{
  "id": 8553889,
  "name": "MARY JACKIE WISDOM JOYNER v. NATIONWIDE INSURANCE",
  "name_abbreviation": "Joyner v. Nationwide Insurance",
  "decision_date": "1980-05-20",
  "docket_number": "No 797DC1054",
  "first_page": "807",
  "last_page": "810",
  "citations": [
    {
      "type": "official",
      "cite": "46 N.C. App. 807"
    }
  ],
  "court": {
    "name_abbreviation": "N.C. Ct. App.",
    "id": 14983,
    "name": "North Carolina Court of Appeals"
  },
  "jurisdiction": {
    "id": 5,
    "name_long": "North Carolina",
    "name": "N.C."
  },
  "cites_to": [
    {
      "cite": "243 S.E. 2d 894",
      "category": "reporters:state_regional",
      "reporter": "S.E.2d",
      "year": 1978,
      "opinion_index": 0
    },
    {
      "cite": "295 N.C. 39",
      "category": "reporters:state",
      "reporter": "N.C.",
      "case_ids": [
        8560959
      ],
      "year": 1978,
      "opinion_index": 0,
      "case_paths": [
        "/nc/295/0039-01"
      ]
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    {
      "cite": "246 S.E. 2d 773",
      "category": "reporters:state_regional",
      "reporter": "S.E.2d",
      "year": 1978,
      "pin_cites": [
        {
          "page": "777"
        }
      ],
      "opinion_index": 0
    },
    {
      "cite": "295 N.C. 500",
      "category": "reporters:state",
      "reporter": "N.C.",
      "case_ids": [
        8564714
      ],
      "year": 1978,
      "pin_cites": [
        {
          "page": "506"
        }
      ],
      "opinion_index": 0,
      "case_paths": [
        "/nc/295/0500-01"
      ]
    }
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  "analysis": {
    "cardinality": 422,
    "char_count": 7755,
    "ocr_confidence": 0.795,
    "pagerank": {
      "raw": 2.775660055063772e-07,
      "percentile": 0.8347461570153318
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    "sha256": "919c3827c61935d2bfd38eca65bdbbead8b1b92f919b6fa344dfb65220557de0",
    "simhash": "1:1e6712ff15b7a90f",
    "word_count": 1252
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  "last_updated": "2023-07-14T21:32:37.131990+00:00",
  "provenance": {
    "date_added": "2019-08-29",
    "source": "Harvard",
    "batch": "2018"
  },
  "casebody": {
    "judges": [
      "Judges Arnold and ERWIN concur."
    ],
    "parties": [
      "MARY JACKIE WISDOM JOYNER v. NATIONWIDE INSURANCE"
    ],
    "opinions": [
      {
        "text": "HEDRICK, Judge.\nThe resolution of the issue presented by this appeal requires our construction of the following provision of the insurance policy:\nA Certificateholder\u2019s coverage under any benefit provision of the Policy terminates upon the first occurrence of the following:\n. . .\n(4) To the last day of the policy month coinciding with or next following his termination of membership in the classes eligible for coverage under that benefit provision. . . .\n\u201cPolicy month\u201d is defined as \u201ca period of successive days commencing on the first day of each calendar month and ending on the day immediately preceding the corresponding day of the next following calendar month.\u201d That is, a \u201cpolicy month\u201d is the equivalent of a calendar month. Our task is to decide whether the language \u201c[t]o the last day of the policy month coinciding with or next following\u201d termination admits of only one interpretation, as defendant argues, or whether the language is ambiguous and thus reasonably susceptible of more than one construction. \u201c|I]f the meaning of the policy is clear and only one reasonable interpretation exists, the courts must enforce the contract as written; . . .\u201d Woods v. Nationwide Mutual Insurance Co., 295 N.C. 500, 506, 246 S.E. 2d 773, 777 (1978). On the other hand, if its import is uncertain or equivocal, that is, if the meaning of words or the effect of provisions is capable of several reasonable interpretations, the doubts will be resolved strictly against the insurer and liberally in favor of the insured so as to permit recovery where possible. Grant v. Emmco Insurance Co., 295 N.C. 39, 243 S.E. 2d 894 (1978). Moreover, in deciding whether the language is plain or ambiguous, the test is what a reasonable person in the position of the insured would have understood it to mean, and not what the insurer intended. See generally 7 Strong\u2019s N.C. Index 3d, Insurance \u00a7\u00a7 6-6.3 (1977); 43 Am. Jur. 2d Insurance \u00a7\u00a7 257-271 (1969). The rationale underlying the principle favoring the insured in situations of uncertainty is obvious: The company writes the policy and chooses the language. \u201c[I]n accord with the presumed intention of the parties, the construction should be such as not to defeat, without a plain necessity, the insured\u2019s claim to the indemnity which it was his object to secure and for which he paid a premium.\u201d 43 Am. Jur. 2d, supra \u00a7 272 at 332; accord, Grant v. Emmco Insurance Co., supra.\nDefendant in the case at bar argues that the language \u201cthe last day of the policy month coinciding with or next following . . . termination\u201d \u2014 although concededly not a \u201cmodel of draftsmanship\u201d \u2014 is capable of only one reasonable interpretation, namely, that coverage extends to the last day of the month \u201cduring which the termination occurred.\u201d Thus, defendant contends, coverage ceased in this case on 31 March 1976, the last day of the month in which plaintiff terminated her employment at Cauley Enterprises.\nWe agree that this is one way to interpret the provision. We disagree that it is the only reasonable construction, nor do we think it the most reasonable signification to give the provision. The language, at best, is ambiguous. Rational persons could justifiably conclude, for example, that \u201cthe last day of the policy month coinciding with\u201d termination means that the cessation of coverage and the termination of employment must occur simultaneously on the last day of the month. On the other hand, and contrary to defendant\u2019s contentions, rational persons could just as logically comprehend \u201cthe last day of the policy month . . . next following\u201d termination to mean that coverage extends through the last day of the month succeeding the month in which employment terminates. Since the plaintiff in this case ended her employment with Cauley Enterprises on 27 March, a date which does not coincide with the last day of the month, she rightly considered the meaning of the words \u201cnext following.\u201d We think she reasonably interpreted the language to provide coverage throughout April.\nHad the defendant truly intended the language to mean only what it now contends, the policy could have been simply and precisely written to say that coverage ceases on the last day of the month in which employment terminates. That language admits of only one construction.\nHowever, since we find the actual language in the provision at issue reasonably susceptible of several interpretations, we resolve the ambiguity in plaintiff\u2019s favor and hold that she was covered under the policy for medical expenses she incurred beginning on 22 April 1976. Moreover, although the factor is not necessarily decisive, we point out that plaintiff paid the April premium.\nThe judgment appealed from is affirmed.\nAffirmed.\nJudges Arnold and ERWIN concur.",
        "type": "majority",
        "author": "HEDRICK, Judge."
      }
    ],
    "attorneys": [
      "Ezzell, Henson & Fuerst, by Thomas W. Henson, for the plaintiff appellee.",
      "Battle, Winslow, Scott & Wiley, by Marshall A. Gallop, Jr., for the defendant appellant."
    ],
    "corrections": "",
    "head_matter": "MARY JACKIE WISDOM JOYNER v. NATIONWIDE INSURANCE\nNo 797DC1054\n(Filed 20 May 1980)\nInsurance \u00a7 43.1\u2014 group health insurance \u2014 coverage in month following termination of employment\nWhere a group health insurance policy provided coverage for the employees of a corporation \u201cto the last day of the policy month coinciding with or next following . . . termination\u201d of employment, one reasonable interpretation of the policy was that it provided coverage extending through the last day of the month succeeding the month in which employment terminated when the termination of employment did not coincide with the last day of the month, and an employee whose employment was terminated on 27 March was covered by the policy for surgery performed on 22 April.\nAPPEAL by defendant from Matthews, Judge. Judgment entered 28 September 1979 in District Court, NASH County. Heard in the Court of Appeals on 24 April 1980.\nPlaintiff seeks to recover benefits under a group health insurance plan for medical expenses she incurred as the result of a hysterectomy during the period from 22 April 1976 through 3 May 1976. Defendant does not contest that the policy was issued to cover the employees of Cauley Enterprises, Inc. as of 1 February 1976, nor does it contend that the policy does not cover the type of medical expense for which plaintiff seeks recovery. Rather, in its answer to plaintiff\u2019s complaint, defendant denied liability on the grounds that the plaintiff was no longer an employee of Cauley Enterprises, Inc. at the time she incurred the hospital and surgical expenses because she terminated her employment on 27 March 1976, and coverage under the terms of the policy ceased when she \u201cwas no longer an employee of Cauley Enterprises, Inc.\u201d\nThereafter, defendant filed a request for admissions which established that plaintiff terminated her employment with Cauley on 27 March 1976 and was not employed by Cauley on 22 April 1976. At a hearing before the judge sitting without a jury, plaintiff testified that she had requested a leave of absence on 27 March, but that when she returned to work after her operation, her job \u201chad been filled.\u201d She introduced into evidence her paycheck from Cauley dated 27 March 1976 which showed that $40.61 had been deducted for the April insurance premium.\nSummary judgment on the issue of coverage was entered for plaintiff on 1 November 1978. Defendant\u2019s appeal from the entry of that judgment was dismissed by this Court as a premature appeal since the issue of damages remained to be determined. The parties subsequently stipulated \u201cthat should the question of coverage ... be finally determined ... in favor of plaintiff, plaintiff shall be entitled to recover of defendant . . . $1864.83. . . .\u201d From a judgment entered 28 September 1979 that plaintiff recover that sum, defendant appealed.\nEzzell, Henson & Fuerst, by Thomas W. Henson, for the plaintiff appellee.\nBattle, Winslow, Scott & Wiley, by Marshall A. Gallop, Jr., for the defendant appellant."
  },
  "file_name": "0807-01",
  "first_page_order": 835,
  "last_page_order": 838
}
