. Mrs. Gregg properly submitted a claim to State Farm which it denied based on the fact that it considered chiropractic treatment other than the x-rays not to be medical expenses covered by the policy "med pay" provision. Mrs. Gregg filed suit for $920.00 and State Farm State Farm tendered $140 to cover the x-rays. The parties agreed that if covered, the $920 represented a reasonable and necessary charge.

The "med pay" provision stated as follows:

We will pay reasonable medical expenses for bodily injuries caused by accident, for services furnished within one year of the date of the accident. The expenses are for necessary medical, surgical, X-ray, dental, ambulance, hospital, professional nursing, and funeral services, eyeglasses, hearing aids, and prosthetic devices. (R. 20) (Emphasis added).

The trial court found no material factual dispute, and granted summary judgment in favor of Mrs. Gregg in the amount of $780. From that judgment State Farm brings this appeal.

I.

Did the Trial Court Err in Holding that State Farm Must

Reimburse for Lawful Chiropractic Services?

In holding that State Farm's policy provided coverage for Mrs. Gregg's expense, the trial court read into the policy what it considered as a coverage mandate which it purportedly found in Miss.Code Ann. Sec. 83-41-215 (Supp.1987). That section provides:

Whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued in this state provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed chiropractor as defined in section 73-6-1, Mississippi Code of 1972, then such service may be performed by a duly licensed chiropractor, and the insured or other person entitled to benefits under such policy, plan or contract shall be entitled to reimbursement for such services. The insured shall have the right to choose the place where the service is to be performed as well as the chiropractor to perform such service, provided that such service shall be performed in the chiropractor's office, clinic or regular place of business.

The trial court held "State Farm should be required to reimburse the Plaintiff and others similarly situated for the treatment of any injury or condition by a chiropractor so long as the treatment is within the lawful scope of the practice of chiropractic."

In so holding, the trial court rejected State Farm's argument that Sec. 83-41-215 applied only "whenever" the policy "provides for reimbursement." To the extent the trial court considered section 83-41-215 to mandate coverage we think he was incorrect. The statute's plain purpose is to assure that "whenever" the policy provides coverage for chiropractic services the insured or the policy beneficiary may obtain services from the chiropractor of his or her choice.

Whether a particular policy binds the insurance company to reimburse its insured for chiropractic services is a product of the policy language, not a matter of statutory law. In addition, where the Legislature intended that payment for certain overlapping services be reimbursable regardless of whether the services were performed by a physician or by some other health care professional, it expressed this intent much more plainly than it did with this statute. See Miss.Code Ann. Sec. 83-41-209 (Supp.1987) (beneficiaries' freedom of choice of practitioner in performance of dental services); Miss.Code Ann. Sec. 83-41-211 (Supp.1987) (beneficiaries' freedom of choice of practitioners in treatment of mental or nervous disorder--psychologist). Thus, Miss.Code Ann. Sec. 83-41-215 (Supp.1987) does not prohibit an insurance company from drafting its medical payment clause to exclude coverage for chiropractic care, to include coverage for all chiropractic care, or to limit its coverage to only some chiropractic services. Of course, any insurance company binding itself to cover chiropractic services brings itself under the dictates of this section's mandatory freedom of choice provision.

Whether under the terms of this particular insurance policy provision State Farm agreed to cover Mrs. Gregg's "reasonable medical expenses for bodily injuries caused by accident, for services furnished within one year," which medical services happened to be rendered by a chiropractor, is the question we must decide. It is significant that the injury was to the back or vertebral column where chiropractors are authorized to treat, and not to the eye or some other part of the body.

II. Did the "Med Pay" Provision Cover Chiropractic Services?

As noted, the trial court found the "med pay" provision to be clear and unambiguous. State Farm is correct that where unambiguous, an insurance contract is not construed in favor of the insured, but rather is construed as written. Ford v. Lamar Life Ins. Co., 513 So.2d 880, 886 (Miss.1987); State Farm v. Scitzs, 394 So.2d 1371 (Miss.1981); Insurance Co. of North American v. Deposit Guaranty National Bank, 258 So.2d 798 (Miss.1972); Key Life Ins. Co. of South Carolina v. Tharp, 253 Miss. 774, 179 So.2d 555 (1965). Since under its policy State Farm agreed to cover "medical expenses," and there is really no dispute that Mrs. Gregg's treatment generated an "expense," the present problem concerns whether that expense is within the construction of the term "medical."

State Farm argues that the plain meaning of "medical" excludes chiropractors. There is, of course, support for the proposition that "medical" pertains to or relates to physicians or the science or practice or study of medicine. See Lowman v. Kuecker, 246 Iowa 1227, 71 N.W.2d 586 (1955); Mashak v. Poelker, 356 S.W.2d 713, 720 (Mo.Ct.App.1962).

There are opinions to the contrary, however, although admittedly many courts reaching the opposite result did so interpreting broad legislative enactments. See Williams v. Capital Life & Health Ins. Co., 209 S.C. 512, 41 S.E.2d 208 (1947) (naturopathy and other healing arts have been so far recognized by the legislature that any one engaged in the practice "stands for all purposes in the position of a physician in the orthodox fields of medicine", at least within specialty); Miller v. Johnson, 496 Pa. 290, 436 A.2d 1187 (1981) (chiropractic services included within "medical services" where legislative act reflected intent to include "not only direct but also supplemental support services."); Green v. Rawlings, 290 Mich. 397, 287 N.W. 557 (1939) (chiropractor...