Hosking v. State Farm Mut. Auto. Ins. Co.

• Decision Date: 15 March 1993
• Docket Number: Docket No. 147199
• Citation: 499 N.W.2d 436,198 Mich.App. 632
• Parties: Mark A. HOSKING, Plaintiff-Appellant, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant-Appellee.
• Court: Court of Appeal of Michigan — District of US

Page 436

499 N.W.2d 436

198 Mich.App. 632

Mark A. HOSKING, Plaintiff-Appellant, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant-Appellee.

Docket No. 147199.

Court of Appeals of Michigan.

Submitted Oct. 6, 1992, at Marquette.

Decided March 15, 1993, at 9:20 a.m.

Released for Publication May 24, 1993.

Bridges & Houghton by E. Nickolas Bridges and Dean A. Antilla, Negaunee, for plaintiff-appellant.

Wietek, Summers & Pence, P.C. by Michael G. Summers, Marquette, for defendant-appellee.

Before CONNOR, P.J., and BRENNAN and MARILYN J. KELLY, JJ.

BRENNAN, Judge.

Plaintiff appeals as of right from a November 18, 1991, order granting summary disposition to defendant and dismissing plaintiff's suit. We affirm.

Plaintiff was rendered a quadriplegic as a result of a diving accident. He filed an action for declaratory judgment and relief against defendant, his insurer, claiming that he was entitled to a lift-equipped, hand-controlled, modified van from defendant pursuant to a catastrophic medical expense rider that provided coverage for "durable medical equipment." Defendant subsequently moved for summary disposition under MCR 2.116(C)(10), claiming, in part, that a modified van was not "durable medical equipment." The court granted summary disposition to defendant, finding that the provision was not ambiguous and that a modified van was not within the coverage provided by the rider.

On appeal, plaintiff argues that the trial court erred in granting summary disposition to defendant and that he is entitled to a modified van under the ambiguous policy language providing coverage for "durable medical equipment." If a term is not defined in an insurance policy, it is given its ordinary and plain meaning, avoiding a technical or strained construction. Wielinga v. American Way Life Ins. Co., 189 Mich.App. 359, 362, 473 N.W.2d 730 (1991). Any ambiguity in an insurance contract will be construed against the insurer, in favor of coverage. Id. The provision in issue provides, in pertinent part:

CATASTROPHIC MEDICAL EXPENSE RIDER

* * *

Covered Medical Expenses means reasonable and customary charges incurred as a result of Injury or Sickness of a Covered Person for the following health care services and supplies to the extent they are necessary to the care and treatment of such Covered Person and prescribed by a Physician:

* * *

10. rental or purchase, as appropriate, of durable medical equipment other than eyeglasses and hearing aids. [Emphasis added.] ¹

The term "durable medical equipment" is not defined in the policy. Further, we have found no case law interpreting the phrase "durable medical equipment." In support of his argument, plaintiff relies on no-fault and workers' compensation cases. However, as the trial court pointed out, these cases are not helpful because the statutory benefits under the workers' compensation law and no-fault law are different from and much broader than the contractual benefits provided in the defendant's policy. See, for example, M.C.L. § 418.315(1); M.S.A. § 17.237(315)(1); M.C.L. § 418.319; M.S.A. § 17.237(319); M.C.L. § 500.3107; M.S.A. § 24.13107. The contractual benefits in the instant case are much more limited.

Nevertheless, we note that other jurisdictions have interpreted similar language. In Camp v. Deseret Mutual Benefit Ass'n, 589 P.2d 780 (Utah 1979), the plaintiff's son was rendered a quadriplegic as a result of a trampoline injury. The plaintiff asserted that he was entitled to a modified van from his insurance company pursuant to language in the insurance policy that provided coverage for "medical supplies and medical equipment prescribed by a physician." The court found that the policy provision was not ambiguous, stating that simply because one party seeks to endow it with a different meaning from that relied on by the drafter does not make the term ambiguous. The court rejected the plaintiff's argument that a modified van was covered under the policy.

Even though the term "medical equipment" is not defined in the policy, it is not without meaning and limit, as suggested by the examples given in the policy. The term itself suggests equipment primarily used for a medical purpose, as distinguished from equipment in general. We do not believe the term "medical equipment" can be ignored, as plaintiff would have us do, and that the above-quoted language of the policy requires the insurer to pay for anything prescribed by a physician. Rather, the prescription must be for "medical equipment ... such as a wheelchair, hospital type bed, iron lung or oxygen equipment."

* * *

Here, the van was prescribed by Dr. Escobar to enable Jeff to be more independent and for his convenience, not for aiding or relieving his physical condition. In his deposition, Dr. Escobar stated the main function of the van was to provide transportation, enabling Jeff to continue his schooling. [Id. at p. 781.]

Further, in Galindo v. Guarantee Trust Life Ins. Co., 91 Ill.App.3d 61, 46 Ill.Dec. 543, 414 N.E.2d 265 (1980), the plaintiff was rendered a quadriplegic as a result of a football accident. He argued that he was entitled to a specially equipped van that was certified as necessary by his attending physician because the accident medical expense provision of the insurance policy provided coverage for "mechanical aids" and "rehabilitation expenses certified as necessary by the attending physician or surgeon." After examining the policy, the court denied the plaintiff's claim. The court stated, in part, that the plaintiff overlooked the phrase "medical care for service" [sic] in the provision, the examples in the policy, and the caption "Accident Medical Expense Insurance." The court then cited Camp, stating that the van in question served to provide transportation rather than to aid or relieve the plaintiff's physical condition.

As in Camp, although the term "durable...