United of Omaha Life Ins. Co. v. Peloquin, 94-0163
| Decision Date | 02 August 1995 |
| Docket Number | No. 94-0163,94-0163 |
| Citation | 660 So.2d 1069 |
| Parties | 20 Fla. L. Weekly D1777 UNITED OF OMAHA LIFE INSURANCE COMPANY, a Nebraska corporation, Appellant, v. Cheryl M. PELOQUIN and University Dental Health Center, Inc., a Florida corporation, Appellees. |
| Court | Florida District Court of Appeals |
R. Fred Lewis of Magill & Lewis, P.A., Miami, for appellant.
Lawrence D. Bache of Law Office of Lawrence D. Bache, Pembroke Pines, and Roy Taylor, Miami, for appellee-Cheryl M. Peloquin.
We reverse a final judgment entered in favor of the insured, Peloquin, against the insurer, United of Omaha, for wrongfully denying her benefits for treatment of a medical condition, endometriosis of the colon. The insurer denied payment for the treatment, as not covered under the terms of its group policy, because the insured was receiving medical care for the condition at the time she applied for the policy. After denying cross motions for summary judgment, the court conducted a final hearing at which no evidence was presented by either side, both relying on the depositions and affidavits of record.
The policy contains a pre-existing conditions rider which defines a preexisting condition as:
a condition for which treatment or service were [sic] received or prescribed drugs or medicines were taken within 180 days prior to the date the person was insured under this Master policy ...
* * * * * *
All related conditions shall be considered to be one injury or sickness.
In the "definitions" portion of the policy, the term "sickness" is defined as:
a disease, disorder or condition (including complications of pregnancy) which requires treatment by a physician....
By her signature on the application, Peloquin agreed that she understood the following:
This (policy/certificate) has a preexisting condition limitation and if a physician has provided treatment or recommended treatment for any injury or illness or other condition within the six-month period prior to issuance of the (policy/certificate) for which I am applying, no coverage will be provided for that illness or injury or other condition until six months after the (policy/certificate) has been issued.
The depositions and affidavits reflect that the insured was being treated in June of 1990 for severe abdominal pain, the cause of which was, at that time, unknown. She was referred to a specialist and a colonoscopy was performed in August leading to a September surgery and biopsy which revealed that the problem was an obstruction caused by the endometriosis. The medical testimony is unrefuted that the...
To continue reading
Request your trial
-
Jones v. State, 95-389
... ... departed to impose concurrent sentences of life for armed burglary and for armed robbery, thirty ... ...
- Jackson v. State, 95-1382
-
Green v. LIFE & HEALTH OF AMERICA
...1039 (Fla. 4th DCA 1992)(requiring clear and ambiguous exclusion to be enforced as written). See also United of Omaha Life Ins. Co. v. Peloquin, 660 So.2d 1069 (Fla. 4th DCA 1995); Life Gen. Sec. Ins. Co. v. Cook, 648 So.2d 237 (Fla. 4th DCA Under the policy terms, a pre-existing condition ......