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Cohen v. Northwestern Nat. Life Ins. Co.

APRIL 17, 1970.

DONALD E. COHEN, PLAINTIFF-APPELLANT,

v.

NORTHWESTERN NATIONAL LIFE INSURANCE COMPANY, DEFENDANT-APPELLEE.



Appeal from the Circuit Court of Cook County; the Hon. RAYMOND E. TRAFELET, Judge, presiding. Affirmed.

MR. JUSTICE SMITH DELIVERED THE OPINION OF THIS COURT.

The plaintiff filed suit on a group insurance policy to recover the sum of $320.55 as reimbursement for medical and hospital bills paid on account of a tonsillectomy performed on his son. Both plaintiff and defendant filed motions for summary judgment accompanied by appropriate affidavits. Plaintiff's motion was denied, defendant's motion was allowed and plaintiff appeals.

The chronology of events is basically as follows:

7-28-68: Plaintiff and his dependents became insured under a group policy of his employer.

8-9-68: A doctor diagnosed the son's difficulty as tonsillitis and adenoiditis and recommended surgery. It was scheduled for August 21.

8-20-68: The son entered the hospital and surgery was postponed because of a hay fever condition until a later date.

9-1-68: Employer terminated its group insurance policy.

9-18-68: The plaintiff submitted a claim for medical expenses of $15 and hospital expenses of $22.50.

9-27-68: The plaintiff terminated his employment with the employer.

11-25-68: The son's tonsils were removed and a claim for $283 was filed with the insurance company.

Payment was denied on the ground that the $37.50 incurred prior to September 1 was less than the $50 deductible provided by the policy and hence the insurance company owed nothing on those two items. It denied liability on the remainder of the claim on the theory that no surgical or hospital expenses were incurred until after the operation on November 25, 1968, and at that time the group insurance policy was not in force. It is the plaintiff's theory that the obligation for the doctor and hospital expenses in the tonsillectomy were "incurred" on August 9 when the diagnosis was made by the doctor and a determination that surgery was necessary. Thus, he says, his rights vested at that time and the subsequent cancellation of the policy was of no consequence. We do not agree.

Two policy provisions and their interpretation control this appeal. The first one reads as follows:

"If, while insured under the policy, an Insured shall incur eligible medical expenses as a result of accidental bodily injury or sickness, the ...


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