McCoy v. Blue Cross and Blue Shield of Utah

2001 UT 31, 20 P.3d 901, 418 Utah Adv. Rep. 19, 2001 Utah LEXIS 56, 2001 WL 305157
CourtUtah Supreme Court
DecidedMarch 30, 2001
Docket990692
StatusPublished
Cited by15 cases

This text of 2001 UT 31 (McCoy v. Blue Cross and Blue Shield of Utah) is published on Counsel Stack Legal Research, covering Utah Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCoy v. Blue Cross and Blue Shield of Utah, 2001 UT 31, 20 P.3d 901, 418 Utah Adv. Rep. 19, 2001 Utah LEXIS 56, 2001 WL 305157 (Utah 2001).

Opinion

ON CERTIORARI TO THE UTAH COURT OF APPEALS

DURRANT, Justice:

§1 Blue Cross and Blue Shield of Utah (hereinafter "Blue Cross") petitions this court to reverse the court of appeals' decision affirming the trial court's denial of Blue Cross's motion to compel arbitration. Blue Cross mailed amendments that included a mandatory arbitration provision to its health insurance policyholders. Gerald MeCoy, a Blue Cross policyholder, requested payment for alternative treatments for his wife's cancer. Blue Cross denied payment, and McCoy filed suit in district court. Blue Cross moved to compel arbitration. MeCoy asserted Blue Cross had not preserved evidence that it notified him of the arbitration *903 amendment. The trial court agreed and denied Blue Cross's motion to compel arbitration. The court of appeals affirmed, and Blue Cross petitioned for certiorari, which we granted. See 994 P.2d 1271 (Utah 1999). We affirm.

BACKGROUND

T2 McCoy purchased a family health insurance policy from Blue Cross in October 1985. Blue Cross reserved "the absolute right to modify or amend [the policy] from time to time." The policy also stated that "any notice ... shall be deemed to have been given to and received by the subscriber when deposited in the United States Mail with first class postage prepaid and addressed to the subscriber at the address shown in the records of the policy."

T3 When McCoy purchased the policy from Blue Cross it did not contain an arbitration provision. Blue Cross amended its poli-cles to add an arbitration clause effective January 1, 1986. Blue Cross prepared a magnetic tape containing the names and addresses of over 30,000 affected policyholders who were to receive a copy of the policy amendment notification that contained the arbitration provision. The magnetic tape was sent to a printing company, which printed a cover letter to be mailed along with the arbitration notification. These were then forwarded to a mailing service with instructions to insert the materials into envelopes and deliver the mailings to the post office. Blue Cross did not retain a copy of the magnetic tape, nor did it obtain a verification list of affected policyholders from either the printer or the mailing service. McCoy denies ever having received an actual notice of the binding arbitration amendment.

T4 McCoy's wife, Frieda, was diagnosed with breast cancer in March 1994. Chemotherapy proved ineffective, and McCoy requested that Blue Cross pre-authorize payment for an alternative cancer treatment. Blue Cross denied the request. It also denied McCoy's subsequent administrative appeal in January 1995. In the same letter notifying McCoy of the denial of his appeal, Blue Cross informed him that if he remained "dissatisfied with this decision, [he had] the right to seek binding arbitration of the dispute pursuant to the Rules of the American Arbitration Association. The Customer Service Department can assist you with information about how to initiate and participate in arbitration."

15 McCoy's wife died as result of her cancer, and McCoy brought suit against Blue Cross in district court in January 1997. His claims advanced various theories for recovery against Blue Cross based on its refusal to provide coverage for treatment of his wife's cancer. In response to MeCoy's suit, Blue Cross filed a motion to compel arbitration.

T6 Blue Cross submitted several affidavits containing the statements of various Blue Cross employees detailing their actions between 1985 and 1990, during which time they mailed three separate notices of the amendment to the policy, purportedly to all policyholders. Blue Cross also argued that because McCoy conceded that he had received the letter denying his appeal and informing him that he had a right to arbitration, he had waived his right to contest the arbitration amendment itself.

17 The trial court denied Blue Cross's motion to compel arbitration. It concluded that Blue Cross had failed to provide any specific evidence that McCoy was on any of the mailing lists, or that it had actually mailed the notice to McCoy. The trial court did not address Blue Cross's argument that McCoy had waived his right to contest the arbitration provision. Blue Cross appealed the trial court's ruling.

18 The court of appeals affirmed. It held that Blue Cross's affidavits did not show that McCoy's name and address were actually on the magnetic tape, or whether written notice of the policy amendment containing the arbitration provision was actually prepared and sent specifically to McCoy. See McCoy v. Blue Cross & Blue Shield, 1999 UT App 199, ¶ 16, 980 P.2d 694. The court of appeals also treated and rejected Blue Cross's argument that McCoy waived his right to contest the arbitration provision. See id. at ¶¶ 21-28.

ANALYSIS

9 In its petition, Blue Cross argues that the evidence it presented, and inferences *904 drawn from that evidence, showed that Blue Cross had mailed the arbitration amendment to McCoy sometime between 1985 and 1990. Blue Cross asserts that the court of appeals erred in affirming the trial court on this issue. Alternatively, Blue Cross renews its argument, which it presented to both the trial court and the court of appeals, that McCoy waived his right to contest the arbitration provision when he failed to assert that right following reception of Blue Cross's January 1995 letter mentioning MeCoy's right to seek arbitration. We address Blue Cross's arguments in that order.

I. PROOF OR INFERENCE OF MAILING

{10 Section 78-3la-4(1) of the Utah Code provides that "[the court, upon motion of any party showing the existence of an arbitration agreement, shall order the parties to arbitrate." In Jenkins v. Percival, 962 P.2d 796 (Utah 1998), a majority of this court held that arbitration agreements must be in writing to be enforceable under the Arbitration Act. See id. at 800 (Stewart, J., joined by Durham, J.); id. at 808 (Russon, J., joined by Howe, C.J., dissenting on other grounds). Where the evidence relating to a purported agreement to arbitrate is undisputed, the district court has no discretion under the statute. It must compel arbitration. See, e.g., Docutel Olivetti v. Dick Brady Sys. Inc., 731 P.2d 475, 479-80 (Utah 1986) (construing contract to mandate arbitration of dispute).

1111 Where the evidence is contested, however, the court must resolve evidentiary conflicts and determine whether the movant has shown the existence of an agreement between the parties according to the dictates of the statute. In such cases, the district court is accorded the traditional discretion attending the exercise of fact finding and weighing of evidence. See Valcarce v. Fitzgerald, 961 P.2d 305, 312 (Utah 1998).

1 12 In this case, the court of appeals held that the evidence Blue Cross presented was insufficient as a matter of law to require enforcement of the binding arbitration amendment. See Sosa v. Paulos, 924 P.2d 357, 360 (Utah 1996). We therefore review the legal correctness of that determination.

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2001 UT 31, 20 P.3d 901, 418 Utah Adv. Rep. 19, 2001 Utah LEXIS 56, 2001 WL 305157, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccoy-v-blue-cross-and-blue-shield-of-utah-utah-2001.