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Mount Sinai Hospital v. Zorek

New York City Civil Court
271 N.Y.S.2d 1012 (1966)


Facts

Jane Zorek had been treated for several medical problems arising from her obesity. Although Zorek had lost some weight while hospitalized, she had difficulty losing weight on her own. Concerned about Zorek’s continuing medical complications from her weight, Zorek’s doctor determined that the best treatment was to put her on an extreme diet known as the Duncan Regime. While on this diet, Zorek would not receive any calories but would consume only water, vitamins, and minerals. This diet was potentially dangerous and known for sometimes causing sudden and serious health issues. Zorek’s doctor admitted her to Mount Sinai Hospital to be observed while on the diet. Zorek stayed at the hospital for an uneventful three weeks and lost a little over 17 pounds. However, Zorek’s insurance company, Associated Hospital Service of New York (AHS) (defendant), refused to pay the hospital bill. AHS argued that obesity was not a covered medical disease. Zorek’s insurance policy excluded coverage for specific conditions, diseases, ailments, and injuries, but obesity was not listed in these exclusions. Zorek’s insurance policy also specifically (1) provided coverage for a hospital stay if it was necessary for her proper treatment and (2) excluded coverage for hospital stays for convalescent care, sanitarium care, or rest. AHS argued that Zorek’s stay fell into the excluded category of rest care rather the covered category of care necessary for proper treatment. Mount Sinai Hospital sued Zorek’s husband (plaintiff) for the unpaid hospital bill. Zorek’s husband then sued AHS for insurance coverage for the bill.

Rule of Law

Issue

Holding and Reasoning (Greenfield, J.)

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