Helal v. Fox, Unpublished Decision (10-18-1999)
Helal v. Fox, Unpublished Decision (10-18-1999)
Opinion of the Court
OPINION
This case presents an appeal by Appellant, Nationwide Insurance Company, Appellee Marianne Helal's insurer, from the Belmont County Common Pleas Court's decision to grant summary judgment to Appellee. For the following reasons, the decision of the common pleas court is hereby reversed and we herein grant summary judgment to Appellant.
On October 18, 1993, Appellee was a passenger in her boyfriend's automobile. In traveling through the town of Adena on Route 250 at an apparently excessive rate of speed, the automobile slid on gravel, rolled over into a ditch and Appellee was thrown through the closed T-top of the car sustaining fairly severe injuries. The parties agree that the medical bills incurred by Appellee within a year of the accident were fully paid by Appellee's boyfriend's insurance company. That insurance policy contained a one-year limitation period on medical payments. Thus, the boyfriend's insurance coverage ended upon the one-year anniversary of the accident. Appellee was forced to incur additional medical expenses due to two surgeries necessitated by hypertrophic scarring of the facial cuts after October 18, 1994, the one year anniversary of the accident. Appellee sought to have Appellant pay for those expenses as they were not paid by her boyfriend's insurer.
While the insurance policy which exists between Appellee and Appellant contains a "medical payments's clause, this clause states that Appellant will pay reasonable medical expenses, ". . . incurred within one year following the accident." A second section of the insurance contract entitled "Limits and Conditions of Payment, " further limits the payment of medical expenses to those which are not paid by other insurers. Under these sections, Appellant refused to pay the expenses incurred by Appellee after the one-year anniversary of the accident.
Appellee filed suit against her boyfriend to recoup these expenses in October of 1995 and filed an amended complaint to add Appellant as a named defendant in April of 1996. After filing an answer, Appellant took Appellee's deposition and filed a motion for summary judgment with the court which was opposed by Appellee. After a very brief hearing, on April 11, 1997, the trial court overruled Appellant's motion for summary judgment in an entry filed April 15, 1997. In the entry, the court impliedly grants summary judgment to Appellee when it held upon overruling Appellant's motion that the insurance contract contained a, "conflict in policy language" and that the conflict would be construed against Appellant. The court ordered Appellant's coverage under the policy to commence upon "the exhaustion of primary coverage"; that is, coverage was to commence beyond the one-year anniversary period stated in the policy. See Docket Entry of the Belmont Common Pleas Court, filed April 15, 1997. The within timely appeal was filed.
At the outset, we must state that this matter was ripe for summary judgment. It is clear from the record before us and the parties' briefs in this matter that there is no dispute over any factual matter and that this case revolves around a legal question; whether the language of the insurance policy in question contains a conflict which must be interpreted at law.
Appellant raises as its sole assignment of error the following:
"The trial court erred when it denied Defendant/Appellant Summary Judgment, finding a conflict in the policy language and commencing the one year contractual period of limitation for medical payment coverage at the time of exhaustion of the primary insurance coverage."
In an appeal of a trial court's grant of summary judgment, an appellate court reviews the record de novo and applies the same standard used by the trial court in its determination. Sethi v.Antonucci (1998),
Civ.R. 56 (C) provides that before a court may grant summary judgment, it must determine that:
"(1) No genuine issue as to any material fact remains to be litigated; (2) the moving party is entitled to judgment as a matter of law; and (3) it appears from the evidence that reasonable minds can come to but one conclusion, and viewing such evidence most strongly in favor of the party against whom the motion for summary judgment is made, that conclusion is adverse to that party."
Temple v. Wean United, Inc. (1977),
Once this initial burden is met, the nonmoving party has a reciprocal burden to show specific facts that demonstrate that a genuine issue for trial exists. Id. The nonmovant cannot rest on his pleadings but must produce evidence on any issue for which he bears the burden of production at trial. Wing v. Anchor Media,Ltd. of Texas (1991),
As earlier stated, all parties agree that there is no dispute involving the facts, here. Instead, the dispute revolves around the trial court's denial of summary judgment to Appellant and the apparent grant of summary judgment to Appellee. The trial court took the two pertinent sections of the Appellant and Appellee's policy of insurance and, rather than construing them together to give both sections effect, found that they were actually in conflict with one another and that they needed to be read in a light most favorable to Appellee. In so doing, the court rendered one section a complete nullity.
As pointed out by Appellant, the insurance contract contains two sections which define coverage here. The first section is appropriately entitled "Coverage Agreement." This paragraph states that payment for reasonable medical and other expenses will be made for accidental bodily injury, but provides that, "[t]he expenses must be incurred within one year following the accident . . ." The next important clause then further limits this coverage. In the "Limits and Conditions of Payment" section under "Other Insurance Clause, " the policy clearly states that the Appellant will only pay for those expenses, over and above the amount of other collectible auto Medical Payments . . . insurance . . .". These two sections are easily found in the general medical payments coverage section of the policy.
Appellant argues Fuerstenberg v. Mowell (1978)
In an attempt to obtain coverage for Appellee's surgeries undergone after October 18, 1994, Appellee argues that these two medical payments clauses, that limiting said payments to a one year period following the accident and that further limiting the insurer to only excess coverage, conflict with one another. Appellee relies heavily on Heil v. United Ins. Co. (1990),
This Court of Appeals has recently dealt with a situation similar to Heil. In Phillips v. State Auto. Mut. Ins. Co. (1998),
We are not faced with the same scenario in the present case. Appellee's own medical payments portion of her insurance contract states that it will pay medical expenses incurred by her within a one year period from the date of her accident and which are not paid by, or are in excess of, another insurance carrier's payments. The one-year period in question is not a "statute of limitation" within which she had to file for these benefits or lose them forever. The one year period was, instead, a limitation on the period in which medical treatments which were sought by Appellee could be paid. Appellee sought recovery for her medical treatments from her boyfriend's insurer for the one year period following the accident. Similarly to Fuerstenberg, the boyfriend's insurer would pay expenses incurred within that year. Appellee's expenses obviously did not exceed the monetary cap set by that insurer, because the insurer paid them in full. Had her expenses exceeded the amount the, boyfriend's insurance company would pay within that year, her own medical payments clause in her own policy of insurance would operate to pay those expenses. While the language of Appellant's policy obligated it to pay any expenses Appellee incurred within that year over and above what her boyfriend's insurer would pay, it did not obligate Appellant to continue paying medical expenses into the second year. The language in the policy between Appellant and Appellee is clear, unambiguous and is not in need of any interpretation. Appellant clearly limited the coverage it would pay Appellee to an excess coverage of her expenses incurred within one year of the accident.
This policy cannot be construed identically to underinsured coverage. To underscore this fact, we need only look to Appellee's policy itself, a policy which contains a separate and distinct uninsured/underinsured motorists provision. Depending on the limits of coverage Appellee contracted and paid for in her own underinsured coverage, she may collect from Appellant her expenses beyond one year from this portion of her coverage. If we allow the trial court decision to stand, we will be nullifying the underinsured motorists provision of the parties' contract of insurance. Thus, we decline to interpret the "Medical Payments" provision of the policy in question here as though it provided coverage identical to that provided by Appellee's underinsured motorist coverage. Appellant was required by unambiguous contractual terms to pay only the excess medical expenses incurred by Appellee within one year after the accident under this provision.
For all of the foregoing, we find that Appellant's assignment of error has merit and we must reverse the decision of the trial court herein and grant summary judgment to Appellant.
Vukovich, J., Cox, P.J., concurs.
APPROVED:
_________________________________ CHERYL L. WAITE, JUDGE
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