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LAMAR LIFE INS. COMPANY v. GEORGE SHAW & DORIS SHAW

FEBRUARY 04, 1987

LAMAR LIFE INS. COMPANY
v.
GEORGE SHAW & DORIS SHAW



BEFORE ROY NOBLE LEE, P.J., PRATHER AND ANDERSON, JJ.

PRATHER, JUSTICE, FOR THE COURT:

Doris Shaw underwent spinal surgery for an injury related to a January, 1980 automobile accident. Mrs. Shaw's claim for medical expenses was denied by Lamar Life Insurance Company because Mrs. Shaw had allegedly not been rendered wholly disabled as defined in the insurance policy.

Subsequently, the County Court of Jones County awarded the Shaws the entire amount of Mrs. Shaw's medical expenses and the Circuit Court of Jones County affirmed. Lamar Life now perfects this appeal. We reverse.

 On January 17, 1980, Doris Shaw was involved in an automobile accident in Laurel, Mississippi. Mrs. Shaw was married to George Shaw and was insured as a dependent under a group insurance policy issued by Lamar Life Insurance Company to Hughes, Inc., George Shaw's employer. Mrs. Shaw was employed full time in the grocery department of Walters Salvage.

 For her injuries, Mrs. Shaw was treated in the emergency room of the Jones County Community Hospital and was released the same day. Mrs. Shaw received additional treatment January 29, 1980, from a Dr. Anderson, her family physician. Dr. Anderson diagnosed Mrs. Shaw's injuries as a pulled muscle and he recommended hot baths and Tylenol for the pain.

 A claim for Mrs. Shaw's medical expenses was filed under her husband's insurance coverage and was paid by Lamar Life.

 On March 31, 1980, George Shaw terminated his employment with Hughes, Inc. thereby discontinuing his insurance coverage under the Hughes, Inc. group insurance policy. However, the" Extension of Benefits "provision of the policy provided:

 If an employee or dependent is wholly disabled as a result of a nonoccupational injury or a nonoccupational disease when his insurance under this coverage is discontinued and if he incurs charges as a result of a nonoccupational injury or a nonoccupational disease, within 1 year after that date and during the continuance of that disability, the same benefit shall be payable for the charges so incurred that would have been payable if they had been incurred while he was insured . (Emphasis added)

 Because she continued to suffer from the January, 1980 automobile accident, Mrs. Shaw consulted Dr. A. Albert Azordegan in April of 1980. In July of 1980, Dr. Azordegan admitted Mrs. Shaw to Doctors Hospital in Jackson, Mississippi and performed spinal surgery. As a result of the surgery, a claim was filed on the Hughes, Inc. group insurance policy for medical charges of $2,236 and Dr. Azordegan's fee of $1,530.

 Lamar Life denied liability for the expenses contending Mrs. Shaw had been employed full-time at Walters Salvage from the time of her accident until being admitted for surgery, and that she had not been" wholly disabled "since March 31, 1980 as required by the" Extension of Benefits "provision of the insurance contract.

 A trial was held in the County Court of the Second Judicial District of Jones County. The trial judge determined Mrs. Shaw had been totally disabled as defined in the insurance contract and awarded the Shaws actual damages of $3,766. The judgment of the county court was subsequently

 affirmed by the Circuit Court for the Second Judicial District of Jones County.

 II.

 To recover the disputed expenses under the Hughes, Inc. group policy, Mrs. Shaw must have been wholly disabled from March 31, 1980 until she incurred the expenses in July of 1980." Wholly ...


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