Court Opinion

ID: 9776864
Source: CourtListenerOpinion
Date Created: 2023-08-29 19:47:12.175359+00
Date Added: 2024-06-11T07:32:43.773423
License: Public Domain

ON MOTION FOR REHEARING
Appellee’s motion for rehearing to the extent indicated in this opinion is granted. In our original opinion, reference was made to a “dividend certificate” which also was issued by the defendant insurance company to the plaintiff below in addition to the insurance policy discussed, but the language of the certificate was not considered in determining the insurer’s liability. To this extent we were in error. In response to Request for Admissions the insurance company admitted the Certificate and the policy were separate and distinct insurance policies providing accident, hospitalization and indemnity coverage; and that they were both in effect on the material dates hereto. The certificate extended “extra protection” and was issued as a “dividend” by the company to persons otherwise insured with them. An additional premium was charged for the certificate and the two policies provided different benefits. The certificate *815provided for “extra income protection in hospital” and indemnity of $10.00 per day for confinement within a hospital for 365 days “in addition to any other insurance or protection”. The insurance policy benefits included “loss of work” benefits of $50.00 per month; indemnity for daily expenses incurred by the insured up to a maximum daily limit of $4.00, not to exceed a total of $120.00.
The certificate insured “against loss caused by accidental bodily injuries which occur while this certificate is in force — which loss is not caused by disease”. The certificate did not refer to the provisions of the policy, nor was the coverage provided for in the certificate “subject to” the provisions of the policy. The certificate does not contain the same restrictive limitations found in the policy discussed in the original opinion. Such restrictive limitations as “solely” or “independently of other causes” are not found in the certificate. We conclude therefore, that Mutual Benefit Health & Accident Association v. Hud-man (supra) does not apply insofar as the certificate is concerned. In the absence of a limiting clause such as “solely” or “independently of other causes” the plaintiff was not placed under the same burden required by the Hudman case. The provisions of the certificate simply do not have such a limiting clause. Coverage under the certificate was not limited to accidental bodily injuries which must be “solely” caused by an accident. Neither does the certificate exclude coverage if a disease was a contributing or concurring cause.
The undisputed medical testimony shows the volvulus condition suffered by the assured was caused principally by extra-abdominal pressure which in turn was caused by the accidental injury. The ad-hesions in the abdominal area of the assured caused him to be more susceptible to the volvulus condition. The adhesions, to this extent, contributed to the volvulus condition, but the accidental injury the assured received when lifting the heavy machinery was the primary and proximate cause of the bodily injury. Under such circumstances, when viewed in the light of the provisions of the certificate, as distinguished from the language of the insurance policy, we conclude the assured is entitled to recover under the certificate only. See Home Benefit Association v. Smith (Tex.Civ.App.) 16 S.W.2d 357 (Error Ref.). Pyramid Life Insurance Company v. Alexander (Tex.Civ.App.) 337 S.W.2d 813 (Ref. N.R.E.). We think this holding is in conformity with the holding in Mutual Benefit Health & Accident Association v. Hud-man, cited and followed in the original opinion. There was sufficient evidence to support the trial court’s findings that Jordan was entitled to the coverage under the provisions of the certificate. We remain convinced there can be no recovery under the insurance policy.
 In view of this holding, we must now examine appellant’s last point of error to the effect the trial court erred in awarding appellee attorneys’ fees of $500.00 in the absence of evidence concerning attorneys’ fees and the reasonableness of such fees. It has been held in such cases that the trial court may determine the amount and reasonableness of the attorneys’ fees. Article 3.62 of the Insurance Code, V.A.T.S. American National Insurance Company v. Points (Tex.Civ.App.) 131 S.W.2d 983 (Dis. Judgment correct). American Income Life Insurance Company v. Davis (Tex.Civ.App.) 334 S.W.2d 486. The trial court’s action in fixing attorneys’ fees in cases controlled by the above article in question is subject to review only for an abuse of discretion. We find no abuse of discretion, but in view of our present holding the amount of attorneys’ fees must be re-examined by the trial court.
The judgment awarding recovery under the dividend certificate is affirmed; that portion of the judgment awarding recovery under policy No. 475236 is reversed and rendered that plaintiff take nothing. The cause is remanded to the trial court with *816instructions to determine the reasonable attorneys’ fees and amount of statutory penalty, and to enter judgment in accordance with this opinion. Richardson v. Raby (Tex.Civ.App.) 376 S.W.2d 422. Herrin Transportation Company v. Robert E. Olson Company (Tex.Civ.App.) 325 S.W.2d 826.
Affirmed in part, reversed and rendered in part and remanded in part.