Causey v. Medical Life Insurance Co.

21 S.W.3d 24, 2000 Mo. App. LEXIS 721, 2000 WL 621118
CourtMissouri Court of Appeals
DecidedMay 16, 2000
DocketNo. ED 76605
StatusPublished
Cited by3 cases

This text of 21 S.W.3d 24 (Causey v. Medical Life Insurance Co.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Causey v. Medical Life Insurance Co., 21 S.W.3d 24, 2000 Mo. App. LEXIS 721, 2000 WL 621118 (Mo. Ct. App. 2000).

Opinion

CLIFFORD H. AHRENS, Judge.

Plaintiff, Earl W. Causey, appeals from summary judgment entered in favor of defendant, Medical Life Insurance Co., in plaintiffs suit to recover life insurance proceeds as well as statutory penalties and attorneys’ fees for vexatious refusal to pay the claim. We affirm in part and reverse and remand in part.

I. Facts

Plaintiffs wife, Stella Ann Causey (“Mrs.Causey”), was employed as a teacher by the Fort Zumwalt School District (“District”) during the 1994-1995 school year. As an active employee, Mrs. Causey qualified for $50,000 of life insurance provided by District under a group policy offered by defendant. Mrs. Causey also exercised an option under the policy to purchase an additional $100,000 of supplemental life insurance, the premiums for which were deducted from Mrs. Causey’s paycheck. Plaintiff was designated as the beneficiary under Mrs. Causey’s policy.

Mrs. Causey was diagnosed with cancer and no longer actively at work as of October 14, 1993, but continued to pay premiums through October 1, 1994.1 She died on January 22, 1995. Plaintiff thereafter filed a claim with defendant for the life insurance benefits afforded by Mrs. Causey’s policy, which defendant denied on the ground that the policy had terminated prior to her death. Plaintiff subsequently sued defendant for breach of contract (Count I), seeking life insurance benefits of $150,000, and for vexatious refusal to pay an insurance claim (Count II), seeking penalties and attorneys’ fees as provided by § 375.420 RSMo (1994). The trial court granted defendant’s motion for summary judgment; this appeal follows.2

II. Standard of Review

Summary judgment is appropriate only where there is no genuine issue as to any material fact and the moving party is entitled tp judgment as a matter of law. Rule [26]*2674.04(c)(3). In the case at bar, the parties are in agreement as to the material facts. Their dispute, and thus the issue on appeal, concerns the proper construction of Mrs. Causey’s life insurance policy. “Where the underlying facts are not in question, disputes arising from the interpretation and application of insurance contracts are matters of law for the court.” Southeast Bakery Feeds, Inc. v. Ranger Ins. Co., 974 S.W.2d 635, 638 (Mo.App.1998).

III. Relevant Policy Provisions

The following sections of the policy are relevant to our analysis.

A.

Effective Date Provisions

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TERMINATION OF COVERAGE

Insurance coverage will end on the earliest of:

1.the date the Insured is no longer actively at work;
If the Insured is no longer actively at work as a result of a disability, lay-off, or leave of absence, insurance coverage may be continued as set forth below:
Disability Until the end of the twelfth insurance month following the month in which the disability began, provided all premiums are paid when due.
B.

Group Term Life Insurance Benefit

BENEFIT
We will pay the Insured’s beneficiary the amount of life insurance in force as of the date of his death provided:
1. he is insured under this policy on the date of his death; and
2. we receive proof of death within two (2) years after the date of death.
We will determine the amount of insurance based upon the Schedule of Benefits.
CONVERSION PRIVILEGE
An Insured may also convert to an individual policy of life insurance if his life insurance ceases because:
* ⅞ *
1. life insurance benefits under this policy cease;
* * *
We must receive written application and the first premium for the individual life insurance policy within 31 days after insurance under the group policy ceases.
C.
Waiver of Premium3

We will continue an Insured’s life insurance benefit under this policy without the further payment of life insurance premium if he becomes totally disabled, provided:

1. he is insured under this policy; and
2. he is under the age of 60; and
3. he provides us with satisfactory written proof of total disability within 12 months after the date he became disabled; and
4. his disability has continued without interruption for a period of 180 consecutive days; and
[27]*275. he is still disabled when he submits the proof of disability.

Totally disabled means the Insured Person is prevented because of that disability from performing the main and important duties of any occupation for which he is reasonably suited by means of education, training or experience.

The initial period for which premium will be waived will retroactively commence with the date of the onset of the disability and will continue while the Insured remains totally disabled for up to twelve (12) months from the date we receive the required proof. Premium will continue to be waived for subsequent 12-month periods provided the Insured:

1. remains totally disabled; and
2. provides satisfactory written proof of continuing total disability during the last 8 months of each 12-month period.

The Insured is responsible for obtaining initial and continuing proof of disability.

The Insured will be covered for the amount of life insurance in force as of the date of disability. The amount of life insurance in force will be subject to any reduction in benefits as a result of age, retirement or amendment to the policy. This life insurance coverage will continue until the Insured Person reaches age 70 or would normally retire, whichever occurs first.

We will pay the amount of life insurance in force to the beneficiary if the Insured Person dies before furnishing satisfactory proof of his total disability provided:

1. the Insured dies within one year from the last date for which premium was paid; and
2. we receive proof that the Insured was totally disabled from the date
premium payments ceased to the date of the Insured’s death; and
3.we receive proof of death not more than two (2) years after the death of the Insured.

IV. Analysis

Defendant’s position that Mrs. Causey’s policy terminated prior to her death is premised on the following construction: Pursuant to the “Termination of Coverage” subsection of the “Effective Date Provisions” section, coverage terminated on October 14, 1993, the date Mrs. Causey was no longer actively at work.

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Bluebook (online)
21 S.W.3d 24, 2000 Mo. App. LEXIS 721, 2000 WL 621118, Counsel Stack Legal Research, https://law.counselstack.com/opinion/causey-v-medical-life-insurance-co-moctapp-2000.