Migliore

This is an appeal by defendant Sheet Metal Workers’ Welfare Plan of Northern California from a judgment awarding plaintiff Richard Migliore the sum of $1,932.

The facts are without dispute. Plaintiff, a sheet metal worker, was a union member to whom defendant had issued a policy of medical and hospital insurance. Plaintiff was injured on September 16, 1965, sustaining severe burns, and was initially admitted to Merritt Hospital, a private institution. Plaintiff was given emergency treatment and retained at Merritt for one day. He was then informed by his physician that Merritt lacked the facilities to treat his burns further, and he was advised that the necessary facilities were available only at Brooke General Hospital, a United States Army installation. Plaintiff’s transfer to Brooke was arranged, and he was hospitalized and treated at that facility for a period of 45 days.

Plaintiff was not eligible for free hospitalization or treatment at Brooke, and he was admitted as a paying patient and was ultimately billed $1,932. Plaintiff claimed coverage under defendant’s medical and hospital plan, but defendant paid only for the hospitalization at Merritt and refused to pay…