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12/23/97 ANTONIO N. RICCIO v. AMERICAN REPUBLIC

December 23, 1997

ANTONIO N. RICCIO, APPELLANT,
v.
AMERICAN REPUBLIC INSURANCE COMPANY, APPELLEE.



Appeal from the Order of Superior Court entered October 18, 1996 at No. 2276PGH95 reversing and remanding the Order of the Court of Common Pleas, Lawrence County, Civil Division, entered November 17, 1995 at No. 565 of 1992, C.A.

Justice Castille

The opinion of the court was delivered by: Castille

OPINION OF THE COURT

JUSTICE CASTILLE

DECIDED: DECEMBER 23, 1997

This Court granted allocatur in this matter in order to address two issues. The first issue is whether the coordinate jurisdiction rule barred a Judge involved in the post-trial motion phase of the litigation sub judice from reversing the ruling of another Judge of a coordinate court in the same matter. The second issue is, if the coordinate jurisdiction rule does not act as a bar, whether the term "spine", as used in the exclusion provision of the medical insurance policy issued by appellee to appellant, included the intervertebral disc injury suffered by appellant. While we find that the coordinate jurisdiction rule under the facts of this matter does not bar the post-trial Judge from reversing the ruling of another Judge of the same court in the same case, we agree with the Superior Court that the term "spine", which was contained in the exclusion provision of the medical insurance policy in question, encompassed the intervertebral disc injury suffered by appellant.

The relevant facts are that on October 16, 1990, appellant applied to appellee for medical insurance for his two children and himself. In the medical history section of his insurance application concerning the back/spine, appellant averred that neither he nor his two daughters had been treated or diagnosed over the last ten years with any type of back pain, curvature or disc problems. However, appellant's insurance application did indicate that he had visited Ellwood City Hospital's emergency room in June of 1986 complaining of stomach pains after eating at a fast-food restaurant.

On October 18, 1990, two days after making the application for insurance with appellee, but before appellee issued the medical insurance policy, appellant suffered a herniated disc while attempting to lift a pizza oven at the pizzeria he owned. On October 19, 1990, appellant underwent a surgical microdisectomy *fn1 as a result of the injury.

Appellee subsequently received appellant's medical insurance application. In response to appellant's admission that he had visited Ellwood City Hospital's emergency room in 1986, appellee requested appellant's medical records from the hospital. Included in Ellwood City Hospital's medical records for appellant was an x-ray of appellant's spine. On November 20, 1990, appellee issued a medical insurance policy to appellant which was retroactive to the application date of October 16, 1990. The insurance policy, however, contained the following explicit exclusion because of appellant's medical records:

This policy provides all the stated benefits except for any loss incurred by or for Antonio N. Riccio which results from: hiatal or diaphragmatic hernia, arthritis, any injury to, disease, disorder of, or treatment or operative repair of the spine, or ulcer of the duodenum. (emphasis added).

Appellant accepted this medical insurance policy and made the appropriate premium payments in order to keep the policy in force.

Approximately ten months after appellant injured his back, appellant submitted medical bills to appellee totalling $10,937.70 for the treatment of his herniated disc. On July 26, 1991, appellee denied appellant benefits based on the above-referenced exclusion provision contained in the medical insurance policy.

On May 18, 1992, appellant instituted an action against appellee in which he sought to recover his medical expenses for the treatment of his intervertebral disc problem from the medical insurance policy issued by appellee. Appellee answered appellant's complaint by denying coverage on the grounds that the medical expenses submitted by appellant were explicitly excluded by the language of the policy exclusion.

On October 13, 1994, the trial Judge conducted a one-day non-jury trial. On October 20, 1994, the Judge entered a verdict in favor of appellee. On that same day, the trial Judge assigned to this matter filed an Opinion in Support of Verdict finding that appellee had no duty to provide coverage for appellant's claim on the grounds that the ...


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