Weber v. Transamerica Occidental Insurance

70 F. App'x 286
CourtCourt of Appeals for the Sixth Circuit
DecidedJuly 1, 2003
DocketNo. 01-1968
StatusPublished

This text of 70 F. App'x 286 (Weber v. Transamerica Occidental Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weber v. Transamerica Occidental Insurance, 70 F. App'x 286 (6th Cir. 2003).

Opinion

CLAY, Circuit Judge.

Plaintiff, Judy Weber, appeals from the district court’s order granting summary judgment to Defendant, Transamerica Occidental Insurance Company, while denying Plaintiffs motion for summary judgment, in this diversity action in which Plaintiff sought to collect the proceeds from an insurance policy in the amount of $100,000 that her late brother, Wayne Gotts, obtained from Defendant. For the [287]*287reasons set forth below, we REVERSE the district court’s order and REMAND with instructions that the district court enter summary judgment in favor of Plaintiff.

BACKGROUND

In November of 1997, Gotts applied for a life insurance policy (“the Policy”) from Defendant in the amount of $100,000. Gotts completed “Part 1” of the application on November 5, 1997, and tendered an initial premium payment of $66 to Defendant. In return, Gotts received a Conditional Receipt outlining the prerequisites that had to be met in order for the Policy to become effective. Gotts completed Part 2 of the of the application, consisting of a para-medical exam, on November 20, 1997. The Conditional Receipt provides that after meeting certain conditions, the “policy applied for shall be effective from the date of Part 1, the date of Part 2, or the date requested in the application, whichever is the latest, regardless of any change of insurability of each person to be covered occurring after completion of both parts of the application.... ” (J.A. at 11.) Because Gotts did not request a date in the application, under the terms of the Conditional Receipt, coverage took effect on November 20,1997.

Defendant issued the formal Policy to Gotts on December 17, 1997. The Policy contains a provision, “the Suicide Clause,” which limited Defendant’s liability in the event that Gotts’ death was the result of suicide. Specifically, the Suicide Clause states: “Amount Payable is Limited in the Event of Suicide-If the insured dies by suicide, while sane or insane, within two years from the date of issue, we will be liable only for the amount of premiums paid.” (J.A. at 28.) The Policy contains a “Definitions” section, but does not provide a definition for the term “date of issue.” On page one and page three of the Policy, however, the term “date of issue” appears with the date of December 17, 1997 appearing thereafter. The Policy expressly provides that the language of the Policy, the two-part application, and the Conditional Receipt together form Defendant’s contract with Plaintiff.

Although Gotts had applied for coverage at a class of risk labeled “Preferred Nonsmoker, Kind Code 6023,” he was ultimately insured at a higher class of risk labeled “Standard Non-Smoker, Kind Code 6021.” Defendant issued Gotts the Policy which insured him at a higher class of risk, and Gotts signed an Application Amendment on January 5, 1998, acknowledging this modification.

Gotts committed suicide on November 26, 1999. As the Policy beneficiary. Plaintiff requested that Defendant pay her the full $100,000 proceeds following Gotts’ death. Defendant refused to pay Plaintiff the full value of the Policy, and instead tendered only the amount of premiums paid by Gotts, plus interest, for a total payment of $1,083.86. Defendant maintained that the Policy’s “date of issue” was December 17, 1997, making Gotts’ suicide on November 26, 1999 within the two-year limitations period, and therefore entitling Plaintiff only to the amount of premiums paid plus interest.

Plaintiff filed suit against Defendant arguing that Gotts’ death by suicide occurred outside the two-year limitation period inasmuch as the Conditional Receipt made coverage effective on November 20, 1997. Plaintiff claimed that at best, the language of the insurance agreement was ambiguous because the agreement as a whole could be read as taking effect on the date provided in the Conditional Receipt, or the date provided twice in the Policy after the term “date of issue.” Plaintiff concluded that as a result of this ambiguity, the language [288]*288had to be construed against the insurer thus requiring Defendant to pay Plaintiff the full value of the Policy.

Faced with cross-motions for summary judgment, the district court found that the date of issue to which the Suicide Clause referred unambiguously meant December 17, 1997, inasmuch as it was this date that appeared after the term “date of issue” as stated on pages one and three of the Policy. Thus, the district court granted Defendant’s motion for summary judgment, and denied Plaintiffs motion for summary judgment. This timely appeal ensued.

DISCUSSION

This Court reviews a district court’s grant of summary judgment de novo. Equitable Life Assurance Soc’y v. Poe, 143 F.3d 1013, 1015 (6th Cir.1998). Summary judgment is appropriate where the evidence submitted shows that “there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c).

In this diversity case, we apply Michigan substantive law. Erie R.R. Co. v. Tompkins, 304 U.S. 64, 78, 58 S.Ct. 817, 82 L.Ed. 1188 (1938). Under Michigan law, an insurance contract, like any contractual agreement between parties, should be read as a whole with meaning given to all of its terms. Auto-Owners Ins. Co. v. Churchman, 440 Mich. 560, 489 N.W.2d 431, 434 (1992). An insurance contract is ambiguous, and therefore construed against the drafter in favor of coverage, if a “fair reading” of the entire contract as a whole “ ‘leads one to understand that there is coverage under particular circumstances and another fair reading of it leads one to understand there is no coverage under the same circumstances.’ ” Farm Bureau Mut. Ins. Co. v. Nikkel, 460 Mich. 558, 596 N.W.2d 915, 919 (1999) (quoting Raska v. Farm Bureau Mut. Ins. Co., 412 Mich. 355, 314 N.W.2d 440, 441 (1982)).

Here, when considering the language of the Conditional Receipt along with the language of the Policy Suicide Clause, as the Court must do, an ambiguity exists because a fair reading of the provisions could lead one to understand that coverage existed on November 20, 1997 for purposes of death by suicide, but could also lead one to understand that coverage did not exist on November 20, 1997 for purposes of death by suicide. See Nikkel, 596 N.W.2d at 919. Moreover, to ignore the language of the Conditional Receipt violates Michigan law, because to conclude that coverage did not exist on November 20, 1997, is to render the language and purpose of the Conditional Receipt mere surplusage. See Churchman, 489 N.W.2d at 434 (instructing that an insurance contract should be read as a whole with meaning given to all of its terms).

If the term “date of issue” was defined in the Policy, the ambiguity would no longer exist inasmuch as a fair reading of the insurance agreement as a whole would lead to only one conclusion.

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Related

Erie Railroad v. Tompkins
304 U.S. 64 (Supreme Court, 1938)
Crowley v. Travelers Ins. Co
196 F.2d 315 (Fifth Circuit, 1952)
Auto-Owners Insurance v. Churchman
489 N.W.2d 431 (Michigan Supreme Court, 1992)
Oakes v. Franklin Life Insurance
516 F. Supp. 445 (E.D. Pennsylvania, 1981)
Raska v. Farm Bureau Mutual Insurance
314 N.W.2d 440 (Michigan Supreme Court, 1982)
Farm Bureau Mutual Insurance v. Nikkel
596 N.W.2d 915 (Michigan Supreme Court, 1999)
Henderson v. State Farm Fire & Casualty Co.
596 N.W.2d 190 (Michigan Supreme Court, 1999)

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70 F. App'x 286, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weber-v-transamerica-occidental-insurance-ca6-2003.