Anthem Health Plans, Inc. v. Action Motors Corp.

850 A.2d 1122, 83 Conn. App. 715, 2004 Conn. App. LEXIS 289
CourtConnecticut Appellate Court
DecidedJuly 6, 2004
DocketAC 24065
StatusPublished
Cited by1 cases

This text of 850 A.2d 1122 (Anthem Health Plans, Inc. v. Action Motors Corp.) is published on Counsel Stack Legal Research, covering Connecticut Appellate Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anthem Health Plans, Inc. v. Action Motors Corp., 850 A.2d 1122, 83 Conn. App. 715, 2004 Conn. App. LEXIS 289 (Colo. Ct. App. 2004).

Opinion

Opinion

PETERS, J.

In this action to recover an unpaid insurance premium, the principal stated issue is the applicability of General Statutes § 52-581 (a), which requires that actions for breach of oral contracts be brought within three years of their accrual. Underlying this disputed issue of law is a more significant disputed issue of fact. This issue is whether the parties ever agreed, in any fashion, on the terms of an insurance policy that would have required payment of the disputed insurance premium. The trial court rendered judgment in favor of the alleged policyholder on the basis of findings made by a designated fact finder. We affirm the judgment.

The plaintiff, Anthem Health Plans, Inc., doing business as Anthem Blue Cross & Blue Shield of Connecticut, Inc., filed a three count complaint against the defendant, Action Motors Corporation. On appeal, it pursues only the first count, in which it alleged that the defendant, in breach of an express health insurance contract, failed to pay a December, 1997 insurance premium allegedly owed to the plaintiff under the terms of a health insurance policy described by its policy number.1 The defendant denied liability and filed two [717]*717special defenses, one alleging termination of a prior insurance policy and the other alleging a statutory time bar to the pursuit of the plaintiffs claims. The trial court, affirming the findings of the fact finder,2 rendered judgment in favor of the alleged insured.

The record before us consists of the facts found by the fact finder, as well as exhibits and a transcript of the proceedings before her. Almost all of the facts are undisputed.

On September 1,1995, the parties entered into a contract for health insurance for the defendant’s employees. This policy, described as Master Group Policy No. 085335-000, which included a rider to provide prescription drug coverage (1995 policy), was set to expire on August 31, 1997.

During August, September and October, 1997, the parties tried, unsuccessfully, to find an acceptable solution to their dispute about the increased premiums that the plaintiff intended to charge for renewal of the insurance policy. Accordingly, the defendant notified the plaintiff that it would pay for health insurance on a month-to-month basis until an agreement could be reached. Premiums higher than those previously required were paid through October 31,1997. Beginning November 1, 1997, the defendant obtained coverage from a different insurer.

On August 22, 1997, while these negotiations were ongoing, the defendant sent the plaintiff a letter (August letter) indicating that the defendant “would like to renew” its insurance coverage, but on terms that differed from those contained in the 1995 policy. The August letter proposed deletion of a prescription drug [718]*718rider and itemized the premiums that the defendant was prepared to pay for this reduced coverage.3

The plaintiff did not respond directly to the August letter. Instead, it sent to the defendant a copy of the 1995 policy, Master Group Policy No. 085335-000, updated with a “release date of September 23, 1997” (1997 policy). It was the plaintiff’s practice to mail such a policy to the policyholder at the time of the issuance of the policy of the group health insurance. Although the 1997 policy included several pages calling for the signature of the policyholder, the defendant never signed the policy.4 In disregard of the renewal terms stated in the. August letter, section SRX in the 1997 policy continued to include coverage for prescription drugs. Furthermore, the 1997 policy did not incorporate the reduced premium rates proposed in the August letter.

Despite the absence of further written documentation of agreement about the terms of the 1997 policy, the plaintiff sent the defendant a bill for $18,405.52 as the premium for coverage for December, 1997.5 At that time, the defendant had no reason to know that such a premium payment was expected.

Although any payment for insurance coverage, if due, should have been made no later than December 31, 1997, the plaintiff did not initiate the present proceedings until February 2, 2001, more than three years after the accrual of its alleged cause of action. This belated filing triggered the defendant’s special defense that the plaintiffs action was barred by § 52-581 (a).

[719]*719At trial, the plaintiff disputed only three findings made by the fact finder. In her original finding of facts, the fact finder found that “[t]here is no writing signed by the defendant evidencing the agreement between the plaintiff and the defendant with respect to the provision of group insurance.” In her supplemental finding she found that “[t]he Master Group Policy . . . and the letter dated August 22, 1997 . . . taken together do not evidence an agreement reduced to writing or a note or memorandum as referenced in General Statutes § 52-581.” She also found that the reduced renewal rates proposed by the defendant “do not appear on the unsigned Master Group Policy (Exhibit 2) or otherwise in evidence.” These findings furnished the underpinnings for the fact finder’s recommendation that the court’s judgment be in favor of the defendant.

In its appeal to this court, the plaintiff again challenges the fact findings to which it objected at trial. It also raises an issue of law about the applicability of § 52-581 (a) under the circumstances of this case. See John H. Kolb & Sons, Inc. v. G & L Excavating, Inc., 76 Conn. App. 599, 609-10, 821 A.2d 774, cert. denied, 264 Conn. 919, 828 A.2d 617 (2003). In light of the findings made at trial, the trial court did not reach this issue of statutory interpretation. Because we are not persuaded by the plaintiffs disagreement with the facts found, we likewise need not, and do not, address the plaintiffs claim of law.

To prevail in its challenge to the findings of fact approved by the trial court, the plaintiff must establish that these findings were clearly erroneous. Practice Book § 60-5; see also Pandolphe’s Auto Parts, Inc. v. Manchester, 181 Conn. 217, 221-22, 435 A.2d 24 (1980). Like the trial court, we are persuaded that, on the record before it, the fact finder reasonably could make the findings that she did. It is true that, in some respects, the record is ambiguous. Such ambiguities, however, [720]*720are of no avail to the plaintiff, because the plaintiff bore the burden of proving its claim for relief.

The plaintiff argues that the fact finder erroneously found a lack of evidence that the parties had agreed in writing on the terms for renewal of the 1995 policy. The plaintiffs principal claim is that it met its burden of proof by presenting evidence of the defendant’s interest in renewal of insurance coverage, as manifested by the defendant’s August letter, and of its own agreement to provide coverage, as manifested by its mailing of the 1997 policy to the defendant in a timely fashion.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

STEWARD MACH. CO., INC. v. White Oak Corp.
462 F. Supp. 2d 251 (D. Connecticut, 2006)

Cite This Page — Counsel Stack

Bluebook (online)
850 A.2d 1122, 83 Conn. App. 715, 2004 Conn. App. LEXIS 289, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anthem-health-plans-inc-v-action-motors-corp-connappct-2004.