B-107906, APRIL 23, 1952, 31 COMP. GEN. 534

B-107906: Apr 23, 1952

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MEDICAL TREATMENT - PRIVATE - SERVICEMEN INJURED IN AUTOMOBILE ACCIDENT DISPOSITION OF INSURANCE PROCEEDS WHERE A SERVICEMAN WHILE ON LEAVE OF ABSENCE WAS INVOLVED IN AN AUTOMOBILE ACCIDENT SUSTAINING INJURIES WHICH NECESSITATED HOSPITALIZATION AT A CIVILIAN HOSPITAL. THE HOSPITAL WAS PARTIALLY REIMBURSED BY AN INSURANCE COMPANY. THE GOVERNMENT IS LIABLE ONLY FOR THE DIFFERENCE BETWEEN THE TOTAL AMOUNT OF THE COST OF THE MEDICAL TREATMENT FURNISHED AND THE AMOUNT PAID TO THE HOSPITAL BY THE INSURANCE COMPANY. IT APPEARS THAT CORPORAL CULBERSON WAS ON AUTHORIZED LEAVE FROM DECEMBER 2 TO 16. HE WAS INVOLVED IN AN ACCIDENT AND SUSTAINED INJURIES WHICH NECESSITATED HOSPITALIZATION AND TREATMENT IN A CIVILIAN HOSPITAL.

B-107906, APRIL 23, 1952, 31 COMP. GEN. 534

MEDICAL TREATMENT - PRIVATE - SERVICEMEN INJURED IN AUTOMOBILE ACCIDENT DISPOSITION OF INSURANCE PROCEEDS WHERE A SERVICEMAN WHILE ON LEAVE OF ABSENCE WAS INVOLVED IN AN AUTOMOBILE ACCIDENT SUSTAINING INJURIES WHICH NECESSITATED HOSPITALIZATION AT A CIVILIAN HOSPITAL, THERE BEING NO GOVERNMENT MEDICAL FACILITIES AVAILABLE IN THE VICINITY OF THE ACCIDENT, AND THE HOSPITAL WAS PARTIALLY REIMBURSED BY AN INSURANCE COMPANY, THE GOVERNMENT IS LIABLE ONLY FOR THE DIFFERENCE BETWEEN THE TOTAL AMOUNT OF THE COST OF THE MEDICAL TREATMENT FURNISHED AND THE AMOUNT PAID TO THE HOSPITAL BY THE INSURANCE COMPANY.

ASSISTANT COMPTROLLER GENERAL YATES TO MAJ. J. M. COOK, JR., DEPARTMENT OF THE AIR FORCE, APRIL 23, 1952:

BY LETTER DATED JANUARY 30, 1952, THE DIRECTOR OF FINANCE FORWARDED TO THIS OFFICE YOUR THIRD ENDORSEMENT OF JULY 11, 1951, WITH ENCLOSURES, REQUESTING DECISION AS TO THE LEGALITY OF PAYMENT IN FULL ON A VOUCHER STATED IN FAVOR OF ST. LUKE'S METHODIST HOSPITAL, CEDAR RAPIDS, IOWA, IN THE AMOUNT OF $555.40, COVERING HOSPITALIZATION EXPENSES INCURRED BY CORPORAL DONALD G. CULBERSON, AF 17 273 623, 1050TH AIR FORCE POLICE SQUADRON, UNDER THE CIRCUMSTANCES SET FORTH IN THE ENCLOSURES.

IT APPEARS THAT CORPORAL CULBERSON WAS ON AUTHORIZED LEAVE FROM DECEMBER 2 TO 16, 1950, AND THAT ON DECEMBER 9, 1950, WHILE DRIVING ALONE IN HIS FATHER'S AUTOMOBILE, HE WAS INVOLVED IN AN ACCIDENT AND SUSTAINED INJURIES WHICH NECESSITATED HOSPITALIZATION AND TREATMENT IN A CIVILIAN HOSPITAL. NO GOVERNMENT MEDICAL FACILITIES WERE AVAILABLE IN THE VICINITY OF THE ACCIDENT. IT FURTHER APPEARS THAT GENE CULBERSON, THE ENLISTED MAN'S FATHER, CARRIED AN AUTOMOBILE INSURANCE POLICY WHICH CONTAINED A MEDICAL EXPENSE ENDORSEMENT PROVIDING FOR THE PAYMENT OF MEDICAL EXPENSES UP TO $300 FOR EACH PERSON INJURED IN THE CAR. IN A LETTER DATED FEBRUARY 23, 1951, THE FATHER STATED THAT HE WAS TOLD BY THE INSURANCE COMPANY THAT HE "DIDN-T HAVE TO PAY ANYTHING" AND THAT THE $300 HE RECEIVED "WAS MINE.'

IN A LETTER DATED JULY 26, 1951, FROM THE IOWA FARMERS MUTUAL INSURANCE COMPANY, DES MOINES 9, IOWA, TO THE ADJUTANT, OFFUTT AIR FORCE BASE, OMAHA, NEBRASKA, IT IS STATED THAT WHILE IT IS NOT POSSIBLE TO FURNISH A PHOTOSTATIC COPY OF THE INSURANCE POLICY ISSUED TO GENE CULBERSON,"THE POLICY DID PROVIDE LIABILITY AND PROPERTY DAMAGE COVERAGES, COMPREHENSIVE, COLLISION AND MEDICAL ENDORSEMENT; " THAT "A SETTLEMENT HAS BEEN MADE WITH GENE CULBERSON COVERING COLLISION DAMAGE TO HIS AUTOMOBILE; " AND THAT "A SETTLEMENT HAS BEEN MADE WITH DONALD G. CULBERSON IN THE AMOUNT OF $300.00 WHICH IS THE LIMITS OF OUR MEDICAL EXPENSE COVERAGE INASMUCH AS HIS TOTAL HOSPITAL EXPENSE AMOUNTED TO $466.00.'

BY LETTER DATED OCTOBER 24, 1951, THE INSURANCE COMPANY FORWARDED TO THE CHIEF, ADJUDICATIONS BRANCH, SETTLEMENTS DIVISION, HEADQUARTERS, AIR FORCE FINANCE CENTER, DENVER, COLORADO, A PHOTOSTATIC COPY OF THE CHECK ISSUED IN SETTLEMENT UNDER THE MEDICAL EXPENSE ENDORSEMENT. THE FACE OF SAID CHECK SHOWS THAT IT WAS MADE PAYABLE TO THE ORDER OF DONALD G. CULBERSON AND ST. LUKE'S METHODIST HOSPITAL, IN THE AMOUNT OF $300," IN FULL SETTLEMENT OF CLAIM GROWING OUT OF M. E. WHICH OCCURRED ON OR ABOUT DECEMBER 9, 1950, AT TIPTON, IOWA BASIS OF SETTLEMENT: PAID $300.00 ON M. E., LIMITS OF POLICY. TOTAL ST. LUKE'S HOSPITAL BILL $466.40.' ON THE REVERSE SIDE OF THE CHECK IS A STATEMENT " ALL PAYEES MUST ENDORSE THIS DRAFT RECEIPT OF THE AMOUNT OF THE DRAFT IS HEREBY ACKNOWLEDGED AND ACCEPTED BY THE UNDERSIGNED PAYEE/S) AS A SETTLEMENT IN FULL OF THE CLAIM OR ACCOUNT STATED ON THE FACE," FOLLOWED BY ENDORSEMENTS OF " GENE CULBERSON," " ST. LUKES METHODIST HOSPITAL, BY C. G. BLACK--- OFF. MGR., " AND " DONALD G. CULBERSON.'

WHILE THE INSURANCE POLICY, OR A COPY THEREOF, ISSUED TO GENE CULBERSON HAS NOT BEEN FURNISHED, IT IS UNDERSTOOD THAT THE STANDARD CLAUSE IN AUTOMOBILE LIABILITY POLICIES FOR THE PAYMENT OF MEDICAL EXPENSES, PROVIDES SUBSTANTIALLY FOR PAYMENT "TO OR FOR EACH PERSON" WHO SUSTAINS BODY INJURIES, ETC., AS A RESULT OF AN ACCIDENT INVOLVING THE AUTOMOBILE CONCERNED. SUCH CLAUSE OBVIOUSLY HAS FOR ITS PURPOSE THE PAYMENT OR REIMBURSEMENT (WITHIN THE LIMITS THEREOF) OF EXPENSES INCURRED BY THE INJURED PERSON AND IS NOT INTENDED TO ENRICH THE INSURED. SINCE THE SETTLEMENT CHECK WAS MADE PAYABLE JOINTLY TO THE ENLISTED MAN AND THE HOSPITAL, IT MUST BE PRESUMED IN THE ABSENCE OF EVIDENCE TO THE CONTRARY, THAT THE INSURANCE POLICY HERE INVOLVED PROVIDED FOR PAYMENT TO CORPORAL CULBERSON--- THE INJURED PARTY--- OR FOR HIM, AND NOT TO THE PERSON TO WHOM THE POLICY WAS ISSUED UNLESS IN THE FORM OF REIMBURSEMENT OF MEDICAL EXPENSES PAID BY HIM.

THE ENLISTED MAN AND THE HOSPITAL, BY THEIR ENDORSEMENT OF THE CHECK ISSUED IN THEIR FAVOR BY THE INSURANCE COMPANY IN SETTLEMENT OF ITS OBLIGATION UNDER THE INSURANCE POLICY TO PAY THE MEDICAL EXPENSES OF THE INJURED ENLISTED MAN TO THE EXTENT OF $300, IN LEGAL CONTEMPLATION ACKNOWLEDGED RECEIPT OF THAT AMOUNT TOWARD THE PAYMENT OF HIS HOSPITAL EXPENSES. THEIR ACTION IN RELEASING THE CHECK TO GENE CULBERSON--- A PERSON NOT A PARTY TO THE SETTLEMENT REPRESENTED BY THE CHECK--- AND PERMITTING HIM TO RECEIVE AND RETAIN THE PROCEEDS THEREOF, REDUCED BY THE AMOUNT OF SUCH CHECK ANY OBLIGATION WHICH THE GOVERNMENT OTHERWISE MAY HAVE ASSUMED IN CONNECTION WITH THE MEDICAL AND HOSPITAL EXPENSES OF THE ENLISTED MAN. ACCORDINGLY, YOU ARE ADVISED THAT PAYMENT ON THE VOUCHER, IF OTHERWISE PROPER, IS AUTHORIZED ONLY FOR THE DIFFERENCE BETWEEN THE AMOUNT SHOWN THEREON AND THE $300 HERETOFORE PAID BY THE INSURANCE COMPANY.

THE VOUCHER AND RELATED PAPERS TRANSMITTED WITH YOUR ENDORSEMENT ARE RETURNED HEREWITH.