Coots v. United Employers Federation

865 F. Supp. 596, 1994 WL 568387
CourtDistrict Court, E.D. Missouri
DecidedOctober 4, 1994
Docket1:93CV79SNL
StatusPublished
Cited by7 cases

This text of 865 F. Supp. 596 (Coots v. United Employers Federation) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Coots v. United Employers Federation, 865 F. Supp. 596, 1994 WL 568387 (E.D. Mo. 1994).

Opinion

865 F.Supp. 596 (1994)

Irma J. COOTS, Plaintiff,
v.
UNITED EMPLOYERS FEDERATION and Durham Life Insurance Company, Defendants.

No. 1:93CV79SNL.

United States District Court, E.D. Missouri, Southeastern Division.

October 4, 1994.

*597 Donald Rhodes, Bloomfield, MO, for plaintiff.

Mike W. Bartolacci, Thompson & Mitchell, St. Louis, MO, for defendants.

MEMORANDUM

LIMBAUGH, District Judge.

Plaintiff seeks medical benefits allegedly due pursuant to a group medical insurance policy provided by defendant United Employers Federation and issued by defendant Durham Life Insurance Co. This matter is before the Court on the defendants' motion for summary judgment (as regards the plaintiff's second amended complaint and the defendants' amended counterclaim for declaratory judgment) (# 22), filed August 15, 1994. This case is set for trial on the Court's trial docket of October 3, 1994.

Courts have repeatedly recognized that summary judgment is a harsh remedy that should be granted only when the moving party has established his right to judgment with such clarity as not to give rise to controversy. New England Mut. Life Ins. Co. v. Null, 554 F.2d 896, 901 (8th Cir.1977). Summary judgment motions, however, "can be a tool of great utility in removing factually insubstantial cases from crowded dockets, freeing courts' trial time for those that really do raise genuine issues of material fact." Mt. Pleasant v. Associated Elec. Coop. Inc., 838 F.2d 268, 273 (8th Cir.1988).

Pursuant to Fed.R.Civ.P. 56(c), a district court may grant a motion for summary judgment if all of the information before the court demonstrates that "there is no genuine issue as to material fact and the moving party is entitled to judgment as a matter of law." Poller v. Columbia Broadcasting System, Inc., 368 U.S. 464, 467, 82 S.Ct. 486, 488, 7 L.Ed.2d 458 (1962). The burden is on the moving party. Mt. Pleasant, 838 F.2d at 273. After the moving party discharges this burden, the nonmoving party must do more than show that there is some doubt as to the facts. Matsushita Elec. Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986). Instead, *598 the nonmoving party bears the burden of setting forth specific facts showing that there is sufficient evidence in its favor to allow a jury to return a verdict for it. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249, 106 S.Ct. 2505, 2510-11, 91 L.Ed.2d 202 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986).

In passing on a motion for summary judgment, the court must review the facts in a light most favorable to the party opposing the motion and give that party the benefit of any inferences that logically can be drawn from those facts. Buller v. Buechler, 706 F.2d 844, 846 (8th Cir.1983). The court is required to resolve all conflicts of evidence in favor of the nonmoving party. Robert Johnson Grain Co. v. Chem. Interchange Co., 541 F.2d 207, 210 (8th Cir.1976). With these principles in mind, the Court turns to an examination of the facts.

Plaintiff's husband, Lan Coots, owns and operates a farm supplies business known as Lanco, Inc. The only employees of Lanco, Inc. (other than Lan Coots) were Mark and Michael Coots, the sons of the plaintiff and her husband.

The Coots were desirous of obtaining medical insurance for themselves and their families. In order to obtain group medical insurance, Lanco, Inc. applied for membership in the defendant United Employers Federation (UEF) as an employer. UEF administers a plan which offers a group medical insurance policy underwritten by defendant Durham Life Insurance Co. The Coots family, including the plaintiff, applied for and obtained medical insurance coverage.

Prior to obtaining insurance coverage, Mr. Coots (as the member employer) was required to fill out an application form on behalf of himself and the plaintiff. Affidavit of Nancy Patton. The application seeks a variety of medical information about the applicant(s). Defendants' Exhibit 2. It states in pertinent part:

10. To the best of your knowledge or belief, has any proposed covered person ever had sought or received advice for, or been treated for any of the following? (If yes, give details below) (Circle Condition).
a. Thyroid disorder, diabetes, albumin, sugar in urine, kidney, or urinary tract disorder?
b. Allergies, asthma, tuberculosis, disorder of the eyes, ears, nose, throat, or respiratory system?
c. Heart disease, chest pain, heart murmur, rheumatic fever, stroke, high blood pressure, anemia or disorder of the blood?
d. Arthritis, gout, rheumatism or disorder of the back, spine, bones, muscles, or joints?
e. Liver, stomach, intestine, or rectal disorder?
f. Cyst, tumor, cancer, or growth of any kind?
g. Any disorder of the reproductive organs or breasts?
h. Mental or nervous disorder, drug addiction, or alcoholism, or arrested for driving under the influence of drugs or alcohol?
11. Are you (or any eligible dependent) taking, or has any physician or other practitioner recommended that you take medication of any kind?
---------------
15. Has any proposed covered person been sick, injured, received treatment, had medical tests, taken medication, consulted a doctor, or other practitioner, or been hospitalized within the past five years for any condition not already listed?
16. Is there any reason to believe that any proposed covered person is not in good health, mentally or physically, and free from any impairment, deformity, or infirmity?
---------------

Mr. Coots, on behalf of himself and the plaintiff, answered No to all of the above-cited questions, except to Question 10(a) wherein Mr. Coots noted that he had been treated recently for kidney stones. Defendants' Exhibit 2.

At the beginning of the questionaire/application, it states: "Please complete ALL of the following questions. Failure to divulge complete facts will result in ALL COVERAGE *599 BEING CANCELLED AS OF THE ORIGINAL ISSUE DATE." At the end of the questionaire/application, it states:

"This is to certify that I have received the summary of benefits, Form No. G3465, and I understand the benefits and exceptions, including pre-existing general limitations and coordination of benefits.

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