Collier v. MD-Individual Practice Ass'n

607 A.2d 537, 327 Md. 1, 1992 Md. LEXIS 101
CourtCourt of Appeals of Maryland
DecidedJune 10, 1992
DocketMisc. No. 29, September Term, 1991
StatusPublished
Cited by111 cases

This text of 607 A.2d 537 (Collier v. MD-Individual Practice Ass'n) is published on Counsel Stack Legal Research, covering Court of Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Collier v. MD-Individual Practice Ass'n, 607 A.2d 537, 327 Md. 1, 1992 Md. LEXIS 101 (Md. 1992).

Opinion

RODOWSKY, Judge.

This case comes to us from the United States Court of Appeals for the District of Columbia Circuit pursuant to the Maryland Uniform Certification of Questions of Law Act, Md.Code (1974, 1989 Repl.Vol.), §§ 12-601 through 12-609 of the Courts and Judicial Proceedings Article. The statement of relevant facts and the order of certification are reported in Washington Hosp. Center Nat’l Rehabilitation Hosp. v. Collier, 947 F.2d 1498 (D.C.Cir.1991). Two questions are certified. One concerns the construction of the definition of “eligible Dependents” in the group policy of health insurance involved here. The second question is whether an insured under a health policy may recover counsel fees if successful in pursuing a claim for breach of contract against the insurer based on a failure to pay promised benefits.

I

The health insurer is MD-Individual Practice Association (MD-IPA). The claimant is Todd Collier (Collier), whose mother maintained a health insurance policy with MD-IPA. *4 Collier became nineteen years of age in May 1987. In September 1987, while playing touch football, he was injured and rendered quadriplegic.

The subject policy provides in relevant part that

“eligible Dependents include:
• Dependent, unmarried children, including step-children, legally adopted children, as well as natural children who depend upon the Subscriber for support and qualify as dependents under applicable provisions of the Internal Revenue Code and who:
• are under 19 years of age and maintain legal residence with Subscriber, or
• are under 23 years of age and are full-time students at a recognized college, university or trade school.”

At all relevant times Collier was a student at Montgomery College, living at home, and dependent upon his mother for financial support.

Collier’s status as a “full-time student” is disputed. That term is not defined in the policy. The basic facts are these.

“Beginning with the spring semester of 1987, the College placed Collier on academic probation and allowed him to register for only six credits. In September 1987 Collier, mistakenly thinking that his probation had ended, tried to register for twelve or more credits for the fall semester. He was again allowed to register for only six credits, and hence was taking that number of credits when he was injured in September 1987.”

Collier, 947 F.2d at 1500. The dispute arises because, “[a]t least for purposes of financial aid and academic honors, Montgomery College requires enrollment in twelve or more credits for a student to be classified ‘full-time.’ ” Id. (Parentheses omitted).

The United States District Court for the District of Columbia granted summary judgment in favor of MD-IPA on Collier’s claim against it, “holding that the term ‘full-time student’ is unambiguous.” Id. at 1502. That Court “noted *5 that the term is ‘frequently employed by colleges and universities,’ and thought that ‘the contractual expectations of the parties are fairly measured by reference to the definition provided by the applicable institution.’ ” Id. at 1502-03.

On appeal to the District of Columbia Circuit, Collier argued that “full-time student” is ambiguous and is not limited to the criteria used by the relevant school. Collier argued that the term means “any student in ‘continuous attendance during the normal school year’ or ‘a person who regularly attends classes as his primary daily occupation.’ ” Id. at 1503.

Against that background the federal appellate court certified the following question to us:

“Does the term ‘full-time student,’ when used as a condition of coverage in a health insurance policy, unambiguously incorporate the criteria of the relevant educational institution?”

Id. The certifying court observed that if this Court answered the above-quoted question affirmatively, then the certifying court would affirm the grant of summary judgment, but if this Court “holds that ‘full-time student' is ambiguous,” then the certifying court asks us to proceed to the second question, involving fees.

In Maryland insurance policies ordinarily are construed in the same manner as contracts generally. We do not follow the rule, adopted in some states, that insurance policies are to be construed most strongly against the insurer. Cheney v. Bell Nat’l Life Ins. Co., 315 Md. 761, 766-67, 556 A.2d 1135, 1138 (1989). It is necessary to discern the intention of the parties. “To determine the intention of the parties ... we construe the instrument as a whole.” Pacific Indemnity Co. v. Interstate Fire & Casualty Co., 302 Md. 383, 388, 488 A.2d 486, 488 (1985). In so doing, we “examine the character of the contract, its purpose, and the facts and circumstances of the parties at the time of execution.” Id. Words are accorded their ordinary *6 and accepted meanings. “The test is what meaning a reasonably prudent layperson would attach to the term.” Id. Thus, “[t]he language used may be ambiguous if it is ‘general’ and may suggest two meanings to a reasonably prudent layperson.” Id. at 389, 556 A.2d at 489. If the language is ambiguous, extrinsic evidence may be consulted. “If the extrinsic evidence presents disputed factual issues, construction of the ambiguous contract is for the jury. The court may construe an ambiguous contract if there is no factual dispute in the evidence.” Id. If, after considering extrinsic evidence, the ambiguity remains, it will ordinarily be resolved against the party who drafted the contract. Mutual Fire, Marine & Inland Ins. Co. v. Vollmer, 306 Md. 243, 251, 508 A.2d 130, 134 (1986). In cases involving insurance contracts of adhesion, that party is the insurer. We shall answer the first certified question in the light of these principles.

Although the insurer was free, within the limits of public policy, to provide a special definition of “full-time student” in the insurance contract, see Valliere v. Allstate Ins. Co., 324 Md. 139, 596 A.2d 636 (1991), the insurer did not do so. Absent such a definition, the certified question obviously is not limited to whether there has been an express incorporation by reference of the criteria of the relevant educational institution. Rather, the question may be interpreted as asking whether, for this type of contract, there is a rule of Maryland law which incorporates the relevant school’s criteria, so that there would be no ambiguity. There is no such rule of Maryland law.

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607 A.2d 537, 327 Md. 1, 1992 Md. LEXIS 101, Counsel Stack Legal Research, https://law.counselstack.com/opinion/collier-v-md-individual-practice-assn-md-1992.