Fittro v. Lincoln National Life Insurance

744 P.2d 631, 49 Wash. App. 499, 1987 Wash. App. LEXIS 4326
CourtCourt of Appeals of Washington
DecidedOctober 21, 1987
DocketNo. 9418-5-II
StatusPublished
Cited by1 cases

This text of 744 P.2d 631 (Fittro v. Lincoln National Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fittro v. Lincoln National Life Insurance, 744 P.2d 631, 49 Wash. App. 499, 1987 Wash. App. LEXIS 4326 (Wash. Ct. App. 1987).

Opinions

Petrich,

J.—On the petition of Sherri Fittro, we accepted discretionary review of the Cowlitz County Superior Court's order on partial summary judgment, which declared that Fittro's major medical benefits under her group health insurance plan terminated on September 30, 1983. The dispositive issue on appeal is whether the various provisions of a certificate of coverage, which outlines the benefits and is issued to an employee, take precedent over and control the provisions of a group insurance policy issued to an employer, when there is an arguable conflict between the two as to benefits.1 We conclude that in cases where a certificate of coverage arguably conflicts with the master policy, and the certificate contains disclaimers stating that it is not an insurance policy and directs the insured to the master policy for benefit coverage, and there is no reasonable reliance on the certificate by the insured, the master policy provisions control over those of the certificate [501]*501of coverage. Accordingly, we affirm.

Facts

The facts are not in dispute. In September of 1981, Sherri Fittro was a full-time grocery checker at Keil's Grocery Store in Longview, Washington. As such, she was insured for health and disability by group policy No. GD6819 issued to Retail Clerk's Local 148 through Lincoln National Life Insurance. Fittro received a certificate of coverage. The certificate stated that Fittro's insurance benefits were as described in the certificate booklet.

On September 26, 1981, Fittro was seriously injured in an automobile accident. Fittro was "totally disabled" as a result of the accident.2 Lincoln paid most of Fittro's medical expenses.

On November 1, 1982, Fittro went to work at Fibre Federal Credit Union. Fittro punches data, one key at a time, into a keyboard with a pencil strapped to her hand. Lincoln terminated Fittro's disability benefits. A lawsuit followed. Fittro alleged, inter alia, that the certificate of coverage and group policy authorized major medical coverage in perpetuity or up to the policy limits.

Both sides moved for summary judgment. On December 4, 1985 a partial summary judgment order was entered in which the trial court concluded, inter alia, that the insurance policy and certificate construed together terminated insurance coverage for Fittro on September 30, 1983.

Summary Judgment

An appellate court engages in the same inquiry as the trial court when reviewing an order of summary judgment. Wilson v. Steinbach, 98 Wn.2d 434, 437, 656 P.2d 1030 (1982). CR 56(c) authorizes the trial court to grant a summary judgment motion if the pleadings, affidavits, depositions and admissions on file demonstrate that there is no [502]*502genuine issue as to any material fact, and that the moving party is entitled to judgment as a matter of law. Wilson v. Steinbach, 98 Wn.2d at 437. The court must consider all of the facts and all reasonable inferences from the facts in a light most favorable to the nonmoving party. Jacobsen v. State, 89 Wn.2d 104, 108, 569 P.2d 1152 (1977).

If the facts are uncontroverted and there are no issues of material fact, the court need only decide if the moving party is entitled to judgment as a matter of law. See State Farm Gen. Ins. Co. v. Emerson, 102 Wn.2d 477, 480, 687 P.2d 1139 (1984); Hodgins v. State, 9 Wn. App. 486, 513 P.2d 304 (1973).

Here, the essential facts are not in dispute. Both parties agree that Fittro was entitled to coverage for major medical expenses through Lincoln. The dispute concerns a question of law as to the length of time Fittro was entitled to benefits.

Interpretation of Contract and Certificate

"The interpretation of an insurance contract is a question of law." Greer v. Northwestern Nat'l Ins. Co., 36 Wn. App. 330, 334, 674 P.2d 1257 (1984). Fittro contends that the certificate of coverage conflicts with the master policy in that the certificate extends major medical benefits indefinitely so long as she is totally disabled and has remained so for 12 months, while the master policy limits the extension of major medical to a maximum of 12 months following the date of termination. Fittro urges us to hold that the language of the certificate controls.

The certificate of coverage provisions at issue are as follows:

Termination
In the event this insurance is terminated or employment terminated and the insured or his dependent is totally disabled, the disabled person will continue to be eligible to receive Major Medical benefits, providing he remains totally disabled for a period of 12 months following termination.
[503]*503Termination of Benefits
Your insurance will automatically terminate on the earliest of the following dates: the last day of the calendar month for which your premium has been paid or the date the Master Policy terminates. If you are unable to work because of disability . . . inquire of your employer as to your rights, if any, under the Master Policy.

The face sheet of the certificate of coverage states as follows:

This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy/policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policy/policies described herein is subject to all the terms, exclusions and conditions of such policies.

The benefits are as described in this certificate booklet. The master policy provisions at issue are as follows:

Benefit Period
A benefit period for an employee's illnesses may be established when the employee has incurred . . .* eligible charges for all illnesses (excluding eligible charges incurred in connection with an illness for which the maximum benefit has been paid hereunder) which in the aggregate are not less than the deductible amount as specified in the Schedule of Benefits.
A benefit period so established will date from the day the employer incurs the last eligible charge used in establishing the benefit period; it will terminate on the earliest of the following dates:
(a) the last day of the calendar year in which it was established, or
(b) the day the employee ceases to be insured for Major Medical Expense Benefits.
Extended Coverage

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Related

Fittro v. Lincoln National Life Insurance
757 P.2d 1374 (Washington Supreme Court, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
744 P.2d 631, 49 Wash. App. 499, 1987 Wash. App. LEXIS 4326, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fittro-v-lincoln-national-life-insurance-washctapp-1987.