Legg v. Fortis Ins. Co.
Legg v. Fortis Ins. Co.
Opinion
Marcus Neal Legg appeals from a summary judgment entered by the Madison Circuit Court on his claims against Fortis Insurance Company ("Fortis") and John Alden Life Insurance Company ("John Alden") *Page 777 of breach of contract and bad-faith refusal to pay an allegedly valid insurance claim. We affirm.
The pertinent facts in this case are undisputed. Therefore, we review the trial court's application of the law to the facts to determine whether Fortis and John Alden were entitled to a judgment as a matter of law. See Carpenter v. Davis,
The record reveals that on June 24, 2003, Legg executed a "Short Term Medical Enrollment Form" seeking short-term medical-insurance coverage from John Alden that would indemnify him with respect to particular medical expenses he might incur; on that form, Legg elected to pay the required initial premium of $161.96 and subsequent monthly premiums of $121.96 by means of personal checks rather than via credit card. In response, John Alden issued Legg a "Short Term Medical Certificate" providing medical-insurance coverage for a maximum period of 185 days; that certificate indicated that the insurance coverage was "administered" by Fortis. John Alden also issued Legg monthly premium-payment coupons directing that premium payments were to be made to Fortis at a post-office box in Milwaukee, Wisconsin, owned by U.S. Bank.
Under Alabama law, "disability insurance" includes insurance of natural persons against, among other things, "expense resulting from sickness." Ala. Code 1975, §
In response to Legg's intent to pay his premium on a monthly basis, an "Optional Monthly Premium Rider" amending the short-term health-insurance certificate was issued to Legg. That rider reiterated that the certificate was "billed monthly for [y]our convenience and to make the payments more affordable" and that Legg's insurance protection would remain in force for up to 185 days "as long as you pay your monthly premium to John Alden Life Insurance Company or its administrator as it becomes due." Also, in conformity with §
"GRACE PERIOD: There is a grace period of 10 days for the payment of each premium due after the first premium. The policy or certificate will stay in force during this grace period. If the premium is not received at Our Home *Page 778 Office by the end of the grace period, this policy or certificate will lapse."
(Emphasis added.)
It is undisputed that Legg made monthly premium payments in a timely manner so as to extend his coverage through at least October 28, 2003, and that a monthly premium payment was due on October 29, 2003. Legg did not make that payment on or before its due date, thereby triggering the 10-day grace period as set forth in the rider to the certificate and as mandated by §
Legg filed a two-count complaint in the trial court naming John Alden and Fortis as defendants. In that complaint, Legg asserted that the defendants had breached the certificate by failing to pay a claim for benefits arising out of the October 31, 2003, surgery and that the defendants had tortiously acted in bad faith in allegedly failing to investigate and pay that claim; he sought damages of $20,074.75 as to each count. The cause was removed to federal court, but it was later remanded. The defendants then filed a motion for a summary judgment, which was supported by excerpts from Legg's deposition transcript, evidentiary exhibits submitted at that deposition, and an affidavit of one of Fortis's supervisory employees. Legg filed a response in opposition, supported by his own affidavit. After a hearing, the trial court entered a summary judgment in favor of the defendants.
The fundamental question presented by the appeal, as framed by the parties' submissions in connection with the defendants' summary-judgment motion, is whether Legg's claim for benefits as to his October 31, 2003, surgery was properly denied. Because that question is due to be answered in the affirmative as a matter of law, as is demonstrated in this opinion, the trial court did not err in entering its summary judgment.
A "grace period," such as that mandated by §
"A statute providing for a mandatory grace period protects an insured whose policy would otherwise lapse upon a failure to pay a premium when due, but if the insurance company does not receive the premium within the grace period, the policy lapses as of the date the premium was due or the policy expired, and the insurer may refuse to provide retroactive coverage."
44 Am.Jur.2d Insurance § 841 (2003) (emphasis added and footnotes omitted); see also id. at § 843 (noting that other than as to life-insurance policies, insurers are not liable for any losses during grace periods when premiums are not paid or tendered during the pertinent grace period).
As the defendants point out in their brief on appeal, New York, like Alabama, requires the inclusion of a grace-period provision in health-insurance policies providing that such policies will "continue in force" during the applicable grace period; however, in Zaitschek v. Empire Blue Cross Blue Shield,
On appeal, Legg cites, for the first time, a case decided by our predecessor court, Blue Cross-Blue Shield of Alabama v.Colquitt,
In Colquitt,' an insured under one group policy of health insurance changed employers and requested a transfer from the former employer's group to the new employer's group, although the insured continued to remit premium payments through his former employer for several months. However, the insured failed to remit a premium payment due on February 15, 1960. The pertinent insurance contract provided for a 10-day grace period and also provided that the insurer would not be liable for payment as to any hospital services rendered to an insured after the due date unless the premium was paid within the grace period. The Alabama Court of Appeals affirmed (conditioned upon a remittitur) a judgment in favor of the insured on his breach-of-contract claim, rejecting the insurer's argument that no coverage was in effect:
Colquitt,"It is argued . . . that the forfeiture clause of the contract came into operation because the premium due February 15 was never paid. The loss (to use insurance terminology) which occurred on February 20, it is argued, was after the expiry of the term of the policy. Under cases such as Inland Mutual Ins. Co. v. Hightower,
274 Ala. 52 ,145 So.2d 422 [(1962)], a new consideration moving from the insured to the underwriter would be necessary to support an extension of the term of the contract."This would be valid except for the fact that the contract provides for a ten-day grace period. Our courts are committed to the rule that when a loss occurs within the grace period, giving rise to an obligation by the underwriter to the insured for an unencumbered sum at least equal to the unpaid premium, then the premium is deemed to have been paid and the term of the policy is appropriately extended. McMaster v. New York Life Ins. Co.,
183 U.S. 25 ,22 S.Ct. 10 ,46 L.Ed. 64 [(1901)]; Kubala v. United States, 5 Cir.,210 F.2d 943 [(1954)], citing with approval United States v. Morrell, 4 Cir.,204 F.2d 490 [(1953)]; Cilek v. New York Life Ins. Co.,97 Neb. 56 ,149 N.W. 1071 [(1914)]; Williston on Contracts, 3d Ed., § 908."In Equitable Life Assur. Soc. of United States v. Roberts,
226 Ala. 8 ,145 So. 157 [(1932)], the court recognized this principle, stating that, with respect to otherwise undesignated dividends, there is a legal obligation on the `insurer' to apply such dividends to the payment of the premium in order to avoid forfeiture of the policy."Again in Benefit Ass'n Ry. Employees v. Bray,
226 Ala. 444 ,147 So. 640 [(1933)], accruing sick benefits were applied to avoid lapse for nonpayment of premiums, and Foster, J., stated, as a general rule, `that an insurance policy cannot be canceled by the insurance carrier for nonpayment of premiums when it has a credit to the insured of an amount equal to such premium otherwise unappropriated by the insured.' See also Prudential Ins. Co. v. Gray,230 Ala. 1 ,159 So. 265 [(1934)]."
The assumption made by the Court of Appeals inColquitt was that a loss occurring during a grace period provided for in a disability-insurance policy "g[ave] rise to an obligation by the underwriter to the insured" to pay the claim, thereby somehow creating a "credit" from which the delinquent premium could be retroactively paid (via a setoff) under the authority of the Alabama caselaw cited. That assumption was erroneous. As this court subsequently noted inBlue Cross-Blue Shield of *Page 781 Alabama v. Craig,
The Alabama Supreme Court has never cited Colquitt as authority, nor does its denial of certiorari review inColquitt "necessarily indicate [that court's] approval of all the language used, nor of the statements of law made in"Colquitt. Ex parte Opelika Coca-Cola Bottling Co.,
Under the facts of record adduced in connection with the defendants' summary-judgment motion, Legg could not, as a matter of law, have prevailed on his breach-of-contract claim. Coverage was promised to Legg "only as long as [he paid his] monthly premium to John Alden Life Insurance Company or its administrator as it becomes due," and Legg failed to cause a monthly premium payment, due on or before October 29, 2003, to be transmitted to the appropriate post-office box by the due date for that payment or by the end of the 10-day grace period mandated by §
Based upon the foregoing facts and authorities, the summary judgment entered in favor of John Alden and Fortis on Legg's claims is due to be affirmed.
AFFIRMED.
THOMPSON, P.J., and BRYAN, THOMAS, and MOORE, JJ., concur.
Reference
- Full Case Name
- Marcus Neal Legg v. Fortis Insurance Company and John Alden Life Insurance Company.
- Cited By
- 2 cases
- Status
- Published