Summary
In Travelers, the Georgia Court of Appeals held that the insured was entitled to combined medical payments under a single policy which insured two automobiles.
Summary of this case from Provau v. State Farm Mut. Auto. Ins. Co.Opinion
41019.
DECIDED JANUARY 28, 1965.
Action on insurance policy. Jesup City Court. Before Judge Gibbs.
Bennett, Pedrick Bennett, Larry E. Pedrick, for plaintiff in error.
Zorn Royal, William A. Zorn, J. Kenneth Royal, contra.
Construing the insurance contract as a whole in ascertaining the intention of the parties, the policy is construed to provide medical payments in different amounts as to each of the two automobiles insured in the single policy, and to mean that the plaintiff would be entitled to the combined medical payments provided in the policy, actually incurred, up to the maximum of $2,500. The provisions of the policy are accident insurance provisions as to medical expenses actually incurred up to the amount of $2,500, since the policy did not except or exclude injuries to plaintiff's wife while occupying one of the automobiles insured.
DECIDED JANUARY 28, 1965.
William Albert Watson, the plaintiff below, brought his action against The Travelers Indemnity Company on a policy of insurance denominated a "family automobile policy." The policy provided: "The insurance afforded is only with respect to such of the following coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such coverage shall be as stated herein, subject to all the terms of this policy having reference thereto." Part I provided coverage for bodily injury and property damage; and Part II covered expenses for medical services. The suit was for $1,804.89 for medical expenses incurred as a result of the injury of plaintiff's wife while she occupied the Plymouth automobile insured while being operated by her husband, the assured. When originally issued, three automobiles were named in the policy as belonging to the assured, William Albert Watson, but one vehicle, a 1953 Ford pickup, was eliminated by endorsement with the consent of the assured, and the policy was continued in force covering No. 1, 1959 Plymouth, and No. 3, 1960 Pontiac.
Under Schedule No. 4305, made a part of the policy, the "Limits of Liability" were fixed as follows:
Limits of Liability Each "Automobile Each Occurrence No. Coverage Person Single Limit ____________ _______ _________ 1 A. Liability Bodily Injury $10,000 $20,000 Property Damage 5,000 ___________________________ _______ _________ B. Medical Payments 500 ________________________________________________________________ Limits of Liability Each Automobile Each Occurrence No. Coverage Person Single Limit ____________ _______ _________ 3 A. Liability Bodily Injury $50,000 $100,000 Property Damage 5,000 ____________________________ _______ _________ B. Medical Payments 2,000 (The automobile number indicated above identifies the automobile similarly numbered elsewhere in the policy.) The limit of liability stated above as applying to a particular automobile also apply to any automobile which replaces or is used as a temporary substitute for such automobile."The obligation of the company with respect to medical expense coverage is stated in the policy as follows:
"Part II — Expenses for medical services
"Coverage B — Medical Payments.
"To pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical, X-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services:
"Division 1. To or for the named insured and each relative who sustains bodily injury, caused by accident, while occupying or through being struck by an automobile;
"Division 2. To or for any other person who sustains bodily injury, caused by accident, while occupying (a) the owned automobile, while being used by the named insured, by any resident of the same household or by any other person with the permission of the named insured; (b) a non-owned automobile, if the bodily injury results from (1) its operation or occupancy by the named insured or its operation on his behalf by his private chauffeur or domestic servant or (2) its operation or occupancy by a relative, provided it is a private passenger automobile or trailer."
Under Definitions in Part I and Part II are the following provisions:
"Definitions — `named insured' means any individual named in Item 1 of the declarations and also includes his spouse, if a resident of the same household; `owned automobile' means a private passenger, farm or utility automobile or trailer owned by the named insured, and includes a temporary substitute automobile."
Under "conditions" in the policy are the following provisions: "Two or More Automobiles. When two or more automobiles are insured hereunder, the terms of this policy shall apply separately to each, but an automobile and a trailer attached thereto shall be held to be one automobile as respects limits of liability under Part I of this policy, and separate automobiles under Part V of this policy, including any deductible provisions applicable thereto.
"Limit of Liability. The limit of liability for medical payments stated in the declarations as applicable to `each person' is the limit of the company's liability for all expenses incurred by or on behalf of each person who sustains bodily injury as the result of any one accident."
The policy further provides under Exclusions under Part II as follows:
"Exclusions — This policy does not apply under Part II to bodily injury. . . (b) sustained by the named insured or a relative (1) while occupying an automobile owned by or furnished for the regular use of either the named insured or any relative, other than an automobile defined herein as an `owned automobile,' or (2) while occupying or through being struck by (i) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads, or (ii) a vehicle operated on rails or crawler-treads."
The Pleadings — The plaintiff's petition has attached thereto a copy of the policy of insurance and the petitioner alleges that after the Ford pickup truck was eliminated from the policy by an amendment endorsement, the limits for medical payment under said policy were $500 for the Plymouth automobile and $2,000 for the Pontiac automobile, "thereby making a total limit of liability for medical payments in the sum of $2,500.00." The suit then alleges that the plaintiff and his wife were involved in an accident while operating the Plymouth automobile, as a result of which plaintiff's wife was injured and that the plaintiff incurred medical expenses in the amount of $2,304.89; that petitioner in due course filed proof of loss with the defendant, and that after consideration the defendant company paid to the petitioner $500, "contending that petitioner was entitled to recover only the amount of medical coverages afforded by the particular automobile being driven by petitioner and occupied by petitioner's wife at the time of said accident." Plaintiff, therefore, prayed for a judgment for the balance of medical expenses in the amount of $1,804.89. The defendant company filed its answer averring that it has complied with every obligation assumed by it in said contract of insurance with respect to the facts alleged in the petition, and, therefore, is not liable to the plaintiff in any sum.
The plaintiff filed his motion for summary judgment, attaching a copy of the policy and an affidavit of the plaintiff alleging substantially the same facts set forth in the original petition and praying for a judgment in favor of plaintiff for $1,804.89.
After a hearing, the judge of said court rendered judgment saying that "the court after argument of counsel concluded that the policy in question is open to conflicting interpretations" and thereupon rendered judgment in favor of the plaintiff for the amounts prayed. It is to this judgment that exception is taken.
Every insurance contract shall be construed according to the entirety of its terms. Code Ann. § 56-2419. "Where the meaning is plain and obvious, the contract should be construed as literally provided therein." Daniel v. Jefferson Standard Life Ins. Co., 52 Ga. App. 620 (2) ( 184 S.E. 366). The basic consideration is the intent of the parties. No strained or unreasonable construction is required. It can fairly be said that in the instant case the parties intended to provide in one policy the exact coverage for the insured and others which would have been provided if two separate policies had been written, each covering one of the vehicles covered by the combined policy.
The terms of the policy are plain and unambiguous and therefore must be construed as written. Part II of the policy covering expense for medical services, division 1, provides for payment of such expenses "To or for the named insured and each relative who sustains bodily injury, caused by accident, while occupying or through being struck by an automobile." This is the only provision providing medical payment for injuries to the named insured and his wife. Division 2 of Part II provides for the payment of medical expenses to or for "any other person," which means any other person than the named insured and relatives. The undertaking in Division 1, except for exclusions hereafter discussed, is unequivocally to pay medical expenses incurred by either the named insured or his wife, or both, as a result of injuries sustained while occupying, or being struck by any automobile, and is not limited to the automobile or automobiles particularly described as the insured automobiles in the policy, nor is it limited to automobiles owned by the insured. Division 1 is simply accident insurance to the named insured and his relatives when either is injured while occupying any automobile or being struck by any automobile, and if there had been two policies, one on each automobile, the insured injured person would have been entitled to payments under each policy up to the limitation of liability provided, and the same is true as to the single policy in this case as written. The insurance company contends that the exclusion clause of Part II of the policy excludes from coverage injuries of the named insured and his wife while occupying an automobile other than one specifically described and insured under the policy, and that this demands a different construction from the one we have placed upon the policy; that is, the insurance company contends that since injuries while occupying other automobiles are excluded from coverage, it necessarily follows that only injuries occurring while occupying an insured automobile are covered, and it follows from this, that the limitation as to the amount of medical payments applicable to the particularly described automobile is the only such payment provided when an injury occurs to a named insured or relative while riding in such insured automobile. Irrespective of any other reasons, the conclusion reached in this contention is not tenable for the reason that it is premised upon an erroneous interpretation of the exclusion clause. The exclusion clause says, "This policy does not apply to injury `(b) sustained by the named insured or a relative (1) while occupying an automobile owned by or furnished for the regular use of either the named insured or by any relative, other than an automobile defined herein as an owned automobile'. . ." The policy defines "owned automobile" as "a private passenger, farm or utility automobile or trailer owned by the named insured, and includes a temporary substitute automobile." While the exclusion clause does exclude automobiles owned by the named insured, it excepts therefrom a certain class of such automobiles, that is, "owned automobiles" as defined in the policy, and "owned automobiles" as defined in the policy is a private passenger automobile owned by the named insured such as that involved in the instant case. It follows, therefore, that the exclusion clause has no application here. So the meaning and effect of the single policy here is the same as if two separate policies had been written for two automobiles as to coverages for medical payments and the same exclusions. If the insurance company had decided to exclude payments for injuries received by a wife or relative while occupying any automobile other than an automobile particularly described in the policy, it could very easily have said so. If the insured could collect for medical expenses under two policies insuring different automobiles when the wife was struck by an automobile belonging to some third person, which he can do, he can certainly do so under one policy, insuring two automobiles, which contains no provision limiting medical payments to injuries received while occupying an insured automobile in which the wife or relative was riding. For foreign cases holding that the total medical payments are due when the wife or relative is injured by being run into by a third person's automobile, see Central Surety Insurance Corp. v. Elder, 204 Va. 192 ( 129 S.E.2d 651) distinguishing and criticizing Sullivan v. Royal Exchange Assurance, 181 Cal.App.2d 644 (5 Cal.Rptr. 878); Southwestern Fire Cas. Co. v. Atkins (Tex.Civ.App.), 346 S.W.2d 892; Kansas City Fire Marine Ins. Co. v. Epperson, 234 Ark. 1100 ( 356 S.W.2d 613).
The plaintiff was entitled to recover a maximum of $2,500 for medical expenses incurred and the court did not err in rendering judgment for $1,804.89.
Judgment affirmed. Frankum and Pannell, JJ., concur.