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PIONEER LIFE INSURANCE COMPANY OF ILLINOIS v. SHIRLEY F. MOSS

SEPTEMBER 30, 1987

PIONEER LIFE INSURANCE COMPANY OF ILLINOIS
v.
SHIRLEY F. MOSS



BEFORE WALKER, C.J., ROBERTSON AND ANDERSON, JJ.

WALKER, C.J., FOR THE COURT:

This case is before the Court on appeal from the Court of George County, Mississippi where, on November 9, 1984 a jury returned a verdict in favor of Shirley Moss and against Pioneer Life Insurance Company in the amount of $100.00 actual damages and $50,000.00 punitive damages. From this adverse decision, Pioneer Life Insurance Company appeals.

FACTS

 On March 20 1981. Pioneer Life Insurance Company of Illinois (hereinafter "Pioneer Life") issued a medical insurance policy to Shirley F. Moss (hereinafter "Mrs. Moss") On February 7 1982, while the policy was in effect, Mrs. Moss was admitted to Singing River Hospital suffering from chest pains. Mrs. Moss was confined at Singing River Hospital from February 7th through February 10th while diagnostic tests were performed. The discharge summary of Singing River Hospital recorded the results of the testing, including an echocardiogram, disclosing that Mrs. Moss was diagnosed as having a prolapsing mitral valve. On March 26, 1982, Mrs. Moss filed her claim form with Pioneer Life, but because the hospital chart was incomplete, Pioneer Life was unable to complete its processing until June 1. 1982. The medical expenses submitted by Mrs. Moss are set forth in tabular form below:

 MEDICAL PROVIDER DATE OF TREATMENT EXPENSES SUBMITTED

 Singing River Hosp. 2/7 - 2/10 $1,114.62

 Dr. Samuel Simmons 2/2 - 2/12 212.00

 Mobile Infirmary 2/10 170.00

 On June 14, 1982, a claims adjuster for Pioneer Life, after reviewing the medical records calculated the maximum benefits available to Mrs. Moss under her medical insurance policy. The medical expenses submitted and the benefits paid in June 1982 are set forth in tabular form below:

 MEDICAL PROVIDER BENEFITS PAID EXPENSES SUBMITTED

 Singing River Hosp. $821.64 $1,114.62

 Dr. Samuel Simmons 30.00 212.00

 Mobile Infirmary -- -- 170.00

 TOTAL $851.64 ...


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