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Galindo v. Guarantee Trust Life Ins. Co.

OPINION FILED DECEMBER 16, 1980.

WILLIAM GALINDO, JR., PLAINTIFF-APPELLANT,

v.

GUARANTEE TRUST LIFE INSURANCE COMPANY, DEFENDANT-APPELLEE.



APPEAL from the Circuit Court of Peoria County; the Hon. EDWARD E. HAUGENS, Judge, presiding.

MR. JUSTICE STOUDER DELIVERED THE OPINION OF THE COURT:

Plaintiff William Galindo, Jr., initiated this action to recover benefits under an accident insurance policy issued by defendant Guarantee Trust Life Insurance Company. After each party moved for summary judgment, the circuit court of Peoria County entered judgment in defendant's favor. This appeal is from that judgment.

In October 1974, plaintiff sustained a broken neck while playing in a high school football game and as a result of that injury, is a quadriplegic. The high school which plaintiff was attending at the time of his injury was a member of the Illinois High School Association (hereinafter IHSA). That association had an accident insurance policy, issued by defendant, providing various benefits for students injured in interscholastic athletic activities. The first two issues with which we are presented concern the coverage afforded by the policy and its companion information brochure.

Plaintiff's initial assignments of error invoke the specific loss provision of the policy, which provides:

"Part III Specific Loss Insurance

If the Insured by reason of injury shall sustain any one of the following specific losses within 180 days from the date of accident, the Company will pay for the loss of:

Life .......... $ 1,000.00 One Foot and Both Hands or One Eye ......... $5,000.00 Both Arms ..... 10,000.00 One Hand or Both Feet or One Arm ......... 5,000.00 Both Legs ..... 10,000.00 One Foot or Both Eyes ..... 10,000.00 One Leg ......... 5,000.00 One Hand and Either Eye ...... 5,000.00 One Eye ....... 5,000.00 Thumb and Index Finger of Either Hand ... 2,500.00

Loss shall mean in regard to hand or hands or foot or feet, actual severance through or above wrists or ankle or ankles, and loss of sight of eye or eyes shall mean the irrecoverable loss of the entire sight thereof."

Plaintiff first contends that this provision provides for the payment of benefits for the loss of arms or legs without the necessity of actual severance. Defendant acknowledges that the provision does not require severance in regard to these members but contends the policy elsewhere provides that dismemberment is a condition for the payment of loss benefits.

The subject policy mentions dismemberment in captions on its front cover and again on the top of its first page:

"This policy provides indemnity for Accidental Death, Dismemberment or Loss of Sight, caused by Accidental Bodily Injury and provides payment for expense incurred for the treatment of Accidental Bodily Injury as herein limited and provided."

The policy additionally contains a box on its first page, under the caption "Schedule," which contains the words and figure:

"Maximum Dismembership Benefit $10,000.00."

A companion brochure, entitled "Catastrophe Accident Insurance Program" prepared by defendant for distribution to principals of IHSA member schools, makes ...


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