Walker v. Conseco Services, LLC

252 F. Supp. 2d 524, 2003 U.S. Dist. LEXIS 4378, 2003 WL 1477015
CourtDistrict Court, N.D. Ohio
DecidedMarch 18, 2003
Docket3:02CV7245
StatusPublished
Cited by2 cases

This text of 252 F. Supp. 2d 524 (Walker v. Conseco Services, LLC) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Walker v. Conseco Services, LLC, 252 F. Supp. 2d 524, 2003 U.S. Dist. LEXIS 4378, 2003 WL 1477015 (N.D. Ohio 2003).

Opinion

ORDER

CARR, District Judge.

Plaintiffs Alice Puppos and Elaine Tello brought this action on behalf of Agnes M. Walker against defendant Conseco Senior Health Insurance Company (“Conseco”) for benefits under a long-term care policy *525 that Walker held with Conseco. Parties cross-motioned for summary judgment. For reasons expressed in an earlier opinion, I granted defendant’s motion for summary judgment on all of plaintiffs claims. Pending is plaintiffs’ motion to reconsider. For the following reasons, plaintiffs’ motion shall be denied. 1

BACKGROUND 2

Under plaintiff Walker’s original long-term care policy, Walker would receive long-term care insurance benefits if she moved into a “Long-Term Care Facility,” such as a nursing home. The policy also included two riders. The first, titled “Alternative Plan of Care Rider,” provided benefits to the insured for other types of long-term care other than nursing home confinement — such as home health care, adult day care, or hospice services — if the insured would have qualified for nursing home confinement and met other stated conditions. The other rider, titled “Assisted Living Facility Rider,” provided benefits if the insured entered an “Assisted Living Facility” and met other stated conditions.

As explained in my previous order, Walker did not pay her premium by the renewal date. Her policy therefore lapsed on October 13, 1999. On December 1, 1999, Walker entered an assisted living facility. In January, 2001, plaintiff entered a nursing home. Because her insurance policy was terminated on October 13, 1999, Walker was accordingly not covered by long-term care insurance when she entered these facilities.

In their motion for summary judgment, plaintiffs asserted that Conseco was in violation of Ohio Revised Code § 3923.44 and Ohio Administrative Code § 3901-4-04. I found these provisions inapplicable to Walker’s long-term care policy. Plaintiffs farther argued that Walker was entitled to benefits under the terms of Walker’s policy and that equity required Walker’s policy be reinstated. Both of these claims were unavailing.

■ In their motion to reconsider, plaintiffs now claim that they also argued in their motion for summary judgment that Walker was entitled to benefits prior to the effective date of termination, October 13, 1999. This argument, however, was not discussed in their motion for summary judgment. Even if the theory were properly presented, however, defendant’s motion for summary judgment was properly granted.

DISCUSSION

In their motion to reconsider, plaintiffs argue that in their motion for summary judgment they argued that Walker was:

entitled to benefits under the policy pri- or to the effective date of termination, October 13,1999 because she was unable to perform two or more activities of daily living without the hands on assistance of another person (in fact the affidavit of Elaine Tello show .that she was unable to perform four (4) of the activities of daily living without the assistance of others) and that therefore under the terms of the policy she was entitled to *526 benefits. The Court’s decision denying Plaintiffs Motion For Summary Judgment and granting Defendant’s Motion for Summary Judgment does not address this issue.

Pl.’s Motion to Reconsideration at 1-2.

In their motion for summary judgment, however, plaintiffs only stated:

Terms of the Policy
Under the terms of the Policy, Plaintiff is entitled to receive benefits. Defendant claims that the policy was terminated October 13, 1999. However, Defendant admits the Policy remained in effect until sometime long thereafter (probably January 11, 2000 when it purportedly sent its last notice) and that it .was terminated retroactively. The Policy provides for the payment of benefits if the policyholder is confined in an Assisted Living Facility. Agnes M. Walker entered an Assisted Living Facility on or about December 1, 1999. The Policy contains a limitation on eligibility requiring that the policyholder be able to perform “without the hands on assistance of another person” two or more of the activities of daily living. The Affidavit of Elaine Tello shows, in fact, that Agnes M. Walker was unable to perform (4) of the activities of daily living without the assistance of others.

Pl.’s Motion for Summary Judgment at 8.

In response to this argument, I wrote: In the alternative to their statutory and regulatory arguments, plaintiffs argue that Walker’s policy did not terminate until at least January 11, 2000 — the date Conseco sent the final overdue payment notice to Walker. Because Walker moved into an assisted living facility on December 1,1999, and the policy provided for assisted living benefits, plaintiffs therefore argue that defendant owes Walker benefits for that time period. Defendant argues that the lapse notices and reinstatement offers on December 4, 1999, and January 11, 2000, were merely offers to reinstate Walker’s policy on payment of her premium — not an extension of the contract.
Walker’s policy specifically provides that a “grace period of 31 days is granted for the payment of each premium due after the first premium, during which time the Policy continues in force.” The contract goes on to state: “If the Renewal Premium is not paid before the Grace Period ends, this Policy will lapse. Later acceptance of the premium by us ... will reinstate the Policy.”
Under the terms of Walker’s policy, nonpayment of a premium by the renewal date or thirty-one days thereafter, will terminate the policy. Because Walker did not pay before the renewal date or within the grace period, plaintiffs’ motion is denied as to this claim.

Order Granting Defendant’s Motion for Summary Judgment at 11-12.

Now, plaintiffs claim that the paragraph cited above also was an argument that Walker was due benefits prior to October 13,1999.

For Walker to have been eligible for benefits prior to October 13, 1999, plaintiffs would have had to argue that, prior to October 13, 1999, either 1) Walker was living in a “Long Term Care Facility,” 2) Walker was living in an “Assisted Living Facility,” or 3) Walker was under an “Alternative Plan of Care.”

Additionally, plaintiffs would have had to argue that Walker was under one of the above conditions for at least ninety days before October 13, 1999. Walker’s policy states: ‘We will waive the payment of each premium coming due after benefits have been payable under this Policy for at least 90 continuous days.”

It is undisputed that Walker did not enter a “Long Term Care Facility” or an *527 “Assisted Living Facility” before October 13, 1999. Thus, plaintiffs must be arguing that Walker was under an “Alternative Plan of Care” for at least ninety days before October 13, 1999. Therefore, her premium was waived, under the terms of the policy, and she is still covered and owed past-due payments.

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252 F. Supp. 2d 524, 2003 U.S. Dist. LEXIS 4378, 2003 WL 1477015, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walker-v-conseco-services-llc-ohnd-2003.