Allen v. United Servs. Auto. Ass'n
Opinion
Plaintiff-Appellant Jeffrey Allen was injured in a car accident in May 2013. His automobile insurance policy includes coverage for medical expenses arising from car accidents, but this coverage contains a one-year limitation period such that he cannot obtain reimbursement for medical expenses that accrue a year or more after an accident. Mr. Allen, who seeks reimbursement for medical expenses accruing more than a year after his accident, argues that this limitation period is invalid for two separate reasons. First, he claims that, because a 2012 disclosure form that his insurer sent him stated that his policy covers reasonable medical expenses arising from a car accident, Colorado's reasonable-expectations doctrine renders the one-year limitations period unenforceable. Second, Mr. Allen argues that Colorado's MedPay statute, which requires car insurance companies to offer at least $5,000 of coverage for medical expenses, prohibits placing a one-year time limit on this coverage. The district court granted summary judgment in favor of Mr. Allen's insurer, Defendant-Appellee United Services Automobile Association ("USAA"). We now reject both of Mr. Allen's arguments and, exercising jurisdiction under
I
Mr. Allen was insured under a car insurance policy purchased by his wife, Ellen Allen, from USAA. As relevant here, the policy's coverage period ran from December 5, 2012 to June 5, 2013, though Ms. Allen obtained the policy years before that. The policy included $100,000 of coverage for "medical payments." Aplt.'s App., Vol. III, at 711 (Auto Policy Renewal Declarations, filed Oct. 26, 2017) (capitalization omitted). The policy stated that USAA "will pay only the medical payment fee for medically necessary and appropriate medical services" and that "[t]hese fees and expenses must ... [r]esult from [a bodily injury] sustained by a covered person in an auto accident; and ... [b]e incurred for services rendered within one year from the date of the auto accident."
*1233
In 2012, USAA sent the Allens a "Summary Disclosure Form" that purported to be "a basic guide to the major coverages and exclusions in your policy."
In May 2013, within the policy's coverage period, Mr. Allen was involved in a car accident. Mr. Allen began suffering lower back pain shortly afterward. The policy provided coverage for up to $100,000 worth of medical payments within the one-year limitation period. According to a clinical assessment carried out about a year after the accident, Mr. Allen's pain "range[d] anywhere from mild to severe on a daily basis."
In May 2016, Mr. Allen brought a class action suit against USAA, on behalf of "all insureds of [USAA]," in federal district court in Colorado.
USAA filed an Answer to Mr. Allen's complaint in September 2016. In December 2016, USAA moved for summary judgment, and the district court granted this motion in July 2017. The district court entered final judgment against Mr. Allen on July 10, 2017, and Mr. Allen timely appealed.
II
"We review a district court's summary-judgment order de novo," and summary judgment "is appropriate when 'the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.' "
Dullmaier v. Xanterra Parks & Resorts
,
III
A
Mr. Allen first argues that the one-year time limit on medical-payments coverage is unenforceable because it violates Colorado's reasonable-expectations doctrine. More specifically, Mr. Allen points to the disclosure form USAA sent to his wife and him in 2012 that outlined the basic parameters of their coverage; he claims that, due to language in this disclosure form, he could have reasonably expected that there would be no time limit attached to medical-payments coverage under the policy. 1
Colorado's "doctrine of reasonable expectations" "renders exclusionary language [in an insurance policy] unenforceable ... where, because of circumstances attributable to an insurer, an ordinary, objectively reasonable insured would be deceived into believing that he or she is entitled to coverage, while the insurer would maintain he or she is not."
Bailey v. Lincoln Gen. Ins. Co.
,
Mr. Allen thinks that the 2012 disclosure form was "deceptive" because it promised coverage for "reasonable health care expenses" arising from a car accident, whereas the policy provided time limits on coverage without regard to whether expenses accruing after the expiration of such limits were also "reasonable" or "accident related."
See
Aplt.'s Opening Br. at 9. However, after studying the disclosure form, we conclude that Mr. Allen is incorrect-
viz.
, a reasonable jury could not conclude that, because of the disclosure form, "an ordinary, objectively reasonable insured would
*1235
be deceived into believing that he or she is entitled to coverage" for medical expenses on a time-unlimited basis.
Bailey
,
The 2012 disclosure form is a four-page-long document that USAA sent to the Allens. See Aplt.'s App., Vol. III, at 743-46. The form is entitled "SUMMARY DISCLOSURE FORM" and states on its first page that "[t]his summary disclosure form is a basic guide to the major coverages and exclusions in your policy. It is a general description. It is not a policy of any kind." Id. at 743. The disclosure form further directs the insured-in bolded, capital letters-to "PLEASE READ YOUR POLICY FOR COMPLETE DETAILS. THIS SUMMARY DISCLOSURE FORM SHALL NOT BE CONSTRUED TO REPLACE ANY PROVISION OF THE POLICY ITSELF." Id. (bold-face font omitted). This text is easily the most prominent feature on the first page of the disclosure form.
The disclosure form includes a subsection describing the "Medical Payments Coverage" of the Allens' policy. Id. at 745. Mr. Allen argues that this subsection creates a reasonable expectation of time-unlimited coverage. Specifically, he points to a portion of the subsection that states: "Medical payments coverage pays for you and your passengers['] reasonable health care expenses incurred for bodily injury caused by an automobile accident." Id. This subsection further elaborates that in the event of an accident, "your medical payments coverage will pay before your health insurance coverage," and that "[m]edical payments coverage will apply toward health coverage coinsurance or deductible amounts." Id. Finally, the subsection admonishes the insured to "[p]lease read your policy for other conditions and exclusions." Id.
Mr. Allen argues that the disclosure form makes the one-year limitation period unenforceable because it creates a reasonable expectation on the part of the insured that he or she will receive coverage for all reasonable medical expenses arising from an accident (up to the policy limit), regardless of when those expenses are incurred. As Mr. Allen puts it: "Common and necessary accident-related health care expenses will naturally arise more than a year after the accident-physical therapy, occupational therapy, surgical treatments used as a last resort ... or a reluctant patient's attitude or pain tolerance can all delay treatment" beyond the one-year mark. Aplt.'s Opening Br. at 15.
But Mr. Allen's argument to this effect fails because, when viewed as a whole, the 2012 disclosure form is simply not deceptive. To begin with, the form never explicitly states that the time limit for medical-payments coverage is unlimited. Moreover, the form instructs the insured to "read your policy for other conditions and exclusions," Aplt.'s App., Vol. III, at 745, and, as the district court correctly observed, the policy's information regarding the one-year limitation period "is not buried knee-deep in legalese or small print" but rather, "is easily readable and accessible under the part of the policy labeled 'MEDICAL PAYMENTS.' "
Id.
at 779 (Op. & Order, dated July 10, 2017). The form's language is also not independently deceptive; on the contrary, it tracks the model disclosure language released by the Colorado Department of Insurance.
See
Additionally, as noted supra , the form instructs readers that it is "not a policy of any kind" and tells them to "please read your policy for complete details." Aplt.'s App, Vol. III, at 743. It holds itself out as no more than "a basic guide to the major coverages and exclusions in your policy," and thus as only " a general description " of the policy's terms. Id. (emphases added).
*1236
For these reasons, the district court was correct to conclude that Colorado's reasonable-expectations doctrine does not supply a means to circumvent the policy's one-year limitation period for medical-payments coverage. The 2012 disclosure form simply did not amount to a "deception."
Bailey
,
Because the policy's exclusionary language was easily accessible and unambiguous, and because an objectively reasonable person would not, upon reading the 2012 disclosure form, have been deceived into thinking that it created a promise of time-unlimited medical-payments coverage, the district court was correct to reject Mr. Allen's reasonable-expectations theory.
3
Put another way, Mr. Allen has not shown that, through "deception attributable to the insurer, an objectively reasonable insured would have believed he or she possessed coverage later denied by [the] insurer."
Bailey
,
The Colorado Supreme Court has made clear that we are not to use the reasonable-expectations doctrine to expand coverage "on a general equitable basis."
B
Mr. Allen advances a second argument for why the policy's one-year time limit on medical-payments coverage is unenforceable: specifically, he contends that it is prohibited by Colorado's MedPay statute, COLO. REV. STAT. § 10-4-635. 4 But this argument *1237 is also without merit: stated briefly, nothing in the plain text of the MedPay statute prohibits insurance companies from including a time limit on medical-payments coverage. Therefore, we reject Mr. Allen's second argument. We explicate our reasoning below.
We apply Colorado law in determining how best to interpret a Colorado statute in a case resting on diversity jurisdiction.
See, e.g.
,
Parish Oil Co., Inc. v. Dillon Companies, Inc.
,
The MedPay statute requires that all automobile insurance policies issued in Colorado provide at least $5,000 of coverage "for medical payments ... for bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of [a] motor vehicle." COLO. REV. STAT. § 10-4-635(1)(a). The statute further provides that "medical payments benefits shall be paid to persons providing medically necessary and accident-related trauma care or medical care."
Mr. Allen does not contest the fact that the MedPay statute is silent as to whether an insurer may include a time limit on medical-payments coverage in an insurance agreement.
See
Aplt.'s Opening Br. at 32 ("The statute limits Med Pay coverage in scope and amount but not time."). Instead, he claims that we should infer from the statute's silence a prohibition on such time limits. We decline to do so, because under Colorado law, we are not at liberty to "supply the missing [statutory] language" that a party believes should have been included in a statute, but "must respect the legislature's choice of language."
Turbyne v. People
,
Our interpretation of the MedPay statute is informed by
Coats v. Dish Network, LLC
,
Mr. Allen argues that subsection 635(1)(c) of the MedPay statute requires "time-unlimited coverage" in the event that an insurer "fails to offer the required [MedPay] coverage." Aplt.'s Opening Br. at 32 (emphasis omitted). He reasons therefore that the MedPay statute should be read to prohibit time limits of any sort. We are unpersuaded. This argument is belied by subsection 635(1)(c)'s text, which states: "If the insurer fails to offer medical payments coverage or fails to maintain or provide proof that the named insured rejected medical payments coverage in the manner required by this section, the insured's policy shall be presumed to include medical payments coverage with benefits of five thousand dollars." COLO. REV. STAT. § 10-4-635(1)(c). This language says nothing about establishing time-unlimited coverage, nor does it purport to restrict insurers from imposing time limits on medical-payments coverage. For instance, even if an insurer fails to offer a particular insured medical-payments coverage, nothing in the statutory text prohibits the insurer from imposing a time limit otherwise present in its policy language on the medical-payments coverage that the statute would presume to be included in that insured's policy. Moreover, to state the obvious, Mr. Allen's argument depends on applying the statute's ostensible prohibition on time limits-expressly found (so the argument goes) in a context where an insurer has failed to comply with statute's mandate, insofar as it has not offered any MedPay coverage at all-to a setting where, as here, the insurer actually complied with the statute's mandate by offering such coverage. Yet, Mr. Allen does not offer a persuasive explanation for why it makes sense to infer that the Colorado legislature contemplated such an application to this dissimilar setting of compliance-especially because, as noted, no such time limits appear in the plain terms of the statutory grant of MedPay coverage.
Mr. Allen also argues that the MedPay statute's purpose and legislative history support reading the statute as prohibiting time limits on medical-payments
*1239
coverage. However, we decline to venture beyond the statute's plain text, since we do not find the MedPay statute to be ambiguous (i.e., we do not think that the text of the MedPay statute is susceptible to more than one meaning, at least as regards the question presented in this case).
Meardon v. Freedom Life Ins. Co. of Am.
,
* * *
In sum, we hold that the one-year time limit in Mr. Allen's insurance policy is enforceable. This is so because we conclude, as a matter of law, that the 2012 disclosure form is not deceptive and because the plain language of the MedPay statute does not prohibit such time limits. 7
IV
In conclusion, we AFFIRM the district court's order granting summary judgment in favor of USAA.
At the threshold, USAA contends that any statutory obligation to disclose its medical-payments coverage "was owed to Ms. Allen as the applicant and policyholder," and "not to" Mr. Allen, as merely a "covered party." Aplee.'s Resp. Br. at 24-25. Not surprisingly, Mr. Allen disputes this assertion and contends that his "claims do not depend on his status as a purchaser" of the USAA policy. Aplt.'s Reply Br. at 10;
see
id.
at 11 ("The time limit is unenforceable as to
any
insured because it violates that expectation."). We need not resolve this dispute. Even assuming that, as a matter of law, USAA owed the same disclosure obligation to Mr. Allen that it owed to his wife, Mr. Allen has not demonstrated (for reasons explicated
infra
) that USAA failed to satisfy this obligation. For similar reasons, we do not address USAA's "no-private-right-of-action" argument, which generally contends that Mr. Allen's "claims challenging the content of USAA's 2012 disclosure form are an end run around
There is also a second circumstance, beyond the deception of an insured by an insurer, where the reasonable-expectations doctrine comes into play: "where an ordinary, objectively reasonable person would, based on the language of the policy, fail to understand that he or she is not entitled to the coverage at issue," Bailey , 255 P.3d at 1043. Mr. Allen does not argue that this theory of reasonable expectations applies in this case.
Mr. Allen also argues, in a footnote, that the district court "abused its discretion by granting summary judgment without an adequate opportunity for discovery into USAA's state of mind." Aplt.'s Opening Br. at 27 n.3. However, Mr. Allen, in his cursory argument on this score, does not specify what discovery materials he seeks or why those materials would be germane to the present appeal. He has therefore waived this argument.
See
Nixon v. City & Cty. of Denver
,
Mr. Allen sometimes characterizes this issue, without specificity, as whether placing a time limit on medical-payments coverage violates Colorado's "public policy." Aplt.'s Opening Br. at 2; Aplt.'s Reply Br. at 20. However, his exposition of this issue clarifies that he actually believes such a time limit is "unenforceable because it violates public policy as expressed in the Med Pay statute." Aplt.'s Reply Br. at 22 (emphasis added).
To be sure, we recognize that, in holding that the MedPay statute does not prohibit an insurer from imposing a two-year limit on medical-benefits coverage, a panel of our court concluded that the MedPay statute is "ambiguous."
Countryman v. Farmers Ins. Exch.
,
Tellingly, in the one Colorado Supreme Court case that
Countryman
cites in support of its logic-
Grant
,
In 2015, a federal district court certified to the Colorado Supreme Court questions about the permissibility under Colorado law of an insurer imposing a time limit on MedPay coverage.
See
Nguyen v. Am. Family Mut. Ins. Co.
, No. 15-cv-0639-WJM-KLM,
We underscore that our task here is simply to give effect to the plain statutory language that the Colorado legislature selected. If, as a consequence of our decision, insurers are tempted "to issue policies with limits as short as 72 hours," or other arguably miserly time limits on medical-payments coverage, the Colorado legislature could conceivably conclude that such time limits "conflict with the legislative purpose and public policy goals of the statute" and re-write the statute to prohibit policy provisions containing them.
Countryman
,
Reference
- Full Case Name
- Jeffrey ALLEN, Plaintiff - Appellant, v. UNITED SERVICES AUTOMOBILE ASSOCIATION, Defendant - Appellee.
- Cited By
- 9 cases
- Status
- Published