Rancosky v. Washington National Insurance

130 A.3d 79, 2015 Pa. Super. 264, 2015 Pa. Super. LEXIS 822, 2015 WL 9261331
CourtSuperior Court of Pennsylvania
DecidedDecember 16, 2015
Docket1282 WDA 2014
StatusPublished
Cited by34 cases

This text of 130 A.3d 79 (Rancosky v. Washington National Insurance) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rancosky v. Washington National Insurance, 130 A.3d 79, 2015 Pa. Super. 264, 2015 Pa. Super. LEXIS 822, 2015 WL 9261331 (Pa. Ct. App. 2015).

Opinions

OPINION BY

MUSMANNO, J.:

Matthew Rancosky, Administrator DBN1 of the Estate of LeAnn Rancosky (“LeAnn”), and Executor of the Estate of Martin L. Rancosky (“Martin”)2 (collectively “Rancosky”), appeals from (1) the March 21, 2012 Order granting summary judgment on Martin’s claims in favor of Washington National Insurance Company (“Conseco”), as successor by merger to Conseco Health Insurance Company (“Conseco Health”), formerly known as Capital American Life Insurance Company (“Capital American”);3 and (2) the Judg[83]*83ment on LeAnn’s bad faith claim, entered on August 1, 2014, in favor of Conseco. We affirm the March 21, 2012 Order granting summary judgment in favor- of Conseco and dismissing Martin’s claims. We vacate in part the Judgment entered on August 1, 2014, and remand for a new trial on LeAnn’s bad faith claim.

In 1998, LeAnn purchased the Cancer Policy from Conseco Health. LeAnn paid a monthly premium rate of $44.00 for the Cancer Policy. The premiums for the Cancer Policy were paid through automatic bi-weekly payroll deductions of $22.00, made by LeAnn’s employer, the United States Postal Service (“USPS”).

The Cancer Policy provides certain limited benefits to an insured diagnosed with an internal cancer while the policy is in effect including, inter alia, cash benefits and payment of surgical, hospitalization and treatment costs. The Cancer Policy requires notice of a claim, as follows:

Written notice of a claim must be given within 60 days after the start of an insured loss or as soon as reasonably possible. The notice must be sent to us at our Administrative Office or to an authorized agent. The notice should in-elude your name and policy number.

Cancer Policy, at 11,

The Cancer Policy requires proof of los?, in relevant part, as follows:

You must give us written proof, acceptable to us, within 90 days after the loss for which you are seeking benefits. If it is not reasonably possible to give written proof in the time required, we shall not reduce or deny the claim for this reason if the proof is filed as soon as reasonably possible. In any event, the proof required must be given no later than one year plus 90 days from the date of loss unless the Policyowner was legally incapacitated during that time.

id. 4

The- Cancer Policy contains a suit limitations clause, which provides as follows:

You cannot take legal action against us for benefits under this policy:
• within 60 days after you have sent us written proof of loss; or
• more than three years from the time written proof is required to be given.

Id

The Cancer Policy contains a Waiver of Premium (“WOP”) provision, which provides as follows:

Subject to the conditions of this policy, premium payments will not be required after the Policyowner is:
• diagnosed as having cancer 30 days or 'more after the Effective Date; and
• disabled due to cancer for more than 90 consecutive days[5] beginning on or after the date of diagnosis.
[84]*84After it has been determined that the Policyowner is disabled, we will waive premium payments for the period of disability, except those during the first 90 days of such period.

Id. at 8 (footnote added).

Pursuant to the Cancer Policy, “disabled”

Means that:
• for the first 24 months after loss begins you are unable, due to cancer, to' perform all the substantial and material duties of your regular occupation; and
After 24 months, “disabled” means that:
• you are unable, due to cancer, to work at any job for which you are qualified by reason of education, training or experience;
• you are not working at any job for pay or benefits; and
• you are under the care of a physician for the treatment of cancer.

Id. at 3.

The WOP provision in the Cancer Policy requires proof of disability as follows:

You must send us a physician’s statement containing the following:
• the date the cancer was diagnosed;
• the date disability due to cancer began; and
• the expected date, if any, such disability will end.

Id. 6

The Cancer Policy states that the term “physician”

Means a person other than you or your spouse, parent, child, grandparent, grandchild, brother, sister, aunt, uncle, nephew or niece who:
• is licensed by the state to practice a healing art[;]
• performs services which are allowed by that license; and
• performs services for which benefits are provided by this policy.

On February 4, 2003, LeAnn, age 47, was taken to the emergency room due to intense abdominal pain. On February 7, 2003, exploratory surgery was performed, after which LeAnn was diagnosed with ovarian cancer. LeAnn remained in the hospital until February 15,2003.

On April 11, 2003, LeAnn contacted Conseco and requested claim forms to seek benefits under the Cancer Policy. On April 12, 2003, Conseco mailed LeAnn claim forms. On May 6, 2003, LeAnn mailed to Conseco two signed and completed claim forms, along with supporting documentation. Conseco received the claim forms and supporting documentation on May 13, 2003. In each of the claim forms, LeAnn indicated that she had been “unable to work in [her] current occupation” since her admission to the hospital on February 4, 2003. The supporting documentation provided by LeAnn included operative records for surgeries she had undergone, pathology reports indicating her diagnosis of Stage III ovarian cancer, and billing records for multiple hospitalizations, surgeries and related medical treatments.7

[85]*85The claim forms initially submitted by LeAnn did not include any section that was required to be completed by a physician. However, the claim forms each included an authorization, signed by LeAnn, which authorized “any medical professional, hospital,. or other medical-care institution, insurance, support organization, government agency, insurance company, employer or other organization, institution or person that has any information, records or knowledge of [LeAnn] or [her] health” to furnish such information to Conseco. See Conseco Claim Form, No. CA-458 (07/02), at 1 (unnumbered).

On May 15, 2003, Conseco made its first payment on LeAnn’s claim in the amount of $3,065.00. On May 20, 2003, Conseco paid an additional $13,023.00 on'LeAnn’s claim.8

LeAnn’s last day at work for USPS was February 4, 2003.

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Bluebook (online)
130 A.3d 79, 2015 Pa. Super. 264, 2015 Pa. Super. LEXIS 822, 2015 WL 9261331, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rancosky-v-washington-national-insurance-pasuperct-2015.