Where, as in this case, an accident insurance policy provides that the company will pay for reasonable and necessary "treatment, confinement or services which shall have commenced within 60 days after the accident causing such injury and shall have occurred within 12 months after the accident causing such injury," the insurance company is not liable for the payment of expenses due to such injury arising after the 12-month period has expired.
W. R. Stephens, as next friend of Janice E. Stephens filed a suit against Pilot Life Insurance Company on an accident insurance policy.
The petition alleged in part that: Janice Stephens was injured on April 1, 1955, and began receiving medical treatments on that date; that it became necessary for her to receive treatments to her hand for several months before it was in a condition to be operated on; she underwent an operation on her hand during the period of July 10, 1956, to July 18, 1956; that Dr. Warner treated her from May 26, 1955, until the date of the operation; that the defendant is indebted to her for a hospital bill she incurred as a result of being a patient in the Piedmont Hospital, Atlanta, from July 10, 1956, to July 18, 1956, and $166 for Dr. Warner's services. The accident policy was attached and made a part of the petition.
The defendant filed a general demurrer which was overruled.
On the trial of the case the judge directed a verdict for the plaintiff. The defendant filed a motion for a new trial and a motion for a judgment notwithstanding the verdict, which were denied. The defendant excepts to the overruling of the general demurrer, the motion notwithstanding the verdict and the motion for new trial.
1. The insurance policy provides that the defendant is liable for all reasonable treatment, confinement or services which shall have commenced within 60 days after the accident causing such injury, and shall have occurred within 12 months after the accident causing such injury.
This provision of the policy which provides that the defendant is not liable for treatment, confinement or services which are not rendered within a twelve-month period of the date of the injury is unambiguous. Under the provision of the policy the plaintiff is not entitled to recover for the alleged hospital expenses because they were incurred subsequent to twelve months after the injury was incurred. However, the petition also sought the recovery of a bill owed to Dr. Warner. The petition having alleged that Dr. Warner treated the plaintiff from May 26, 1955 through the date of the operation, the plaintiff would be entitled to recover the fee due for his services during the twelve-month period after the date of the injury. The trial judge did not err in overruling the general demurrer to the petition.
This uncontradicted evidence established the fact that the defendant paid for the medical services which were rendered during the twelve-month period subsequent to the date of the injury. Under the ruling made in division 1 of this opinion the defendant fully complied with the requirements of the insurance contract. The evidence demanded a verdict for the defendant and the judge erred in denying the motion for a judgment notwithstanding the verdict.
Judgment reversed, with direction that the trial judge enter judgment for the defendant notwithstanding the verdict. Felton, C. J., and Nichols, J., concur.