Weaver v. Blue Cross-Blue Shield of Wyoming, CROSS-BLUE

• Decision Date: 28 March 1980
• Docket Number: CROSS-BLUE,No. 5207,5207
• Citation: Weaver v. Blue Cross-Blue Shield of Wyoming, 609 P.2d 984 (Wyo. 1980)
• Parties: Tim WEAVER and Allison Weaver, Appellants (Plaintiffs), v. BLUESHIELD of WYOMING, Appellee (Defendant).
• Court: Wyoming Supreme Court

Page 984

609 P.2d 984

Tim WEAVER and Allison Weaver, Appellants (Plaintiffs), v. BLUE CROSS-BLUE SHIELD of WYOMING, Appellee (Defendant).

No. 5207.

Supreme Court of Wyoming.

March 28, 1980.

W. H. Vines of Jones, Jones, Vines & Hunkins, Wheatland, signed the brief and appeared in oral argument on behalf of appellants.

Blair J. Trautwein of Hathaway, Speight & Kunz, Cheyenne, signed the brief and appeared in oral argument on behalf of appellee.

Before RAPER, C. J., and McCLINTOCK, THOMAS, ROSE and ROONEY, JJ.

RAPER, Chief Justice.

In this appeal, we are concerned with the rights, both contractual and noncontractual, of an individual to convert a group health insurance policy to another group policy or to an individual policy and, at the same time, maintain continuous coverage which avoids repeating lengthy waiting periods for certain types of coverage. The appellant, Allison Weaver, made several attempts to convert her coverage with appellee, Blue Cross-Blue Shield, to another type of policy when she learned her employer was gong to cancel the group policy under which she was covered. The appellant was pregnant at the time, and her employer intended to switch to a group which did not include pregnancy benefits. Appellant had been a member of the group for almost five years at the time these events transpired. She was told by appellee's employee that the conversion was possible. However, due to clerical error on the part of appellee, the conversion did not take place in a timely manner and when the employer terminated the group policy in mid-October 1977, the appellee refused to give appellant a policy that would include continuous coverage. Upon motion of the appellee, the district court granted summary judgment in its favor. The appellant asserts:

(1) The district court erred in granting summary judgment for appellee, because there is a genuine issue of material fact as to whether employees of appellee bound the appellee to provide the benefits sought by the appellant and as to whether those employees waived policy provisions by their statements and actions;

(2) The district court erred in applying the law to the facts that were established, because the maternity coverage vested in the appellant at the time she became pregnant when the original group policy was still in force;

(3) The policy does not speak to the circumstances which arose in this case. Ambiguities in such a policy should be interpreted in a light most favorable to the insured.

We will reverse the summary judgment of the district court and remand for additional proceedings.

The appellant began working for Basins Engineering Company, Inc. in Wheatland in October 1972 and became insured by appellee in November 1972. From that time until October 16, 1977, she was covered by one of appellee's group policies which included maternity benefits. The appellant became pregnant in July 1977. In September 1977, her employer was comparing other group health insurance plans with a view to a change because of complaints about appellee's service and rising costs. The employer asked if any of its employees or their spouses were pregnant. Appellant informed her employer that she was. In September 1977, the employer had requested from the appellee's member service center information on how to transfer an employee to an individual policy so that continuous coverage could be maintained. No information was provided by appellee, although one of its employees indicated in a telephone conversation this could be done. On October 11, 1977, appellant herself called appellee and requested such information. Again, it was not provided, although appellant claims the employee to whom she spoke assured her there would be no problem with such a changeover which would provide continuous coverage. The employer's policy was apparently canceled as of midnight October 15, 1977. Appellant then signed up for another of appellee's groups, a bank depositor group, on October 31, 1977. The insurance agent through whom appellant obtained the policy also assured appellant there would be no problem with continuous coverage. Very shortly thereafter appellant was informed by appellee that she was not entitled to continuous coverage. On April 22, 1978, the appellant gave birth to a child by caesarean section and incurred expenses of $2,323.25. The appellee refused to pay benefits to the appellant. The appellant then filed this lawsuit. Appellee answered generally denying the claim of appellant. Appellee also named the employer as a third-party defendant whom appellee claimed would be liable for any sum it might be required to pay appellant. The employer filed a motion to dismiss and the third-party complaint of the appellee was dismissed with prejudice. No appeal was lodged concerning that dismissal.

The district court granted the appellee's motion for summary judgment without providing any reasons or explanations. Although the specific basis or bases upon which a summary judgment is granted is not a mandatory part of the record, the absence from the record of the district court's reasoning process is a handicap to this court, and we would prefer that the reasons for granting a motion for summary judgment appear clearly in the record. Centrella v. Morris, Wyo.1979, 597 P.2d 958.

The case is before us in the posture of a summary judgment in favor of appellee. An appellee defending a summary judgment has a heavy burden in this court. In the last several terms, we have reversed a number of summary judgments. While the rule ¹ governing summary judgment is a useful tool to cut short litigation in which there is no useful purpose for trial, it is not a useful device for deciding doubtful cases in a summary manner and passing difficult questions of law on to this court for resolution with an inadequate record.

In dealing with a motion for summary judgment, this court has a number of well-defined, and now too-often-repeated, rules that guide our disposal. The motion for summary judgment is a drastic remedy and one which is designed to pierce the formal allegations and reach the merits of the controversy but only when no material issue of fact is present. Minnehoma Financial Company v. Pauli, Wyo.1977, 565 P.2d 835, 838; Keller v. Anderson, Wyo.1976, 554 P.2d 1253. The propriety of granting a motion for summary judgment depends on the correctness of the court's dual findings that there is no genuine issue as to any material fact and that the prevailing party is entitled to judgment as a matter of law. Laird v. Laird, Wyo.1979, 597 P.2d 463, 466. A summary judgment is proper only where no issue of material fact is involved and where inquiry into facts is not desirable to clarify the application of the law. Johnson v. Soulis, Wyo.1975, 542 P.2d 867, 871. Although both parties are obligated to come forward with their evidence, the burden is on the moving party to demonstrate clearly that there is no genuine issue of material fact and if that is not done, the motion for summary judgment should be denied. This court looks at the record from the viewpoint most favorable to the party opposing the motion, giving to him all favorable inferences to be drawn from the facts contained in the affidavits, exhibits, and depositions. Miller v. Reiman-Wuerth Company, Wyo.1979, 598 P.2d 20, 24; Shrum v. Zeltwanger, Wyo.1977, 559 P.2d 1384, 1388; Greenough v. Prairie Dog Ranch, Inc., Wyo.1975, 531 P.2d 499, 503. The object of a motion for summary judgment is to separate what is formal or pretended in denial or averment from what is genuine and substantial so that only the latter may subject a suitor to the burden of a trial, the purpose being to eliminate formal trials where only questions of law are involved. Johnson v. Soulis, supra, 542 P.2d at 869. When a motion for summary judgment is before this court, we have exactly the same duty as the trial judge and, if the record is complete, we have exactly the same material and information in front of us as he did. We follow the same standard as the trial court. We apply the above-described tests in a way designed to give the party who defended the motion the benefit of any doubt as to the propriety of granting summary judgment. Hunter v. Farmers Insurance Group, Wyo.1976, 554 P.2d 1239, 1244.

In this case, there appears to be no great disagreement about the evidentiary facts. However, it is very clear that the parties, justifiably, put two different interpretations on these facts. If the evidence is subject to conflicting interpretations or reasonable minds might differ as to its significance, summary judgment is improper. Fegler v. Brodie, Wyo.1978, 574 P.2d 751, 753-755. While this rule has its roots primarily in negligence cases, we think it is applicable in the circumstances of this case as well. Here the appellant claims she made a good faith and honest effort to transfer her health insurance to another group or an individual policy so that she would be able to maintain continuous coverage. This was of great importance to her because she was pregnant, had been enrolled with appellee for over five years and had fully completed all waiting periods for pregnancy coverage. It seems plain that appellant made an effort to maintain continuous coverage. In response to her inquiries, she was assured on several occasions that she could obtain continuous coverage but due to mix-ups, nothing was done to convert her group policy to another group or an individual policy until the eleventh hour and then without the benefit of continuous coverage.

Appellee, on the other hand, while not denying that the facts are essentially as appellant alleges, casts the facts in such a way as to indicate that appellant gave appellee incomplete information and, indeed, was deceptive, if not fraudulent, in failing to reveal that she was pregnant and that her employer was about to cancel the group policy of which she was a member. The appellee fails to demonstrate why appellant...