What Do You Mean It's Not Covered: Once Again, the Court Upholds the Policy Exclusion
The court held: [T]he record reveals that Mrs. Parks' sickness in January 1982 resulted from her esophageal varices condition which manifested itself within 90 days before the effective date of the policy. The continuing nature of her illness was confirmed by the fact that she was kept on [a therapeutic drug] from June 1, 1981, until she was again hospitalized on January 13, 1982. As in that case, Bartolina had received medication prescribed by a physician during the preexisting condition period defined by the policy. "We find Bartolina's external cause argument persuasive, but to find coverage for Bartolina would require us to ignore the express terms of the policy," the appeals court concluded. termination date: The date on which coverage ends. This date is shown on page EI2,5.
Coverage ends on the termination date stated in the policy. Usually this is shown at the beginning of the policy in a schedule that also shows the policy number, effective date, names of insureds, benefit amounts, and premium. usual and customary charge: The prevailing charge which is made for the same type of or comparable care by most providers in the area in which the care is furnished.
"Usual and customary charge" is simply a variation of the term "regular or customary charge." Some policies use this alternative language when limiting benefits to the usual or customary charges in the local area, in order to discourage excessive charges for services.
We, our, us: The insurance company providing this policy. In the general provisions we are referred to as the company.
You, your: The owner of this policy. The owner may be someone other than an insured person. In the general provisions the owner is referred to as the policyholder.
Policies often use the personal pronouns "we," "our" and "us" to refer to the insurance company, and "you" or "your" to refer to the policyholder. The owner or holder of a policy (the person who initiates the contract and pays the premiums) does not have to be an insured person.
