Cullum v. Mutual of Omaha Insurance

840 F.2d 619
CourtCourt of Appeals for the Eighth Circuit
DecidedMarch 7, 1988
DocketNo. 87-5142
StatusPublished
Cited by1 cases

This text of 840 F.2d 619 (Cullum v. Mutual of Omaha Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cullum v. Mutual of Omaha Insurance, 840 F.2d 619 (8th Cir. 1988).

Opinion

WOLLMAN, Circuit Judge.

Scott Cullum (Cullum) appeals from a summary judgment1 entered in favor of Mutual of Omaha Insurance Company (Mu[620]*620tual) on his claim for insurance benefits under a student health insurance policy issued by Mutual to Black Hills State College (Black Hills) in Spearfish, South Dakota. We affirm.

I.

Cullum was enrolled as a, student at Black Hills during the 1983-84 academic year. In January 1984, Cullum procured student health insurance under the Black Hills policy by paying a premium of $302.50 to Mutual. By payment of this premium, Cullum obtained insurance coverage for himself, his spouse, and all dependent children.

Cullum’s daughter, Candace Cullum (Candace), was born prematurely on June 3, 1984. She remained hospitalized until September 3, 1984, for treatment of a lung disorder resulting from her premature birth. Cullum submitted a claim of approximately $100,000 for medical expenses incurred in treating Candace’s lung disorder. Mutual denied the claim because the lung disorder originated before Candace reached the age of thirty days and therefore was excluded under the terms of the policy.

The insurance policy in question was captioned “Nonrenewable Student Blanket Accident and/or Sickness Policy.” This dispute involves three provisions of the policy: (I) “ ‘Sickness’ means sickness contracted and causing loss while the policy is in force as to the Insured”; (II) “‘Dependents’ means the spouse of the Insured and any children who are: (1) dependent on the Insured, (2) over the age of thirty days and under the age of nineteen years and (3) residing with the Insured”; and (III) “Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the Insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.”

Cullum argues that Mutual’s policy with Black Hills was required to provide newborn coverage pursuant to S.D. Codified Laws Ann. §§ (hereinafter SDCL) 58-18-32 and 58-18-33, which provide in relevant part:

58-18-32. Family coverage to include newborn and newly adopted children. All group health insurance policies and group service or indemnity type contracts issued by a nonprofit corporation which provide coverage for a family member of the insured or subscriber shall, as to family members' coverage, also provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber from the moment of birth * * *.
58-18-33. Premature birth and congenital defects covered. The coverage for a newly born child from the moment of birth * * * shall consist of coverage of injury or sickness including the necessary care and treatment of premature birth and medically diagnosed congenital defects and birth abnormalities.

“Group health insurance” and “blanket health insurance” are statutorily defined:

58-18-1. Group health insurance defined. Group health insurance is hereby declared to be that form of health insurance covering groups of persons as defined in §§ 58-18-2 to 58-18-6, inclusive, with or without one or more members of their families or one or more of their dependents, or covering one or more members of the families or one or more dependents of such groups of persons, and issued upon the basis set forth in §§ 58-18-2 to 58-18-7, inclusive.
58-18-12. Blanket health insurance defined. Blanket health insurance is hereby declared to be that form of health insurance covering groups of persons as enumerated in one of §§ 58-18-13 to 58-18-19, inclusive.

South Dakota statutes provide that blanket health insurance policies may be issued for the following groups: passengers of a common carrier, SDCL 58-18-13; employees subject to specified work hazards, SDCL 58-18-14; students, SDCL 58-18-15; participants in activities sponsored by a religious, charitable, recreational, educational, or civic organization, SDCL 58-18-16; members of a sports team, SDCL 58-18-17; members of a volunteer group, [621]*621SDCL 58-18-18; and other groups subject to risk as approved by the Director of Insurance, SDCL 58-18-19.

In granting Mutual’s motion for summary judgment, the district court stated:

By its own terms, SDCL 58-18-82 only pertains to group health insurance policies and group service or indemnity type contracts. The policy in question is a blanket health insurance policy. Blanket health insurance has a specific definition under South Dakota law which is contained in SDCL 58-18-12. Furthermore, SDCL 58-18-15 provides that blanket health insurance policies may be issued to a school. The policy in question is just such a policy. Group health insurance is also specifically defined under South Dakota law. That definition is contained in 58-18-1.

Cullum v. Mutual of Omaha Ins. Co., No. 86-5041, slip op. at 3 (D.S.D.Mar. 12, 1987) (emphasis in original).

II.

We accord deference to the district court on undecided questions of state law. Nat’l Corp. for Hous. Partnership v. Liberty State Bank, 836 F.2d 433, 436 (8th Cir.1988). We will overturn the district court's interpretations of South Dakota law only if we find them “ ‘fundamentally deficient in analysis, without a reasonable basis, or contrary to a reported state-court opinion.’ ” McCarthy Bros. Constr. Co. v. Pierce, 832 F.2d 463, 467 (8th Cir.1987) (quoting Economy Fire & Casualty Co. v. Tri-State Ins. Co., 827 F.2d 373, 375 (8th Cir.1987)).

Cullum does not contend that Mutual’s policy with Black Hills falls within the statutory definition of group health insurance set forth in section 58-18-1. Rather, he argues that “group health insurance” should be construed in its popular sense, which would include insurance issued to the “group” of students at Black Hills.

Words used in South Dakota statutes are to be construed in their ordinary sense. SDCL 2-14-1 (1985).

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Related

Cullum v. Mutual Of Omaha Insurance Company
840 F.2d 619 (Eighth Circuit, 1988)

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Bluebook (online)
840 F.2d 619, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cullum-v-mutual-of-omaha-insurance-ca8-1988.