Kinzie v. Physician's Liability Ins. Co., 65358

• Decision Date: 22 September 1987
• Docket Number: No. 1,No. 65358,65358,1
• Citation: 750 P.2d 1140
• Parties: 1987 OK CIV APP 69, 75 A.L.R.4th 757 Karin K. KINZIE, Appellant, v. PHYSICIAN'S LIABILITY INSURANCE CO., Appellee. Court of Appeals of Oklahoma, Division
• Court: United States State Court of Criminal Appeals of Oklahoma. Court of Civil Appeals of Oklahoma

Page 1140

750 P.2d 1140

1987 OK CIV APP 69, 75 A.L.R.4th 757

Karin K. KINZIE, Appellant, v. PHYSICIAN'S LIABILITY INSURANCE CO., Appellee.

No. 65358.

Released for Publication by Order of the Court

of Appeals of Oklahoma, Division No. 1.

Court of Appeals of Oklahoma,

Division No. 1.

Sept. 22, 1987.

Rehearing Denied Nov. 24, 1987.

Certiorari Denied Feb. 23, 1988.

Jack L. Kinzie, Laura J. Stakley, Andrews, Davis, Legg, Bixler, Milsten & Murrah, Oklahoma City, for appellant.

Kent F. Frates, Michael K. Harrah, Frates & Farris, Oklahoma City, for appellee.

REYNOLDS, Judge:

As an employee of the Oklahoma City Clinic, Karin Kinzie obtained comprehensive medical insurance coverage from Physician's Liability Insurance Co. (hereinafter referred to as "PLICO"), effective May 1, 1982. In September, 1982, Mrs. Kinzie began treatment at the Oklahoma City Clinic for infertility. She received both outpatient surgery as well as inpatient surgery and hospitalization for an attempted tuboplasty. This surgery was designed to surgically repair Mrs. Kinzie's fallopian tube, obstructed by adhesion formation, in the hope that she could become fertile.

The expenses of the surgical treatment were deemed by PLICO to be covered by the terms of the policy, which provided that PLICO would pay "reasonable and customary charges for medically necessary services...."

Mrs. Kinzie was subsequently diagnosed as having secondary failed tuboplasty, the surgical procedure having been unsuccessful. She was then referred to the Hillcrest Fertility Clinic in Tulsa, where a child was conceived by the in vitro fertilization procedure.

On February 7, 1984, Mrs. Kinzie submitted a claim for reimbursement of expenses for the conception of the child by means of in vitro fertilization. PLICO denied coverage on March 23, 1984 for the stated reason that the in vitro fertilization procedure was not medically necessary.

Mrs. Kinzie then initiated the present lawsuit, and upon Motions for Summary Judgment being filed by both parties, the trial court granted summary judgment in favor of PLICO.

Summary judgment is appropriate if there is no substantial controversy as to any material fact, and it appears that any party is entitled to judgment as a matter of law. Sellers v. Oklahoma Pub. Co., 687 P.2d 116 (Okl.1984).

When reviewing a summary judgment, this Court must examine the record to determine what facts are material to the cause of action and whether the evidentiary materials introduced indicate no substantial controversy as to any material fact. Thompson v. Madison Machinery Co., 684 P.2d 565 (Okl.App.1984). The reviewing court may affirm the granting of a summary judgment if any proper ground exists to support the ruling. Lindsey v. Dayton-Hudson Corp., 592 F.2d 1118 (10th Cir.1979).

The trial court ruled as a matter of law that in vitro fertilization was not a medically necessary service because it was elective and was not required to cure or preserve Mrs. Kinzie's health. The court further ruled that it was not medically necessary to a woman's health to give birth to a child. We agree.

The only genuine issue to be determined was the meaning of the term, "medically necessary."

The existence of ambiguity in the language of a contract is a decision to be made by the trial court. Mercury Inv. Co. v. F.W. Woolworth Co., 706 P.2d 523 (Okl.1985). If the court determines that the language is not ambiguous, the construction of the contract is also a matter of law for the court. Ferrell Const. Co., Inc. v. Russell Creek Coal Co., 645 P.2d 1005 (Okl.1982).

Appellant cites several cases from other jurisdictions in which courts have disagreed on the meaning of similar terminology. Compare Abernathy v. Prudential Insurance Co. of America, 274 S.C. 388, 264 S.E.2d 836 (1980) (equating "necessary" with appropriate); Van Vactor v. Blue Cross Ass'n., 50 Ill.App.3d 709, 8 Ill.Dec. 400, 365 N.E.2d 638 (1977) (interpreting "medically necessary" to require that the services be prescribed in good faith by a physician); Fassio v. Montana Physicians' Service, 170 Mont. 320, 553 P.2d 998 (1976) (suggesting that "necessary services" requires that the services be prescribed and performed by a licensed physician); Victum v. Martin, 367 Mass. 404, 326 N.E.2d 12 (1975) ("necessary" means wise in the light of facts known at the time rendered); Group Hospitalization, Inc. v. Levin, 305 A.2d 248 (D.C.App.1973) ("necessary" means reasonably calculated to shorten and relieve an ordeal of agonizing pain and thereby effectuate the most rapid recovery possible); and Aetna Life Insurance Co. v. Sanders, 127 Ga.App. 352, 193 S.E.2d 173 (1972) (finding the physician's recommendation entitled to great weight under the language "necessary to the treatment").

However, none of the above cases are instructive in the context of the present fact situation. In all of the cases cited above, the medical services conducted were performed to the insured's body in order to physically alleviate or correct a serious illness, disease or affliction.

The infertile condition of Mrs. Kinzie's body was not corrected by in vitro fertilization. Although Mrs. Kinzie and her husband did indeed become parents, Mrs. Kinzie's...