Standish v. Business Men's Assur. Co. of America

• Decision Date: 20 April 1977
• Docket Number: No. 13527,13527
• Citation: 172 Mont. 264,563 P.2d 552
• Parties: Melvin STANDISH, Plaintiff and Respondent, v. BUSINESS MEN'S ASSURANCE COMPANY, OF AMERICA, Defendant and Appellant.
• Court: Montana Supreme Court

Page 552

563 P.2d 552

172 Mont. 264

Melvin STANDISH, Plaintiff and Respondent, v. BUSINESS MEN'S ASSURANCE COMPANY, OF AMERICA, Defendant and Appellant.

No. 13527.

Supreme Court of Montana.

Submitted March 9, 1977.

Decided April 20, 1977.

Berg, Angel, Andriolo & Morgan, Charles F. Angel, argued, Bozeman, for defendant and appellant.

Bennett & Bennett, Lyman H. Bennett, Jr., argued and Lyman H. Bennett, III, argued, Bozeman, for plaintiff and respondent.

HARRISON, Justice.

Defendant appeals from denial of a motion for judgment notwithstanding the verdict by the district court, Park County. The jury returned a verdict in favor of plaintiff Melvin Standish in the amount of $7,679.32. The parties agree this amount is due, if there was coverage under the group health insurance policy purchased by Brand S Lumber Company for its employees from defendant, Business Men's Assurance Company of America.

On appeal, the standard of review from a denial of a motion for judgment notwithstanding the verdict made pursuant to Rule 50(b), M.R.Civ.P., is the same as that for review of a motion for directed verdict. Sheeketski v. Bortoli, 86 Nev. 704, 475 P.2d 675; 9 Wright & Miller, Federal Practice and Procedure, Civil § 2524. A directed verdict may be granted only where it appears as a matter of law that plaintiff cannot recover upon any view of the evidence, including the legitimate inferences to be drawn from it. Parrish v. Witt, Mont., 555 P.2d 741, 742, 33 St.Rep. 999, 1,000; Slagsvold v. Johnson, Mont., 544 P.2d 442, 443, 32 St.Rep. 1273, 1275, and cases cited therein.

Here, the basic question on appeal is whether plaintiff was covered by the group insurance policy. There are two aspects to this question 1) had plaintiff met the initial eligibility requirements, 2) had he been terminated ending policy coverage prior to the injury.

We first note that because there was no employee payment or other affirmative act on the part of the employee which initiates coverage, the determination of when coverage began or when it ends requires inferences from circumstantial evidence. There are a number of similarities between the instant case and cases involving the question of coverage under the Worker's Compensation Act or other social legislation, and while both are for the benefit of the employee and paid by the employer, there is a major difference between the two. Worker's Compensation coverage is required by statute, while the group health insurance policy is not. The Worker's Compensation statute is construed to prevent avoidance of the statute. Here it is the provisions of the group insurance policy which must be interpreted. Those provisions in question here are:

'An Individual in an eligible class of Individuals shall be eligible for insurance under this policy as follows:

'* * *

'(b) on the day following the date the Individual completes one calendar month of membership in an eligible class.'

The termination provision reads:

'(b) If an Individual's insurance under this policy is contingent upon employment, the insurance of such Individual shall terminate upon termination of such employment. Cessation of active work shall be deemed termination of employment, except that while an Individual is absent on account of sickness or injury, employment shall be deemed to continue until premium payments for such Individual's insurance are discontinued. At the option of the Policyowner, the insurance of an Individual may be continued during a temporary lay-off but not beyond the end of the policy month following the policy month in which the lay-off starts, or maybe continued during an authorized leave of absence granted by the policyowner for reasons other than sickness or injury, but not beyond the period ending three months after such leave of absence starts.'

The questions to be determined for coverage are (1) when, if ever, did coverage begin, (2) was the cessation of active work due to injury, and (3) if it was, when were the premiums...