Albany Medical Center v. Preferred Life Insurance

19 Misc. 3d 209
CourtNew York Supreme Court
DecidedJanuary 31, 2008
StatusPublished
Cited by2 cases

This text of 19 Misc. 3d 209 (Albany Medical Center v. Preferred Life Insurance) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Albany Medical Center v. Preferred Life Insurance, 19 Misc. 3d 209 (N.Y. Super. Ct. 2008).

Opinion

OPINION OF THE COURT

Richard M. Platkin, J.

Plaintiff Albany Medical Center moves for summary judgment in this action brought to recover benefits allegedly due under an excess insurance policy. Defendant Allianz Life Insurance of New York (formerly known as Preferred Life Insurance Company of New York) cross-moves for summary judgment dismissing the complaint.

Background

In 1994, Albany Medical Center (AMC) purchased a policy of insurance entitled Excess Risk Insurance Policy from defendant (the insurer). Pursuant to the policy, the insurer agreed to reimburse AMC for medical expenses exceeding $100,000 in any one year paid on behalf of a covered employee or dependent under its self-funded health care plan.

Stephen Robinson started employment at AMC in January 1994. Approximately one year later, he enrolled in AMC’s health and dental insurance plan on an individual basis. On January 30, 1997, Mr. Robinson’s wife, who was employed by Fleet Financial at the time, gave birth to their daughter. On April 22, 1997, Mrs. Robinson left employment with Fleet.

Initially, Mrs. Robinson elected to continue family health insurance coverage under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). However, she terminated such coverage on July 31, 1997. On or about that time, Mr. Robinson applied to change his enrollment in the plan from individual to family coverage. The AMC plan administrator approved the change.

Following Mr. Robinson’s change to family medical coverage, his daughter received extensive medical treatment for a serious illness, which continued through her death on December 9, 1997. The Robinsons incurred $804,476.58 in medical expenses for their daughter’s care during this period.

Pursuant to the plan, AMC paid these medical expenses and provided proof of loss and supporting documents to the insurer. On June 11, 1999, the insurer denied AMC’s claim, asserting [211]*211that a midyear change from individual coverage to family coverage was not authorized under the plan’s eligibility guidelines and was, therefore, not covered under the policy.

By summons and complaint filed June 7, 2002, AMC brought this action against the insurer to recover $704,476.58 plus interest. The insurer answered on July 15, 2002. Following discovery, the parties narrowed the issues in dispute to two: (1) whether AMC’s claim is barred by the policy’s three-year limitations period; and (2) whether AMC approved Mr. Robinson’s midyear application for family health coverage in accordance with the plan’s eligibility requirements.

The court now has before it the parties’ cross motions for summary judgment on these issues. Oral argument was held on January 3, 2008, and this decision and order follows. Contractual Limitations Period

Under New York law, an action on a contract must be commenced within six years (CPLR 213). However, the parties may agree in writing to a shorter period (CPLR 201).

The policy contains the following agreement regarding the commencement of an action against the insurer:

“LEGAL ACTION. No action at law or in equity shall be brought to recover on this Policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this Policy. No such action shall be brought after the expiration of 3 years after the time written proof of loss is required to be furnished.
“CONFORMITY WITH STATE STATUTES. If any time limitation of this Policy with respect to giving notice of claim or furnishing proof of loss or bringing action is less than that permitted by the law of the state in which the Policyholder resides, such limitation is hereby extended to agree with the minimum period permitted by such law.”

Pursuant to the policy, written proof of loss must be provided to the insurer “within twelve months from the end of that Policy Year.” The claims for reimbursement at issue here were incurred between August and December of 1997, and the applicable policy expired on December 31, 2007. Accordingly, AMC was required to furnish written proof of loss with respect to such claims by December 31, 1998.

The insurer contends that under the legal action clause of the policy, AMC was required to commence suit within three years [212]*212after the last date upon which to file written proof of loss. Accordingly, the insurer argues that this action is untimely insofar as it was not commenced by December 31, 2001.

In opposition, AMC relies on the conformity with state statutes clause (conformity clause), which it contends extends the three-year period established by the legal action clause to agree with the six-year statute of limitations provided by CPLR 213. On this basis, AMC contends that it had until December 31, 2004 in which to sue — well after the commencement date of this action.

The principles of New York law governing the interpretation of a contract are well settled. Whether an agreement is ambiguous is a question of law to be determined by the court (see Van Wagner Adv. Corp. v S & M Enters., 67 NY2d 186, 191 [1986]). The test of ambiguity is whether the language in question is “susceptible of two reasonable interpretations” (Essex Ins. Co. v Pingley, 41 AD3d 774, 776 [2d Dept 2007]). An insurance “policy must, of course, be construed in favor of the insured, and ambiguities, if any, are to be resolved in the insured’s favor and against the insurer” (United States Fid. & Guar. Co. v Annunziata, 67 NY2d 229, 232 [1986]).

While the relevant policy language cannot be said to be a model of drafting clarity, the court concludes that the conformity clause, read as a whole, is susceptible to only one reasonable construction: if state law does not permit the parties to agree to the three-year limitations period established by the legal action clause, then such period is extended to conform with the minimum period to which parties may agree. Since there is no dispute that CPLR 201 and applicable case law permitted the parties to agree to the policy’s three-year limitations period, the conformity clause therefore is inapplicable.

In reaching this conclusion, the court begins, as it must, with the plain language of the contract. The first step in applying the conformity clause is to determine whether the three-year limitation period provided by the legal action clause “is less than that permitted by the law of the state of [New York].” In such cases, the conformity clause extends the policy’s limitations period to agree with “the minimum period permitted by [New York] law.”

In arguing for application of the conformity clause, . AMC asserts that the policy’s three-year limitations period is less than the six years to sue “permitted” by CPLR 213. The insurer disagrees with this construction, contending that since the parties’ agreement to a three-year limitations period is “permit[213]*213ted” by New York law, the conformity clause is inapplicable. The insurer notes that courts interpreting CPLR 201 have upheld contractual limitations periods of one year or less with respect to similar claims (see e.g. Blitman Constr. Corp. v Insurance Co. of N. Am., 66 NY2d 820 [1985]).

If the court were to view the initial use of the term “permitted” in isolation, it would be inclined to conclude that the policy suffers from an ambiguity.

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Cite This Page — Counsel Stack

Bluebook (online)
19 Misc. 3d 209, Counsel Stack Legal Research, https://law.counselstack.com/opinion/albany-medical-center-v-preferred-life-insurance-nysupct-2008.