Bumpers v. Guarantee Trust Life Ins. Co.

• Decision Date: 01 August 1991
• Docket Number: No. 90CA1267,90CA1267
• Citation: 826 P.2d 358
• Parties: 73 Ed. Law Rep. 276 Paula K. BUMPERS, Plaintiff-Appellant, v. GUARANTEE TRUST LIFE INSURANCE COMPANY, Defendant-Appellee. . II
• Court: Colorado Court of Appeals

Page 358

826 P.2d 358

73 Ed. Law Rep. 276

Paula K. BUMPERS, Plaintiff-Appellant, v. GUARANTEE TRUST LIFE INSURANCE COMPANY, Defendant-Appellee.

No. 90CA1267.

Colorado Court of Appeals Div. II.

Aug. 1, 1991.

As Modified on Denial of Rehearing Oct. 10, 1991.

Certiorari Denied March 10, 1992.

Anderson, Sommermeyer, Wick & Dow, Samuel L. Anderson, Fort Collins, for plaintiff-appellant.

Fischer, Howard & Francis, Stephen E. Howard, Fort Collins, for defendant-appellee.

Opinion by Judge SMITH.

Plaintiff, Paula Bumpers, appeals the summary judgment granted in favor of defendant, Guarantee Trust Life Insurance Company (Guarantee), on her claim for reimbursement of medical and surgical expenses totalling $7,279.40. We reverse and remand with directions.

The material facts are not in dispute. Bumpers was a student at Colorado State University (CSU) from August 1984 through May 1989. At the beginning of each school year, she purchased a one-year health insurance policy from CSU, underwritten by Guarantee.

By their terms, each of the five policies Bumpers purchased commenced on the first day of registration or the date of enrollment (whichever was later) and terminated the first day of classes the next fall semester. Each policy contained two provisions pertinent here. The first, the pre-existing condition provision, stated:

"Benefits are provided for a sickness or injury which has not been treated or for which no expense has been incurred within six months immediately preceding the effective date of coverage. If there has been treatment or expense during this time, the insured person must be covered for six continuous months after the effective date of coverage during which no treatment or expense has been incurred in order to qualify for benefits for such injury or sickness."

The second, the 52-week provision, stated:

"Benefits are payable for covered expenses incurred within 52 weeks from the date of first medical treatment/expense for an injury or sickness which is the basis of the claim."

In October 1984, while her initial policy was in effect, Bumpers sustained facial injuries, including a fracture to her nasal septum. Related medical expenses, incurred that October and November were paid by Guarantee.

Apparent complications necessitated subsequent surgical and medical treatment in December 1985, May 1986, June 1987, and December 1988. Expenses for these treatments totalled $7,279.40.

In December 1989, Bumpers sought reimbursement for these expenses under her various annual policies. Guarantee denied reimbursement and the matter was submitted to mandatory arbitration under C.R.C.P. 109.1. After the arbitrator denied Bumpers' claim, she filed a demand for a trial de novo. Both parties then filed motions for summary judgment.

Based on the undisputed facts, the trial court found that the expenses Bumpers incurred in the policy years of 1985-86 and 1986-87 did not qualify based on the initial 1984 policy's 52-week provision and, thus, concluded, as a matter of law, that Bumpers' expenses were not reimbursable. On this basis, the trial court granted summary judgment in favor of Guarantee.

It is implicit in the above finding and conclusion that the trial court interpreted the 52-week provision as forever precluding, after 52 weeks, any claim which might be related back to the 1984 injury, even though the need and claim for such treatment might arise in subsequent policy periods. The effect of such ruling is to create an unwritten exclusion in all future policies for any illness or accident which may have originally occurred during any previous policy period if more than 52 weeks have elapsed since the first treatment, or incurrence of expense therefore.

The sole issue on appeal is whether this interpretation of the 52-week provision was proper. We conclude that it was not.

The interpretation of an insurance contract, like any other written contract, is a matter of law. Thus, on review, this court is not bound by the findings and conclusions of the trial court. Eisenhower Hospital Osteopathic v. Taylor, 43 Colo.App. 498, 609 P.2d 1114 (1979).

Here, the evidence is clear and, indeed, undisputed, that each of the policies Bumpers purchased was a separate annual policy which took effect the first day of registration in the fall and terminated the first day of classes the following fall semester. And, despite an amendment...