Case Name: SUCCESSION of Leonce L. CORMIER
Court: Louisiana Court of Appeal
Jurisdiction: Louisiana
Decision Date: 1955-05-17
Citations: 80 So. 2d 571
Docket Number: No. 4011
Parties: SUCCESSION of Leonce L. CORMIER.
Judges: 
Reporter: Southern Reporter, Second Series
Volume: 80
Pages: 571–576

Head Matter:
SUCCESSION of Leonce L. CORMIER.
No. 4011.
Court of Appeal of Louisiana. First Circuit.
May 17, 1955.
Mouton & Mouton, Lafayette, for appellant.
Davidson, Meaux, One bane & Nehrbass, Lafayette, for appellee.

Opinion:
TATE, Judge.
The District Court sustained an opposition by the "Hospital Association of the Southern Pacific Lines in Texas and Louisiana" (hereinafter referred to as the "Hospital Association"), appellee herein, and ordered the tableau of account filed by the administrator to be amended to include the additional, sum of $946.40 as due the Hospital Association, Easton J. Cor-mier, Administrator of the succession of Leonce L. Cormier, appealed to this court.
The evidence indicates -that Leonce L. Cormier had been an employee of. a. railroad company for more than fifteen years ptior to his death, .and .in connection with hi^ employment during that period was a member of the Hospital Association.
By-Law 1 thereof provides, that "the object of the Hospital Association is to furnish medical and surgical treatment and services to sick and injured employees of..the" railroad company and its corporate affiliates.
The Hospital Association is maintained by payroll deductions from the employees of the railroad .company. The treatment and services provided include, Rule , 1: "a. treatment in hospital; b. treatment at surgeon's offices and at members residences; c. medicines and surgical dressings
The record indicates that Leonce L. Cor-mier entered the Hospital Association hospital in Houston, Texas, on November 17, 1952, for treatment of a malignant tumor of the second lumbar vertebra. Cormier died as a result of this malignant tumor on December 8, 1953. He was hospitalized at this hospital from November 17, 1952-March 9, 1953; then again April 6-21, 1953; and finally June 7th-December 8, 1953, .upon which latter date he died.
Rule 7 of the rules and regulations of the Hospital Association provided that for each separate disease or illness suffered by the employee protected by the agreement:
"7. Treatment for an illness or injury shall be continued until the patient is discharged by the attending surgeon , but in no event shall the patient be entitled to continuous treatment in excess of one year."
By stipulation of evidence, the sole question for our determination is an interpretation of this rule, particularly the italicized last clause thereof.
In particular, the Hospital Association contends that it is not responsible for the charge of $946.40 representing treatment at their hospital from November 18, 1953, to December 8, 1953, because under said clause it was not responsible for treatment continued beyond a calendar year from November 17, 1952, when Cormier first entered their hospital. Contrariwise, the Administrator contends that the' Hospital Association is liable for such treatment because the term "continuous treatment" refers to treatment continuous for a period of 365 days, and as is seen from the above Cormier only received hospital treatment for approximately 300 days, since he left the hospital at intervals during the year and returned home to Carenero.
As pointed out by .the Hospital Association, citing jurisprudence from other jurisdictions, the term "medical treatment" is a broad general term covering all the steps taken to effect a cure of the injury or disease, including not only examination and diagnosis and the furnishing of medicines and hospitalizátion, but also the application of remedies by the patient following medical advice, and even the sending of medicines and prescriptions through the mail.- Further, the services of an Association physician were available to Cormier when he was at home, had he needed same.
Therefore, when Cormier was home in Carenero, La., from March 10-April 6, 1953, and from April 21-June 7, 1953, it is argued, Cormier was receiving medical treatment continuously even though at home resting and taking the medicines (to relieve pain) received from the Hospital Association before he left the hospital. The Hospital Association further relies upon testimony of a medical expert that patients suffering from such cancerous conditions are considered under medical treatment although at home: the condition being incurable, the only medical treatment is to afford relief from pain by furnishing such medicines- as Cormier took home with him from the hospital.
In short, the Hospital Association urges that the contract or agreement between itself and its members is the law between the parties and to be interpreted according to its terms, and that therefore under the terms thereof Cormier's year of continuous treatment for which the Association was liable had ended November 17, 1953, or a calendar year after the first date Cormier received treatment for this specific condition or disease. Cormier's estate would therefore be liable for treatment received after that date.
This is not an unreasonable construction of the policy, and the able District Court agreed therewith.
But the interpretation of thé clause in 'question urged by the Administrator is equally reasonable, to the effect that the words of a contract must be interpreted according to the intent of the parties, Article 1945, C.C., and if ambiguous, must be construed against him who has prepared the contract, Article 1957, LSA-C.C.
The, Administrator argues that the obvious intention of the limitation of liability for a year's continuous treatment was to limit the cost to the Hospital Association to cost of 365 days' treatment. Therefore, a patient resting at home pursuant to medical advice of "go home and rest", while perhaps generally speaking is "under medical treatment", is nevertheless not receiving medical treatment within the intention and meaning of the policy or contract. This refers to treatment by reason of which the Hospital Association incurs expense to itself, and by reason of which the policy •holder or member avoids expense or cost which he -might otherwise have to pay.
Without such a contract, a policyholder would pay the examining physician for the office visit, for any medicines received, and for any house calls; but he would not pay the doctor for each day he stayed in bed at home pursuant to the doctor's advice. 'The medicines received by the patient at the hospital and taken home are a cost incurred during his stay in the hospital or at the doctor's office, not a cost incurred while he is staying home.
The Administrator further argues that if we accept the Hospital Association's interpretation of the agreement or policy prepared by it, an employee medically treated at the beginning of the year and told for instance to gargle his throat at home each day before going to work, would not be entitled to hospitalization 365 days later in graver -or more aggravated subsequent stages of such condition.
The cause or consideration for this contract between the Association and its members was for the former to a.ssume, and the latter.to avoid, payment of the costs of medical treatment and medicines. The intention was not to include items for which the member would not be liable anyway in absence of the contract. For this rea-, son, we-feel that the interpretation urged by the Administrator more nearly reflects the intention of the parties-to the agree-; ment than that urged by the Hospital Association.
But. if this clause should be regarded as ambiguous, then the well settled rule is-that-insurance contracts should be liberally construed in favor of the insured; or even if- not regarded as an insurance contract, but an agreement between the parties, should be interpreted against the party who has prepared the contract; Article 1957, LSA-C.C.; Powell v. Liberty Industrial Life Insurance Co., 197 La. 894, 2 So.2d 638; Muse v. Metropolitan Life Insurance Co., 193 La. 605, 192 So. 72, 125 A.L.R. 1075; Ernest A. Carrere's Sons v. Rumore, La.App., 52 So.2d 57.
For these reasons, the judgment of the District Court herein is reversed, and the opposition filed by the Hospital Association herein to approval of the Administrator's account, and its claim for $946.40 medical expenses, is dismissed. All costs of these opposition proceedings and of this appeal to be paid by opponent-appellee.
Reversed and rendered.