Weber v. Blue Cross of Montana

643 P.2d 198, 196 Mont. 454, 1982 Mont. LEXIS 761
CourtMontana Supreme Court
DecidedFebruary 4, 1982
Docket80-453
StatusPublished
Cited by37 cases

This text of 643 P.2d 198 (Weber v. Blue Cross of Montana) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weber v. Blue Cross of Montana, 643 P.2d 198, 196 Mont. 454, 1982 Mont. LEXIS 761 (Mo. 1982).

Opinions

MR JUSTICE HARRISON

delivered the opinion of the Court.

Richard and June Weber, plaintiffs and respondents, filed this action in the Seventeenth Judicial District, in and for Valley County, on February 7,1974, seeking damages for contract benefits and wrongful cancellation by Blue Cross on their medical plan contract. On September 19, 1977, the case was transferred to the Eighth Judicial District in Cascade County. On February 9,1979, Webers moved to add punitive damages for fraud, intentional infliction of emotional distress, and bad faith to their original complaint. Shortly before trial Webers also sought to add an additional claim alleging violation of the Montana Insurance Code. The case was tried June 23 through 27,1980, and the district judge allowed the case to go to the jury on all issues of liability. The jury returned a verdict in favor of plaintiffs for every dollar in compensatory damages sought, $157,137, and for all but one dollar of the punitive damages, $999,999. Blue Cross filed motions for judgment notwithstanding the verdict, and to amend or alter the judgment, all of which were denied. Blue Cross now appeals.

Richard and June Weber, plaintiffs-respondents, have nine children and live in Glasgow, Montana, where Richard Weber has a successful dental practice. Blue Cross of Montana, defendant- appellant, is a private, nonprofit health service corporation marketing health care plans throughout Montana.

In March 1972 Dr. Weber received an informational brochure describing the “Montana Dental Plan”, a new group policy for Montana dentists. Dr. and Mrs. Weber reviewed the plan, determined that it was less expensive than their current health insurance, and decided to apply for membership. Although every dentist in Montana could apply, only medically-qualified applicants were accepted.

On April 12, 1972, Jim Burke, a Blue Cross sales representative, met with Dr. Weber at his dental office to complete the [457]*457membership application. Burke asked Weber questions and filled out the application form as Weber answered the questions. Dr. Weber checked the application for. accuracy, and then both Weber and Burke signed the application.

The application, which Dr. Weber read once before signing, noted that “there will be a waiting period of 12 months for all pre-existing conditions” and that “misrepresentations in this application will render the contract void”. However, Dr. Weber was not given a copy of the application or the contract and was not advised that the application was part of the contract.

Dr. Weber specifically asked Burke if Blue Cross could cancel any member’s policy without canceling the whole group plan, and Burke assured him that it was noncancelable. The contract, however, allowed Blue Cross to cancel upon thirty days’ notice.

The “completed” application was then sent to Blue Cross for processing. Although the application requested the name of the family doctor, and the date, hospital, and physicians that had treated any medical problem, this information was not provided. Blue Cross nonetheless accepted the application and issued the Webers a membership card and a copy of the application on May 1, 1972. It is not clear whether a copy of the contract was first sent to Webers on May 1, 1972, or in 1973 when their attorney requested one. In any event, Webers canceled their old insurance shortly after May 1,1972.

On May 25, 1972, and in October 1972, June Weber was hospitalized in Glasgow for what was initially diagnosed as a bleeding ulcer. On both occasions the bills were sent to Blue Cross but were not paid.

In November 1972 June Weber went to Billings for extensive testing by Dr. Hurley, an internist. Dr. Hurley diagnosed varices of the esophagus (vericose veins in the esophagus) and a polyp in her duodenum (growth in the small intestine). This bill was also sent to Blue Cross but was not paid.

In April 1973 June Weber had another bleed, and an airplane was chartered to fly her to Billings for treatment. She had surgery for the esophageal varices. Again the bill was submitted to Blue Cross and was not paid.

[458]*458Webers first became aware that bills were not being paid in August 1972 when Dr. Weber got a second bill for the May 1972 hospitalization. Dr. Weber contacted the local Blue Cross agent and was told that Blue Cross did not receive a bill. (In fact, Blue Cross had received the bill on June 22, 1972.) Dr. Weber asked the hospital to send Blue Cross another bill, but it too was not paid.

In March 1973 Dr. Weber wrote the Montana Dental Association, the Montana legislature and Blue Cross to complain about the trouble he was having with Blue Cross. In response to this letter, Blue Cross claims manager Nehus wrote on March 23,1973, indicating that the April 12,1972 application was reviewed, considered for cancellation, but retained. Blue Cross then denied payment on grounds of preexisting conditions.

Blue Cross had originally received the May 1972 hospital bills on June 22, 1972. On July 14, 1972, Dr. Shull, medical director for Blue Cross, reviewed the bills and requested a copy of the hospital history from the Glasgow hospital in order to determine whether the claim was pre-existing. Blue Cross received incomplete information, made several more requests for information, and completed its files on February 7, 1973, when it determined that June Weber’s medical condition was pre-existing.

On March 23, 1973, Blue Cross notified Webers that bills associated with esophageal varices would not be paid because the condition was pre-existing. Then, on June 1, 1973, Blue Cross sent the Webers a letter unilaterally declaring the contract void because Dr. Weber had misrepresented his family’s health on the application. This suit followed.

At trial there was voluminous testimony concerning whether or not June Weber’s esophageal varices were preexisting. In general, there was a great deal of evidence indicating that they were not pre-existing, and little credible evidence indicating that they were pre-existing. The point became moot, however, when Jury Instruction No. 12 was given, which indicated that a medical condition should not be considered pre-existing unless it manifests itself prior to the effective date of insurance. All the evidence Blue Cross [459]*459presented indicated that the condition may have existed, but the condition was unknown prior to May 1, 1972. Therefore, Blue Cross admitted during closing argument that, based on the jury instructions, there were no pre-existing conditions.

However, there continues to be a great deal of disagreement as to whether Dr. Weber misrepresented the health of his family when completing the application for membership in the Montana Dentists’ Group Plan.

Dr. Weber did reveal that June Weber had a minor kidney infection twelve years earlier, that June Weber had her spleen and gallstones removed three years earlier, and that seven of his nine children wore glasses.

Medical conditions that Dr. Weber did not reveal include:

1. June Weber’s familial (inheritable) anemia;

2. Dr. Weber’s heart condition for which he occasionally took medication; and that Dr. Weber also suspected his son had a heart problem;

3. June Weber’s continuing bladder trouble;

4. Removal of June Weber’s ovary;

5.

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Bluebook (online)
643 P.2d 198, 196 Mont. 454, 1982 Mont. LEXIS 761, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weber-v-blue-cross-of-montana-mont-1982.