Berg v. State Board of Agriculture

919 P.2d 254, 20 Brief Times Rptr. 1085, 1996 Colo. LEXIS 225, 1996 WL 361200
CourtSupreme Court of Colorado
DecidedJuly 1, 1996
Docket94SC629
StatusPublished
Cited by32 cases

This text of 919 P.2d 254 (Berg v. State Board of Agriculture) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Berg v. State Board of Agriculture, 919 P.2d 254, 20 Brief Times Rptr. 1085, 1996 Colo. LEXIS 225, 1996 WL 361200 (Colo. 1996).

Opinion

Justice MULLARKEY

delivered the Opinion of the Court.

We granted certiorari to review Berg v. State Board of Agriculture and Public Employees’ Retirement Association of Colorado, No. 92CA1760 slip op. (Colo.App. July 14, 1994) (not selected for official publication), in which the court of appeals affirmed the denial of the defendants’ motion for summary judgment on the basis of sovereign immunity, but upheld the granting of the motion on the basis of the statute of limitations. Four grounds are before us for certiorari review:

(1) Whether the court of appeals erred in determining that the statute of limitations for a claim of nonpayment of medical services begins to run as of the date upon which the policy failed to provide coverage rather than when the claim for such expenses was denied;
(2) Whether the statute of limitations, section 13-80-101(l)(a), 6A C.R.S. (1987), is triggered by breach of contract by a self-insurer if the self-insurer did not provide adequate notice of any policy change as required by section 24r-51-1202(4), 10B C.R.S. (1988), and any other court of appeals decisions;
(3) whether the trial court erred in determining that the deletion of an endorsement to an insurance policy resurrects pri- or language of that policy; and
(4)Whether the court of appeals erred in concluding that plaintiff’s claims labeled “promissory estoppel” and “breach of contract” were not barred by the Colorado Governmental Immunity Act, sections 24-10-106, -108, 10A C.R.S. (1988), because they were not claims which lie in tort or could lie in tort.

We affirm the judgment of the court of appeals.

I.

Petitioner, Roger D. Berg (Berg), a former employee of Colorado State University (CSU), initiated this action against the State Board of Agriculture (SBA), the governing board of CSU, and the Public Employees’ Retirement Association of Colorado (PERA) (collectively defendants), to recover unpaid medical expenses related to two heart transplant surgeries performed on him in July and August of 1988.

Berg was employed by CSU from 1970 until he took medical disability retirement in June of 1984. His early retirement resulted from cardio myopathy, a heart disease with which he was diagnosed in 1978. From the time of his diagnosis, Berg knew that a heart transplant might be required. Berg’s health insurance was provided through a group policy issued to CSU by the Prudential Insurance Company of America (Prudential group policy) from 1970 through 1986. As of the time of his retirement, the Prudential group policy provided coverage for heart transplant surgery.

Effective July 1, 1986, PERA was authorized by statute to provide health insurance to retirees, and CSU ceased providing its own insurance. Berg selected a group health plan offered by PERA and administered by American Medical International (AmiCare). This plan also covered heart transplants. A memorandum issued in April of 1986 by the CSU benefits officer stated that coverage under the PERA sponsored plan was comparable to or more favorable than coverage *257 under the Prudential plan. 1 In a memorandum dated June 1986, the officer stated that no coverage other than the PERA sponsored plan was necessary to maintain a retiree’s “current level of benefits.” The memorandum also advised that an “umbrella” insurance plan was not offered to the retirees under the age of 65, including Berg, because “the PERA plan reimbursements are equal to or greater than your current coverage.” 2 CSU continued to pay Berg’s health insurance premium to PERA as part of his retirement benefits package.

In the fall of 1986, after AmiCare abruptly announced it would no longer offer a health insurance plan, PERA selected Blue Cross and Blue Shield of Colorado (Blue Cross) as its new plan administrator. Berg, along with the other covered retirees in the AmiCare plan, received two letters dated August 22, 1986, and October 17, 1986, from the Executive Director of PERA, which assured them that their health care coverage would continue and that their benefits would remain the same. 3

Berg also received a document that described the various plans offered by PERA including the Blue Cross plan. The description of the Blue Cross plan contained a disclaimer stating that the actual policy would be negotiated between Blue Cross and PERA. The booklét listed the general limitations and exclusions to the policy; heart transplant surgery was not mentioned. Berg alleges that in reliance on the information contained in the PERA letters and the descriptive document, he enrolled in the Blue Cross administered plan. Other HMOs were available to him and, for purposes of this appeal, the parties agree that Berg could have selected an HMO which provided coverage of heart transplants.

The Blue Cross administered plan took effect January 1, 1987, and included the following applicable provision under “Limitations and Exclusions”:

Organ Transplants

If you or your Dependent is a recipient of an organ transplant, and is charged for the services furnished the donor, covered charges are allowed. Only the following transplant procedures will be covered:
a. Corneal (eye) transplant.
b. Kidney (renal) transplant.
c. Bone marrow transplant.

(emphasis in original). Berg at no time received a copy of the actual policy, but in the first half of 1987 he did receive a document summarizing the Blue Cross plan which clearly described the policy’s exclusion of heart transplants in the language quoted above.

In June of 1987, endorsement number 5 was added to the Blue Cross policy. This endorsement deleted the section entitled “Organ Transplants” in the original policy, and provided the following substitution:

Organ Transplants:
Coverage for organ transplants is limited to the following procedures:
a. Corneal (eye) transplant.
b. Kidney (renal) transplant.
c. Bone marrow transplant.
If the participant or Dependent is a recipient of an organ transplant stated above, and is charged for services furnished to the donor, covered charges are allowed.

Berg renewed his insurance policy with Blue Cross effective January 1988. On March 9, 1988, endorsement number 6 was *258 added to the Blue Cross policy. It provided: “Endorsement Number 5 is deleted and is no longer applicable to the contract.” In July 1988, Blue Cross published a new medical plan summary which was provided to Berg. The statement regarding organ transplants was identical to the statement in the 1987 policy summary quoted above.

In July and August of 1988, Berg underwent two heart transplant surgeries.

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Bluebook (online)
919 P.2d 254, 20 Brief Times Rptr. 1085, 1996 Colo. LEXIS 225, 1996 WL 361200, Counsel Stack Legal Research, https://law.counselstack.com/opinion/berg-v-state-board-of-agriculture-colo-1996.