Howard v. Blue Cross of Idaho Health Service, Inc.

757 P.2d 1204, 114 Idaho 485
CourtIdaho Court of Appeals
DecidedJune 13, 1988
Docket16370
StatusPublished
Cited by3 cases

This text of 757 P.2d 1204 (Howard v. Blue Cross of Idaho Health Service, Inc.) is published on Counsel Stack Legal Research, covering Idaho Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Howard v. Blue Cross of Idaho Health Service, Inc., 757 P.2d 1204, 114 Idaho 485 (Idaho Ct. App. 1988).

Opinions

SWANSTROM, Judge.

Dan and Stephanie Howard filed suit against Blue Cross of Idaho Health Service, Inc., to recover benefits allegedly due under their contract, for medical services furnished to their newborn son. Blue Cross denied liability based in part on the Howards’ failure to enroll their son as required by the contract. A magistrate awarded judgment to the Howards with interest, costs and attorney fees. Blue Cross appealed to the district court where the magistrate’s decision was affirmed. Blue Cross now appeals to this Court, contending that (1) the magistrate erred in finding that Blue Cross’ enrollment requirement for newborns violates I.C. § 41-3437; (2) the Howards’ failure to timely enroll their son as required by their contract bars the Howards’ claim of coverage; (3) cancellation of the group contract under which the Howards were insured extinguished Blue Cross’ contractual liability to the Howards; (4) the district court erred in equating the enrollment requirement with a proof of loss requirement; and (5) both lower courts erred in awarding attorney fees against a non-profit health service corporation. For reasons set forth below, we affirm the magistrate’s judgment except as to the award of attorney fees.

In 1980, Dan Howard began work at the Buhl, Idaho, outlet of Roper’s, a group of retail clothing stores. Roper’s had a contract with Blue Cross to which Roper’s employees could subscribe to obtain coverage for health services. Roper’s acted as liaison between the employees and Blue Cross, distributing and collecting application forms, submitting requested coverage changes, and deducting monthly subscription charges from the employees’ wages, and remitting the charges to Blue Cross.

Beginning in 1981 and continuing through May of 1982, Dan and Stephanie Howard were covered by a “two-party membership” under the contract Blue Cross issued to Roper’s. On April 4, 1982, Stephanie gave birth to a son, Stephen. The providers of medical services for Stephanie and Stephen sent bills to Blue Cross as requested by the Howards. In accordance with provisions of the contract, Blue Cross paid hospital and doctor maternity benefits for Stephanie. These benefits paid included the usual incidental services for the newborn child during the mother’s maternity confinement. About these benefit payments there is no dispute.

During delivery, complications arose that required Stephen to remain hospitalized for [487]*487■six days, resulting in bills totalling more than $2,700 for his care. Following Stephen’s release from the hospital, Dan Howard approached Roper’s bookkeeper at the Buhl store to determine the necessary steps to assure Stephen’s coverage under the group contract and was told that nothing need be done. In fact, however, the contract stated: “Newborn infants shall be covered hereunder from date of birth for illness, injury or congenital anomaly, provided the infant is added as an eligible dependant within thirty (30) days of birth.”

During April, Blue Cross received bills from the doctors and hospitals who treated Stephen while he was, according to the contract, “a patient in his own right.” In May, the Howards began receiving notices from Blue Cross advising them that Stephen was not covered under their contract.

Effective June 1, 1982, Roper’s terminated its group contract with Blue Cross. Subsequently, Stephanie Howard asked Blue Cross to explain its denial of claims submitted for Stephen’s care. Following this inquiry, on June 24, the Howards submitted a formal request to Blue Cross to enroll Stephen under the contract. Blue Cross refused the request due to the expiration of the enrollment grace period and to Roper’s termination of Blue Cross group coverage. The Howards brought this action to recover Stephen’s medical costs, asserting that Blue Cross is statutorily required to furnish coverage for Stephen from the moment of birth under I.C. § 41-3437. The relevant part of the statute reads as follows:

There shall be a provision that a subscriber’s contract, delivered or issued for delivery in this state ... which provides coverage for injury or sickness for dependent children of subscribers or other members of the covered group, shall provide coverage for such newborn and infants from and after the moment of birth. Coverage provided in accord with this section shall include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth.

The magistrate held that Blue Cross’ enrollment conditions for newborns violated I.C. § 41-3437; that Stephen was entitled to automatic coverage from the moment of birth; and that the Howards had made a timely request to Blue Cross to have their son added to their contract. On appeal, the district court affirmed the magistrate’s ruling, but held that the “automatic” coverage extended for only thirty days following Stephen’s birth. The district court also held that the bills submitted by the hospital and doctors gave sufficient notice to Blue Cross that the Howards were making a claim for Stephen’s coverage. The district court did not, however, hold that the enrollment requirement was invalid. Rather, it equated the enrollment requirement with a “proof of loss” requirement. Accordingly, the district court concluded that the Howards' untimely attempt, on June 24, to enroll Stephen would not defeat their claim absent a showing by Blue Cross that the delay had caused some prejudice. This ruling is also challenged by Blue Cross in this appeal.

The first question we address is whether I.C. § 41-3437 mandates “automatic” coverage for newborns. The Ho-wards contend, and the magistrate held, that it does. Blue Cross argues that the statute requires only that coverage for newborns be offered. In deciding this issue we are presented solely with a question of law. Accordingly, we exercise free review, without deferring to the conclusions of either the magistrate or the district judge. Linn v. North Idaho District Medical Service Bureau, Inc., 102 Idaho 679, 638 P.2d 876 (1981).

The principal rule governing statutory interpretation is to give effect to the Legislature’s intent. Of course, if the intent is clear from the language used, “there is no occasion for construction.” Worley Highway District v. Kootenai County, 98 Idaho 925, 928, 576 P.2d 206, 209 (1978), quoting State v. Riley, 83 Idaho 346, 349, 362 P.2d 1075, 1076-77 (1961). However, where, as here, it is necessary to construe a statute, [488]*488this Court may examine the language used, the reasonableness of the proposed interpretations, and the policy behind the statute. The legislative purpose in enacting a statute is also a factor to be considered in statutory construction. Mix v. Gem Investors, Inc., 103 Idaho 355, 647 P.2d 811 (Ct.App.1982).

Idaho Code § 41-3437 was enacted as part of 1974 Idaho Sess. Laws, ch. 66. The statement of purpose accompanying this Act noted that most existing disability insurance contracts and subscriber contracts providing coverage for newborn dependent children had a two-week delay before commencement of coverage.

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Related

State v. Gardiner
898 P.2d 615 (Idaho Court of Appeals, 1995)
Eriksen v. Blue Cross of Idaho Health Services, Inc.
778 P.2d 815 (Idaho Court of Appeals, 1989)

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757 P.2d 1204, 114 Idaho 485, Counsel Stack Legal Research, https://law.counselstack.com/opinion/howard-v-blue-cross-of-idaho-health-service-inc-idahoctapp-1988.