Case Name: Sandra Mutina RUDLOFF v. LOUISIANA HEALTH SERVICES AND INDEMNITY CO. d/b/a Blue Cross of Louisiana
Court: Louisiana Supreme Court
Jurisdiction: Louisiana
Decision Date: 1979-12-13
Citations: 385 So. 2d 767
Docket Number: No. 65037
Parties: Sandra Mutina RUDLOFF v. LOUISIANA HEALTH SERVICES AND INDEMNITY CO. d/b/a Blue Cross of Louisiana.
Judges: MARCUS, J., dissents and assigns reasons.
Reporter: Southern Reporter, Second Series
Volume: 385
Pages: 767–771

Head Matter:
Sandra Mutina RUDLOFF v. LOUISIANA HEALTH SERVICES AND INDEMNITY CO. d/b/a Blue Cross of Louisiana.
No. 65037.
Supreme Court of Louisiana.
Dec. 13, 1979.
On Rehearing June 23, 1980.
Howard E. Sinor, Jr., Jones, Walker, Waechter, Poitevent, Carrere & Denegre, New Orleans, for defendant-respondent.
Leon Rudloff, New Orleans, for plaintiff - applicant.

Opinion:
STONE, Judge ad hoc.
The plaintiff, Sandra Mutina Rudloff, brought suit against Louisiana Health Services and Indemnity Co. ("Blue Cross") in the First City Court of New Orleans. She sought reimbursement for certain hospital and doctors' charges under a group health and accident policy issued by defendant to the City of New Orleans. Plaintiff also sought penalties and attorney's fees under La.R.S. 22:657. The court entered judgment in favor of the plaintiff for $1,254.41 for the hospital and doctors' charges. The Fourth Circuit Court of Appeal reversed and found for the defendant. We affirm the Fourth Circuit's ruling.
Sandra Mutina Rudloff was hospitalized at Tulane Medical Center from May 30, 1977 until June 17 of that year for a mental disorder. At the time of the hospitaliza tion, Rudloff was insured as a dependent under a contract of hospitalization insurance between Blue Cross and the City of New Orleans (plaintiff's spouse's employer). Blue Cross refused Rudloff's claim for reimbursement of the hospital and doctors' charges under an article of the contract which provided:
No benefits shall be paid hereunder on account of:
Professional services, supplies or hospitalization for mental or nervous disorders and psychiatric disorders (such as minimal brain dysfunction) of the central nervous system. .
After Blue Cross denied the claim, Rud-loff filed suit for the charges contending that Blue Cross failed to comply with La. R.S. 22:213.2, and because of that failure the court should construe the contract as including the disputed coverage. La.R.S. 22:213.2 provides in pertinent part:
A. Every insurer authorized to issue policies of health and accident insurance in this state shall offer to all prospective group, blanket, and franchise policyholders at their option a provision in the insurer's health and accident insurance policies which shall state that benefits shall be payable for services rendered for the treatment of mental and/or nervous disorders, under the same circumstances, conditions, limitations, and exclusions as benefits are paid under those policies for all other diagnoses, illnesses, or accidents;
Assuming for the moment that R.S. 22:213.2 applies to the policy in question, and further assuming that Blue Cross failed to make the proper offer as required by that statute, we note that no penalty is prescribed by the insurance code for such a failure. To permit recovery in this case, assuming a valid offer, would require us to impute acceptance by the city. We are forced to conclude that the plaintiff may not recover in this case under her hospitalization insurance contract.
The plaintiff draws the court's attention to R.S. 22:653 which states:
Any insurance policy, rider, or endorsement, hereafter issued and otherwise valid, which contains any condition or provision not in compliance with the requirements of this Code, shall not be rendered invalid thereby, but shall be construed and applied in accordance with such conditions and provisions as would have applied had such policy, rider or endorsement been in full compliance with this Code.
It must be noted that nothing in the policy under consideration fails to comply with the insurance code. A contract of hospitalization insurance is in perfect conformity with the code where there is no coverage for mental or nervous disorder treatment. If R.S. 22:213.2 is applicable to a hospitalization insurance contract, it merely requires that mental coverage be offered, not that it be included in all such contracts. The contract conforms to the code without the disputed coverage and therefore R.S. 22:653 does not allow us to construe the contract as including coverage for the treatment of mental disorders.
The plaintiff argues that R.S. 22:213B(8) requires the court to construe the contract as including the disputed coverage. The statute seeks only to assure that if a policy uses certain terms or has reference to certain matters the terms used and the matters referred to should be uniformly understood. In short, R.S. 22:213B seeks to provide for uniform definitions for terms commonly used in insurance contracts. R.S. 22:213B(8) defines "conformity with state statutes" in a certain way and calls upon the courts to construe clauses pertaining to such conformity in the way set forth. There is no such construction problem at issue here. The plaintiff's argument fails to persuade us.
The court has not been able to find any other provision of the insurance code which convinces it that the specifically excluded coverage should be read into the contract.
The court notes that Tabb v. La. Health Services & Indemnity Co., 361 So.2d 862 (La.1978) held that a policy of hospitalization insurance was not "health and accident insurance" as contemplated by the insurance code. This court does not overrule Tabb today but simply finds that, even if R.S. 22:213.2 is applicable to the insurance contract at issue contrary to Tabb, the plaintiff fails here.
AFFIRMED.
MARCUS, J., dissents and assigns reasons.
CALOGERO and DENNIS, JJ., dissent for the reasons assigned by MARCUS, J.