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Craig v. Central Nat. Life Ins. Co.

FEBRUARY 21, 1958.

ELNA E. CRAIG, PLAINTIFF-APPELLEE,

v.

CENTRAL NATIONAL LIFE INSURANCE COMPANY, AN INSURANCE CORPORATION, DEFENDANT-APPELLANT.



Appeal from the Circuit Court of McLean county; the Hon. WILLIAM C. RADLIFF, Judge, presiding. Affirmed.

PRESIDING JUSTICE CARROLL DELIVERED THE OPINION OF THE COURT.

Defendant appeals from a judgment of the Circuit Court of McLean county in favor of plaintiff in an action to recover hospital expenses and surgical operation benefits under the provisions of an insurance policy.

The facts are not in dispute. On January 18, 1956, defendant issued its hospital expense policy to plaintiff. The insuring clause of the policy provides that the company:

"DOES HEREBY INSURE

the person whose name appears on the last page hereof THE HEAD OF THE FAMILY against loss due to Hospital Expenses, incurred by any member of the Family Group (herein called Member) who is named in the Schedule below, because of bodily injuries received after the effective date hereof or sickness which originates after said date; and, agrees to pay indemnities to the Insured as hereinafter provided."

Part I of the policy contains a schedule of the various hospital expenses which the company agrees to pay. Part II of the policy reads as follows:

"PART II. MATERNITY

Hospital expenses incurred by a member as a result of pregnancy or results therefrom, or sickness of the female organs, will be paid for loss which occurs at least nine months after said member became included in the Schedule of Insured Members."

Attached to the policy is a rider entitled "SURGICAL OPERATION BENEFITS" which provides for the benefit to the insured of certain amounts for various surgical operations therein specified. This rider contains the following provision:

"The surgical benefits for sickness provided for herein are payable for sickness originated after this Rider has been maintained in force for four months, but surgical benefits resulting from accident herein covered are payable for injuries sustained while this Rider is in force."

The rider also contains a schedule of operations for which benefits are payable and which includes abdominal surgery.

Plaintiff was in good health when she purchased the policy and rider. On June 4, 1956, plaintiff consulted Dr. Ray Baxter. The occasion for such consultation was the fact that for about three weeks prior thereto plaintiff had been hemorrhaging and was aware of such condition since about the middle of May. Dr. Baxter examined plaintiff, diagnosed her condition, and immediately ordered her hospitalized. On June 6, 1956, she underwent a surgical operation which was referred to by Dr. Baxter, who performed the operation, as a total hysterectomy, that is, the removal of the uterus, tubes and ovaries. According to the Doctor's testimony, the operation was necessitated by the presence of a fibroid tumor of the uterus. Dr. Baxter further testified that fibroid tumors do not occur exclusively in the uterus but are also found in other parts of the body; that such tumors could occur in both the male and female body; that their cause is unknown and the presence thereof is not associated with marriage, childbirth or sex. The Doctor further testified that he had not previously treated plaintiff for the ailment which existed before the operation; that the time required for growth of a fibroid tumor is indefinite; that in plaintiff's case it could have been three months, six weeks, four months or five months but that he did not know.

This action was originally instituted in a police magistrate's court where judgment by default was entered against the defendant. Upon appeal to the circuit court, the defendant offered no proof but filed a certain written defense which in substance is that the sickness for which plaintiff was hospitalized was a sickness of the female organs and excluded by Part II of the policy until plaintiff has been insured by the policy for a period of 9 months and that such sickness originated prior to the time said policy was issued. A trial by the court resulted in ...


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