Court Opinion

ID: 9545845
Source: CourtListenerOpinion
Date Created: 2023-08-07 17:20:33.734106+00
Date Added: 2024-06-11T15:15:38.156249
License: Public Domain

Grady, J.
(dissenting)—I do not think the situation presented by this record warrants the holding that the Valley View Convalescent Home was not a “hospital” within the contemplation of the insurance policy. The policy on its first page provides indemnity for “Hospital and Surgical Expenses,” “Hospital Residence Indemnity,” and “Hospital Expense Benefits.” This is followed by a statement and schedule of payments which the insurance company promised to make for each day the insured “because of sickness or accidental bodily injury covered by this policy shall be necessarily confined as a resident bed patient within any hospital upon the advice of, and regularly attended by, a legally qualified physician or surgeon”; also that the company will pay the amount of expense actually incurred during the period of such hospital confinement for certain named items. Following these statements is a schedule of hospital service, and on the same page is an exception from *584the general coverage in cases of pregnancy, childbirth, etc. Reference is made to the latter being provided for in part two of the policy. This part immediately follows on the next page under a printed heading readily observed by a casual examination. All of this is followed by a very lengthy schedule covering two and one-half pages of the policy.
Nothing is said about any exceptions to general hospital coverage until one reaches the fourth page. On this page is found in rather large bold-faced print a limitation with reference to hospitals operated by the veterans administration and with reference to the rate to be charged those under eighteen years of age. Tucked away among some other and much smaller printing is found the following: “The word hospital as used in this policy shall not include a rest, convalescent, or nursing home.” The word “hospital” is neither underscored, italicized, nor in quotation marks so as to call attention to a restricted use of that word or one different to what one would gather from reading the opening part or first page of the policy. Statutes in many states protect insured parties from such deception. 44 C. J. S. 1029, Insurance, § 254.
The insured parties had the right to assume from what they would read on the front page and on the outside of the policy when folded, that if by reason of sickness or accident either of them had to be taken to a place where sick or injured persons were treated by a physician or surgeon, they would be indemnified according to the policy schedule. It would make no difference to them when they bought indemnity insurance whether the place was designated as a “hospital” or by some other word or words. They were interested in being reimbursed for what they paid the place or institution that took them in and gave needed and usual hospital service while under their doctor’s care.
Mrs. Rew was attended by a physician, who caused her to be taken to the Deaconess Hospital in Spokane. The hospital was somewhat crowded. The physician later concluded to remove his patient to another place where she would receive the same class of service as rendered by the Deaconess Hos*585pital, and while she was there she continued to receive the same service and was attended by her physician.
Although the Home was licensed and was denominated a “convalescent home,” it rendered the service the cost of which the policy protected and for which the premium was paid. Whether the place of service is called a “hospital” or something else is immaterial. The kind of service that is given is an important factor in determining whether the place or institution is a hospital and furnishes an important guide in determining liability on the part of an insurer. Mrs. Rew was necessarily confined in both the Deaconess Hospital and the Valley View Convalescent Home as “a resident bed patient” and “upon the advice of, and regularly attended by, a legally qualified physician and surgeon.” This met the terms of the policy coverage. It is not necessary to indulge in any refined definition of words or distinctions between different kinds of institutions.
The judgment should be affirmed.
Schwellenbach, C. J., concurs with Grady, J.
January 27,1953. Petition for rehearing denied.