Bernice Russell v. CMFG Life Insurance Company

CourtCourt of Appeals of Wisconsin
DecidedJune 13, 2023
Docket2022AP000747
StatusUnpublished

This text of Bernice Russell v. CMFG Life Insurance Company (Bernice Russell v. CMFG Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bernice Russell v. CMFG Life Insurance Company, (Wis. Ct. App. 2023).

Opinion

COURT OF APPEALS DECISION NOTICE DATED AND FILED This opinion is subject to further editing. If published, the official version will appear in the bound volume of the Official Reports. June 13, 2023 A party may file with the Supreme Court a Sheila T. Reiff petition to review an adverse decision by the Clerk of Court of Appeals Court of Appeals. See WIS. STAT. § 808.10 and RULE 809.62.

Appeal No. 2022AP747 Cir. Ct. No. 2020CV93

STATE OF WISCONSIN IN COURT OF APPEALS DISTRICT III

BERNICE RUSSELL,

PLAINTIFF-APPELLANT,

V.

CMFG LIFE INSURANCE COMPANY,

DEFENDANT-RESPONDENT,

COVANTAGE CREDIT UNION,

DEFENDANT.

APPEAL from an order of the circuit court for Langlade County: JOHN B. RHODE, Judge. Affirmed.

Before Stark, P.J., Hruz and Gill, JJ.

Per curiam opinions may not be cited in any court of this state as precedent

or authority, except for the limited purposes specified in WIS. STAT. RULE 809.23(3). No. 2022AP747

¶1 PER CURIAM. Bernice Russell appeals from an order dismissing her complaint on summary judgment after the circuit court determined that there was no coverage for her husband’s death under a credit life insurance policy issued by CMFG Life Insurance Company (CMFG). The policy provided coverage for all deaths, subject to an exclusion for deaths occurring within six months of the effective date of the policy and resulting “directly or indirectly” from a pre-existing condition. It is undisputed that Russell’s husband’s death occurred within six months of the policy’s effective date and resulted in part from a pre-existing condition. Therefore, we agree with the circuit court that the policy exclusion for pre-existing conditions applies. In addition, we reject Russell’s argument that the policy provides coverage for her claim based on the application of the independent concurrent cause rule. Accordingly, we affirm the circuit court’s order.

BACKGROUND

¶2 On July 28, 2017, Raymond and Bernice Russell1 obtained a vehicle loan from CoVantage Credit Union and, at the same time, applied for a joint credit life insurance2 policy issued through CMFG. CoVantage was the group policyholder.3 The policy provided benefits in the event of a covered life event, 1 Because Raymond and Bernice Russell share a surname, we will refer to the plaintiff-appellant, Bernice Russell, as “Russell” and her husband as “Raymond.” 2 Credit life insurance is defined as “insurance on the lives of borrowers or purchasers of goods in connection with specific loans or credit transactions when all or a portion of the insurance is payable to the creditor to reduce or extinguish the debt.” WIS. ADMIN. CODE § Ins 6.75(1)(a)1. (July 2022). 3 CMFG issued a group credit insurance policy to CoVantage. According to the terms of that policy, the terms and conditions “shown in the Certificate issued to insured Borrowers” “are incorporated into this policy by this reference.” For ease of reading, we will simply refer to the “certificate” issued to Russell under the group policy as “the policy.”

2 No. 2022AP747

defined as the insured’s “death, accidental dismemberment, or certified diagnosis of a terminal illness.” However, the policy included an exclusion for death resulting from a pre-existing condition. The exclusion provided that CMFG will not pay benefits if the covered life event “occurs within 6 months after the Effective Date” of the policy “and results directly or indirectly from a Pre-existing Condition,” defined as “an illness, disease, or medical condition for which [the insured] received medical advice, consultation, or treatment within the 6 month period immediately prior to the Effective Date of Insurance.”

¶3 On September 21, 2017, Raymond died after changing a flat tire on a 2014 Dodge Ram. According to the record, Raymond removed the 74.2-pound tire from the vehicle himself and placed it in the trunk of another vehicle to take it to be repaired. Sometime later, he became ill, began vomiting blood, was taken to the hospital by ambulance, and died at the hospital that evening. Raymond’s death certificate listed his cause of death as “acute gastrointestinal hemorrhage” due to “complications of chronic ethanolism.” (Formatting altered.) There is no dispute that Raymond was diagnosed with esophageal varices4 on August 6, 2014; that esophageal varices were also noted in his medical records in July 2016 and on June 29, 2017; that he suffered from end-stage liver disease as a consequence of chronic alcohol abuse, among other medical concerns; and that he was awaiting a liver transplant at the time of his death.

4 A varix—the singular of varices—is defined as “[a] tortuous dilatation of a vein,” or “[l]ess commonly, dilatation of an artery or lymph vessel.” Varix, TABER’S CYCLOPEDIC MEDICAL DICTIONARY (19th ed. 2001). Thus, an esophageal varix is “[a] tortuous dilatation of an esophageal vein, esp. in the distal portion.” Esophageal Varix, TABER’S CYCLOPEDIC MEDICAL DICTIONARY (19th ed. 2001). An esophageal varix “results from any condition that causes portal hypertension, typically cirrhosis of the liver.” Id. “If an esophageal varix bursts, massive hemorrhage occurs, and the patient may die within minutes.” Id.

3 No. 2022AP747

¶4 On October 30, 2017, Russell filed a claim for life insurance benefits under the CMFG policy as a result of Raymond’s death. During its claim investigation, CMFG received Raymond’s medical records, which revealed that Raymond’s internal bleeding was “likely” the result of the “varices” with which he had previously been diagnosed. The records further revealed that Raymond had been treated for “cirrhosis and varices” within the six months prior to his death. Raymond’s physician also provided a “Health Care Provider’s Statement,” which asserted that the “[c]ondition[] which caused or contributed to death” was an “[u]pper [gastrointestinal] bleed, with end[-]stage liver disease.” The physician also averred that Raymond “receive[d] medical advice, consultation or treatment” for this condition between January 29, 2017, and July 28, 2017, which would have been within the six months immediately prior to the effective date of the policy. CMFG denied Russell’s claim on March 21, 2018.

¶5 Russell initiated this case on August 31, 2020, and filed an amended summons and complaint the next day. Russell alleged three causes of action: (1) reformation of the insurance contract; (2) payment of death benefits under the policy, including interest; and (3) return of excess premiums, also including interest. The parties filed cross-motions for summary judgment. Based on the briefing and the documents in the record, the circuit court granted CMFG’s motion for summary judgment and denied Russell’s motion, concluding that “[t]he policy language logically and reasonably excludes coverage for death caused by pre-existing conditions, which are reasonably defined in the policy.” The court entered an order dismissing Russell’s complaint. Russell appeals.

4 No. 2022AP747

DISCUSSION

¶6 “We independently review a grant of summary judgment, using the same methodology as the circuit court.” Ehr v. West Bend Mut. Ins. Co., 2018 WI App 14, ¶7, 380 Wis. 2d 138, 908 N.W.2d 486. Summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” WIS. STAT. § 802.08(2) (2021-22).5 Where the circuit court’s decision to grant or deny summary judgment rests on its interpretation of an insurance policy, which is a question of law, we review that decision de novo. Olson v. Farrar, 2012 WI 3, ¶24, 338 Wis. 2d 215, 809 N.W.2d 1.

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Bernice Russell v. CMFG Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bernice-russell-v-cmfg-life-insurance-company-wisctapp-2023.