Interpreting Medical Payments Coverage

For attorneys in Grand Prairie, Arlington, Fort Worth, Hurst, Euless, Bedford, and other places in Tarrant County, interpreting insurance policies can be difficult. Even experienced Insurance Law Attorneys will often times disagree on what the wording in a policy means as it relates to the facts of a claim.
Here is a case wherein “medical payments coverage” is being interpreted in order to determine how it is paid under the given facts.
This case is a 1973, case out of the Waco Court of Appeals. The style of the case is, Haskell M Dhane et ux. v. Trinity Universal Insurance Co.
Here is some background.
Haskell M. Dhane is the named insured in a three-car family automobile policy issued by Trinity. While driving one of the three owned vehicles designated in the policy, Mrs. Dhane was in a collision with an uninsured motorist and suffered severe personal injuries. The Dhanes brought this action for policy benefits.
The questions posed on appeal are: should Dhane be allowed to recover triple benefits under medical payments coverage and triple benefits under uninsured motorists coverage; and should Trinity be permitted to deduct any award for medical payments benefits from the uninsured motorists benefits allowed? Only the medical payments coverage question will be discussed here.
The pertinent provisions of the policy are as follows:
“It is agreed that with respect to each owned automobile described below, the insurance afforded by this policy is only with respect to such and so many of the following coverges as are indicated for each such automobile by specific premium charge or charges, and the limit of the company’s liability against each such coverage shall be as stated herein as applicable to such automobile, subject to all the terms of the policy having reference thereto ….
…
Part II — EXPENSES FOR MEDICAL SERVICES Coverage C–Medical Payments. To pay all reasonable expenses incurred within one year from the date of accident for necessary medical … services: …
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Two or More Automobiles–Parts I, II and III.
When two or more automobiles are insured hereunder, the terms of this policy shall apply separately to each, …”
The case was tried in the trial court on stipulated facts. In January 1970, while the policy was in force, Mrs. Dhane was driving the automobile described as “Car No. 1” in the policy when it was in a collision with an uninsured vehicle. As a result of bodily injuries suffered by Mrs. Dhane in the accident, she incurred reasonable and necessary medical expenses in excess of $10,000 within one year following the collision. Mrs Dhane made a demand for medical payments benefits of $2,000 per automobile (the limit) for a total of $6,000.
In discussing this case, the court stated that as a general rule, a contract of insurance is to be construed as other contracts, and all parts of that particular contract are to be taken together, and such meaning shall be given to them as will carry out and effectuate to the fullest extent the intention of the parties.
But as they said, this does not affect the settled principle of insurance law that when a contract is capable of two constructions, one of which allows recovery and the other of which denies it, that construction will be given which permits a recovery.
This policy “Insofar as medical payments coverage is concerned, the ‘two or more automobiles’ clause of the policy expressly effectuates a contract of insurance separately as to each car insured, and binds each policy with all the provisions and conditions of the single policy.”
Literally then, the relevant terms of each of the three policies provide that, within the stated limits, Trinity will:
“Pay all reasonable expenses incurred within one year from the date of accident for necessary medical services to or for the named insured and each relative who sustains bodily injury caused by accident (a) while occupying a private passenger, … described in this policy for which a specified premium charge indicates that coverage is afforded, ….”
In this case, the policy language had to be read carefully, then applied to the facts supporting the basis of the claim.
The end result here was that Mrs. Dhane was able to recover the $2,000 Medical Payments coverage on all three of her insured cars, not just the one she was driving when the accident occurred.
These situations can be confusing. A reading of the case itself can be very helpful.