Nesbitt v. American Community Mutual Insurance

600 N.W.2d 427, 236 Mich. App. 215
CourtMichigan Court of Appeals
DecidedOctober 1, 1999
DocketDocket 205764
StatusPublished
Cited by10 cases

This text of 600 N.W.2d 427 (Nesbitt v. American Community Mutual Insurance) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nesbitt v. American Community Mutual Insurance, 600 N.W.2d 427, 236 Mich. App. 215 (Mich. Ct. App. 1999).

Opinions

O’Connell, J.

Defendant appeals as of right, and plaintiff cross appeals, from orders on motions for summary disposition concerning plaintiff’s statutory and contract claims. We affirm in part, reverse in part, and remand for further proceedings.

Plaintiff’s wife, Ethel Nesbitt, a smoker, visited a physician on October 16, 1993, complaining of cough, congestion, and shortness of breath. The doctor referred Mrs. Nesbitt for a lung x-ray, which, four days later, indicated a large pleural effusion on the lung. Five days after the x-ray, Mrs. Nesbitt applied for a six-month, short-term insurance policy with defendant. The application stated that the insurance, if issued, would include no benefits for “sickness first manifested before the Policy Date.” Defendant issued a policy with an effective date of October 25. The policy included a statement excluding from coverage any preexisting condition, defined as “an illness, disease, accidental bodily damage or loss that first appears (makes itself known) before the Effective Date.” Continuing medical attention for Mrs. Nesbitt ultimately led to a diagnosis of lung cancer. Mrs. Nesbitt died in January 1994.

Defendant declined to cover the expenses attendant to Mrs. Nesbitt’s treatment for her lung cancer, maintaining that it was a preexisting condition. Plaintiff commenced the present litigation in response, alleging both breach of contract and a violation of the consumer protection laws of Ohio and Michigan.1 [219]*219Defendant filed a motion for summary disposition, arguing that there was no genuine issue of fact that the deceased’s illness was a preexisting condition that was therefore not covered by her insurance policy with defendant. Defendant also argued that the Michigan Consumer Protection Act (MCPA), MCL 445.901 et seq.; MSA 19.418(1) et seq., did not apply to the insurance industry. The trial court granted defendant’s motion with respect to plaintiff’s claim under the mcpa. However, the court found that whether the deceased’s illness had been a preexisting condition was a question of material fact and denied defendant’s motion in that regard.

Plaintiff then filed a motion for summary disposition, asserting that the deceased’s illness did not appear or make itself known before the insurance policy with defendant was in effect. Plaintiff argued that the language of the policy was ambiguous and thus should be construed against the insurer. The trial court, upon consideration of the documentary and other evidence, granted plaintiff’s motion.

The parties stipulated the entry of a final order without prejudice in order to expedite their respective appeals.

i

Defendant argues that the trial court erred in granting plaintiff summary disposition with respect to the breach of contract claim. This Court reviews a trial court’s decision on a motion for summary disposition de novo as a matter of law. Miller v Farm Bureau Mut Ins Co, 218 Mich App 221, 233; 553 NW2d 371 (1996). When reviewing a decision on a motion under [220]*220MCR 2.116(C)(10),2 a reviewing court must examine all relevant documentary evidence in the light most favorable to the nonmoving party to determine whether a genuine issue of material fact exists on which reasonable minds could differ. Farm Bureau Mut Ins Co of Michigan v Stark, 437 Mich 175, 184-185; 468 NW2d 498 (1991); Shirilla v Detroit, 208 Mich App 434, 437; 528 NW2d 763 (1995). Where the moving party has produced evidence in support of the motion, the opposing party bears the burden of producing evidence to establish that a genuine question of material fact exists. Skinner v Square D Co, 445 Mich 153, 160; 516 NW2d 475 (1994), citing MCR 2.116(G)(4). “Summary judgment should only be granted when the plaintiffs claim is so clearly unenforceable as a matter of law that no factual development can possibly justify a right to recovery.” Young v Michigan Mut Ins Co, 139 Mich App 600, 603; 362 NW2d 844 (1984).

The parties agree that Ohio law should govern the inteipretation of this insurance contract, which was executed in that state, where plaintiff and Mrs. Nes-bitt resided at the time. Because the parties’ reasons for applying Ohio contract law are sound, see Chrysler Corp v Skyline Industrial Services, Inc, 448 Mich 113, 122; 528 NW2d 698 (1995), and because the pertinent Ohio case law well comports with the case law of this state governing the inteipretation of insurance contracts, we will allow Ohio case law to guide our resolution of this issue.

[221]*221“The construction of written contracts is a matter of law.” Knowlton v Nationwide Mut Ins Co, 108 Ohio App 3d 419, 423; 670 NE2d 1071 (1996). Accord Sunshine Motors, Inc v New Hampshire Ins Co, 209 Mich App 58, 59; 530 NW2d 120 (1995) (“Construction of an insurance contract is a matter of law for the court.”). “When the language of an insurance contract is reasonably susceptible of more than one interpretation, it is ambiguous and will be construed in favor of the insured and against the insurer.” Knowlton, supra at 423. Accord State Farm Mut Automobile Ins Co v Enterprise Leasing Co, 452 Mich 25, 38; 549 NW2d 345 (1996) (ambiguities should be construed strictly against the drafter); Fire Ins Exchange v Diehl, 450 Mich 678, 687; 545 NW2d 602 (1996) (exclusionary clauses in insurance contracts should be construed strictly against the insurer).

Not in dispute is that before the effective date of the insurance policy, Mrs. Nesbitt came to her doctor with symptoms that led directly to an x-ray that indicated a large pleural effusion on her lung, which, after the effective date, was diagnosed as cancer. At issue is whether Mrs. Nesbitt’s symptoms and the attendant medical investigation that occurred before the effective date of the policy constituted a manifestation of her lung cancer even before that specific condition was identified.

In DeMatteis v American Community Mut Ins Co, 84 Ohio App 3d 459; 616 NE2d 1208 (1992), a case involving the same contract language regarding preexisting conditions as the language at issue in the present case, id. at 461, the court held that the meaning of “first appear” was ambiguous as applied to a manifestation of a chronic condition that had generated [222]*222symptoms requiring diagnosis and treatment in previous years and that accordingly any “reasonable construction which results in coverage of the insured must be adopted by the trial court,” id. at 463. However, the present case is distinguishable from DeMat-teis in that there is no suggestion that Mrs. Nesbitt’s cancer was similarly a manifestation of a chronic condition, and thus the holding in DeMatteis that the insurance contract should be read in favor of coverage does not compel that result here. Further, the convention of construing insurance policies against the drafter does not require “forced or strained construction.” Knowlton, supra at 423. Accord Royce v Citizens Ins Co, 219 Mich App 537, 542-543; 557 NW2d 144 (1996), citing Hosking v State Farm Mut Automobile Ins Co, 198 Mich App 632, 633-634; 499 NW2d 436 (1993).

No published decisions from the appellate courts of Ohio or Michigan are precisely on point concerning whether Mrs. Nesbitt’s condition was known for purposes of its coming under her policy’s exclusion. However, Goshorn v Hospital Care Corp,

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Nesbitt v. American Community Mutual Insurance
600 N.W.2d 427 (Michigan Court of Appeals, 1999)

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Bluebook (online)
600 N.W.2d 427, 236 Mich. App. 215, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nesbitt-v-american-community-mutual-insurance-michctapp-1999.