Is a plaintiff entitled to recover the costs of certain medical treatment and surgery under a major medical policy?

California, United States of America


The following excerpt is from Bower v. Roy-Al Corp., 109 Cal.Rptr. 612, 33 Cal.App.3d 1027 (Cal. App. 1973):

[33 Cal.App.3d 1040] In Hovis v. Industrial Hospital Association (1967) 71 Wash.2d 169, 426 P.2d 976, the plaintiff sued defendant insurer on a major medical policy to recover the costs of certain medical treatment and surgery. The policy was issued to the plaintiff in October, 1961, and provided coverage for 'Those physical illnesses, unless specifically excluded, which become manifest or have their original date of onset after Membership hereunder has been continuously effective for thirty or more days.'

The pertinent facts are set out in the opinion as follows (426 P.2d at p. 977):

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