PUBLISHED OPINION
Case No.: 96-0613
Complete Title
of Case:
THOMAS KULEKOWSKIS and
SANDRA KULEKOWSKIS,
Individually and as Special
Administrator of the
ESTATE OF JEFFREY
KULEKOWSKIS, Deceased,
Plaintiffs,
v.
BANKERS LIFE AND CASUALTY
COMPANY,
Defendant-Respondent,
WPS HEALTH INSURANCE,
Defendant,
AMERICAN FAMILY INSURANCE,
Defendant-Appellant.
Submitted on Briefs: December 3, 1996
COURT COURT
OF APPEALS OF WISCONSIN
Opinion Released: February 12, 1997
Opinion Filed: February 12, 1997
Source of APPEAL Appeal
from a judgment
Full Name JUDGE COURT: Circuit
Lower Court. COUNTY: Walworth
(If "Special", JUDGE: JOHN R. RACE
so indicate)
JUDGES: Snyder,
P.J., Nettesheim and Anderson, JJ.
Concurred:
Dissented:
Appellant
ATTORNEYSOn
behalf of the defendant-appellant, the cause was submitted on the briefs of James
J. Mathie of Mitchell, Baxter, O'Meara & Mathie, S.C. of
Milwaukee.
Respondent
ATTORNEYSOn
behalf of the defendant-respondent, the cause was submitted on the brief of Terrance
L. Kallenbach and David J. Nolden of Capwell and Berthelsen
of Racine.
COURT OF APPEALS DECISION DATED AND RELEASED February 12, 1997 |
NOTICE |
A party may file with the
Supreme Court a petition to review an adverse decision by the Court of
Appeals. See § 808.10 and
Rule 809.62, Stats. |
This opinion is subject to
further editing. If published, the
official version will appear in the bound volume of the Official Reports. |
No. 96-0613
STATE
OF WISCONSIN IN COURT OF
APPEALS
THOMAS KULEKOWSKIS and
SANDRA KULEKOWSKIS,
Individually and as
Special
Administrator of the
ESTATE OF JEFFREY
KULEKOWSKIS, Deceased,
Plaintiffs,
v.
BANKERS LIFE AND
CASUALTY
COMPANY,
Defendant-Respondent,
WPS HEALTH INSURANCE,
Defendant,
AMERICAN FAMILY
INSURANCE,
Defendant-Appellant.
APPEAL from a judgment
of the circuit court for Walworth County:
JOHN R. RACE, Judge. Affirmed.
Before Snyder, P.J.,
Nettesheim and Anderson, JJ.
SNYDER, P.J. American Family Insurance appeals from a
judgment requiring it, inter alia, to pay Bankers Life and Casualty Company on
its subrogation claim to recoup medical payments. American Family now raises the following issues for our
review: (1) that the trial court failed
to follow the appropriate procedure in making its determination; (2) that
Bankers Life has not retained a contractual right to seek subrogation in this
case; (3) that Bankers Life does not have a claim for equitable subrogation;
(4) that the American Family policy specifically excludes recovery by Bankers
Life; and (5) that overriding American Family's subrogation exclusion clause
violates its freedom to contract.
Because we conclude that the second and fourth claims are determinative,
we initially direct our attention to those.
American Family's claims
all revolve around conflicting clauses in two separate insurance contracts and
question whether Bankers Life can exercise a right of subrogation in light of
contract language in the American Family policy which excludes payment under
its underinsured motorist (UIM) coverage to any “person or organization
claiming by right of subrogation.”
Because we conclude, under Wisconsin case law and the language of the
policies at issue, that the Bankers Life policy includes a right of subrogation
which overrides the American Family subrogation disallowance, we affirm.
The underlying action in
this case arose out of a one-car accident which killed the driver of the
vehicle and a passenger, Jeffrey Kulekowskis.
The driver's insurance company paid its liability limits and was
released.[1]
Jeffrey's parents, the
Kulekowskises, were insured by American Family under three separate automobile
policies, each of which contained UIM coverage. The Kulekowskises also carried health insurance through Bankers
Life, which had paid certain medical bills and expenses stemming from the
accident. The Kulekowskises brought a
lawsuit, seeking recovery under their UIM coverage; Bankers Life, named as a
defendant by the Kulekowskises, cross-claimed against American Family to
recover the medical payments it had made on behalf of Jeffrey. Bankers Life and American Family then filed
cross-motions for summary judgment on the subrogation issue.
The trial court granted
summary judgment to Bankers Life, concluding that the subrogation exclusion in
the American Family policy “has been precluded by the language in the [Bankers
Life] plan.” Following a trial on the
issue of damages in order to settle the Kulekowskises' UIM claim against
American Family, the court ordered that American Family pay the Bankers Life
claim in the amount of $39,455.27, plus costs.[2] It is from that portion of the final
judgment which American Family appeals.
We review decisions on
summary judgment de novo, applying the same methodology as the trial
court. See Armstrong v.
Milwaukee Mut. Ins. Co., 191 Wis.2d 562, 568, 530 N.W.2d 12, 15 (Ct.
App. 1995), aff'd, 202 Wis.2d 258, 549 N.W.2d 723 (1996). That methodology, as set forth in
§ 802.08(2), Stats., has
been recited often and we will not repeat it here. See Armstrong, 191 Wis.2d at 568, 530 N.W.2d
at 15. In addition to our review of the
summary judgment determination, this appeal also requires the interpretation of
provisions in two insurance contracts.
Construction of an insurance contract is a question of law also subject
to de novo review. See Continental
Cas. Co. v. Homontowski, 181 Wis.2d 129, 133, 510 N.W.2d 743, 745 (Ct.
App. 1993).
American Family argues
that Bankers Life is not entitled to recover its payments for Jeffrey's medical
care because it has not retained a contractual right to seek subrogation, nor
does it have a claim for equitable subrogation. Furthermore, American Family contends that the policy language of
its UIM coverage specifically excludes Bankers Life's claim for
subrogation.
A right of subrogation
may be statutory, contractual or arise through equity. See Demmer v. American Family
Mut. Ins. Co., 200 Wis.2d 94, 98, 546 N.W.2d 169, 170 (Ct. App.
1996). We first address the question of
whether Bankers Life has a contractual right of subrogation, having concluded
that this is the dispositive question.[3] See id. at 98, 546
N.W.2d at 170-71.
We then turn to a review
of relevant portions of the conflicting insurance policies. An insurance policy is to be construed as it
would be understood by a reasonable person in the position of the insured, and
it is to be given its common and ordinary meaning. See id. at 98, 546 N.W.2d at 171. The Bankers Life policy contained the
following pertinent language:
REIMBURSEMENT PROVISION
If a covered person is injured, and
benefits are paid by this Plan:
a.
the Plan shall be immediately reimbursed by the covered person for any
damages collected, whether by action at law, settlement or otherwise, to the
extent that the Plan has provided benefits to or on behalf of any such covered
person;
b. the Plan shall have a lien, to the extent
of benefits provided. Such a lien may
be filed against the person who's [sic] act caused the injury, the person's
agent or a court having jurisdiction in the matter;
and
c.
the Plan requires the covered person to furnish such information and
assistance and to execute such documents or other instruments as the Plan may
require to facilitate enforcement of the Plan's rights hereunder, and shall
take no action prejudicing such rights.
The
American Family UIM coverage provision stated:
We will pay compensatory
damages for bodily injury which an insured person is legally
entitled to recover from the owner or operator of an underinsured motor
vehicle.
The
policy then defined “insured person” as:
a. You
or a relative.
b. Anyone
else occupying your insured car.
c. Anyone, other than a person or organization
claiming by right of assignment or subrogation, entitled to recover damages
due to bodily injury to you, a relative or another
occupant of your insured car.
[Emphasis in italics added.]
Insurance contracts are
subject to the same rules of construction as any other contract. See Whirlpool Corp. v. Ziebert, 197 Wis.2d 144, 152, 539
N.W.2d 883, 886 (1995). In construing
policy provisions, the policy should be considered as a whole. See Schaefer v. General Cas.
Co., 175 Wis.2d 80, 84, 498 N.W.2d 855, 856 (Ct. App. 1993). We therefore look at the language contained
in the reimbursement provision of the Bankers Life policy to determine whether
it includes a right of subrogation.
In paragraph (a), the
Bankers Life policy states that it shall be reimbursed “for any damages
collected, whether by action at law, settlement or otherwise ....” It goes on to state in paragraph (b) that
“the Plan shall have a lien ... against the person who's [sic] act caused the
injury ... or a court having jurisdiction in the matter.” (Emphasis added.) Finally, paragraph (c) contains the following broad subrogation
language: “the Plan requires the
covered person to ... take no action prejudicing [its] rights.”
The first paragraph
states that if it has made any payment on behalf of its insured, it shall be
reimbursed for any damages collected.
The policy further specifies that this right of reimbursement exists
whether the insured collects through a lawsuit, settlement or
otherwise. This broad language
plainly establishes Bankers Life's right to be reimbursed by its insured if damages
are collected from any other liable party.
In the next paragraph,
Bankers Life reserves for itself another option. It states that it may file a lien against the wrongdoer, an agent
or a court having jurisdiction in the matter. This last statement, a disjunctive, plainly reserves Bankers
Life's right to bring an action against any potentially liable party. See Dailey v. Secura Ins. Co.,
164 Wis.2d 624, 629, 476 N.W.2d 299, 301 (Ct. App. 1991) (“‘Any party who may
be liable’ is not limited to wrongdoers.”).
Finally, in the last
paragraph of this section, the policy includes broad language prohibiting its
insured from taking any action to prejudice its rights. This is “boiler plate” language inserted to
protect the company's subrogation rights.
Reading this section of the policy as a whole, we conclude that by its
plain language, Bankers Life has reserved a right of subrogation against any
liable party.
American Family,
however, argues that the Bankers Life policy language “reserves a subrogation
claim only for ‘damages collected’ against the ‘person whose act caused the
injury.’” It offers a statement from Employers
Health v. General Casualty Co., 161 Wis.2d 937, 469 N.W.2d 172 (1991),
which it contends defines damages as “pecuniary compensation from a negligent
act of another” and then reasons that because it was only obligated to pay its
insured under the UIM endorsement, these monies paid are not “damages
collected.” We are unpersuaded by this
characterization of the court's language in Employers Health or
by American Family's reasoning.
The policy at issue in Employers
Health contained the phrase “recover damages from a responsible third
party.” Id. at 945, 469
N.W.2d at 175. Within that context, the
court construed the entire phrase and arrived at its determination that this
language did not confer a right of subrogation against another insurer. “Damages” was gratuitously defined in
reference to the following phrase, “a responsible third party.” See id. at 946, 469
N.W.2d at 175‑76. We agree with
the statement in Bankers Life's brief that the definition in Employers
Health specifies “what may be recovered, but is neutral as to who
may be liable.”
We are also unpersuaded
given American Family's narrow reading of the language of the Bankers Life
policy. While American Family's
construction focuses on two phrases in the reimbursement section, it ignores
other equally pertinent language that is part of the same section. We find the overlooked language to be
particularly applicable to the subrogation issue under the facts presented
here.
Having concluded that by
its plain language the Bankers Life policy reserved a right of subrogation, we
must yet consider the impact of the subrogation exclusion clause in the
American Family policy. The subrogation
exclusion clause in American Family's policy is plain and unambiguous, and not
reasonably susceptible to more than one construction by a reasonable person in
the position of the insured. See Continental Cas., 181
Wis.2d at 133, 510 N.W.2d at 745. The
task before us is to decide which policy language prevails. See WEA Ins. Corp. v. Freiheit,
190 Wis.2d 111, 117, 527 N.W.2d 363, 365 (Ct. App. 1994).
In WEA Insurance,
this court determined that language which prohibited the insured from impairing
the insurer's subrogation rights at any time was sufficient to preserve
an insurer's right of subrogation. See
id. at 120, 527 N.W.2d at 366‑67. This was true, irrespective of a conflicting uninsured motorist
policy exclusion. See id. While the court acknowledged in that
decision that the subrogation exclusion was in direct conflict with the statute
governing uninsured motorist coverage, § 632.32, Stats., the court also determined that the subrogation
exclusion was overcome by the prohibition in the other policy which prevented
the insured from impairing its subrogation rights. See WEA Ins., 190 Wis.2d at 119-20, 527
N.W.2d at 366‑67.
In Demmer,
200 Wis.2d at 102, 546 N.W.2d at 172, this reasoning was extended and applied to
a similar exclusion found within a UIM policy.
This court there determined that as in WEA Insurance, if
the insurer who is seeking subrogation has a policy which “functionally
recites” the preservation of its subrogation rights without any time limitation,
such language will prevail over subrogation exclusion language in a conflicting
policy. See Demmer,
200 Wis.2d at 102-03, 546 N.W.2d at 172; see also WEA Ins.,
190 Wis.2d at 120, 527 N.W.2d at 367.
In the Bankers Life
policy, an insured is required to “take no action prejudicing such
rights.” This language recites no time
limitation, and we conclude that it is analogous to the language we upheld in WEA
Insurance and Demmer.
The Bankers Life policy has secured its subrogation rights as against
the American Family policy.
However, American Family
contends that this analysis ignores the time-limiting language it reads in the
Bankers Life policy, where the section which includes the paragraph prohibiting
any interference with the company's subrogation rights begins with the clause
“[i]f a covered person is injured, and benefits are paid by this Plan.” American Family argues that this is a time
limitation which parallels the time limitation which we construed as disallowing
a subrogation claim, and therefore requires our decision to follow the
reasoning of that case. Cf. Continental
Cas., 181 Wis.2d at 134-35, 510 N.W.2d at 745‑46.
The precise language we
focused on in the Continental Casualty case was: “[Our insured] must do everything necessary
to secure our rights and must do nothing after ‘loss’ to impair them.” Id. at 131, 510 N.W.2d at 744
(emphasis added). The insured in that
case had signed an agreement with a demolition company which included a
waiver-of-subrogation clause. See
id. After this separate
contract was executed and work began, the building was damaged in a fire caused
by the demolition company's negligence.
After paying its insured, Continental Casualty attempted to subrogate a
claim against the demolition company's insurer. Focusing on the above-quoted language, we held that when placed
in opposition to the waiver-of-subrogation clause, the Continental Casualty
policy had failed to protect its subrogation rights in this instance. See id. at 135, 510
N.W.2d at 746.
American Family's
argument now asks that we apply the rationale of Continental Casualty
to the Bankers Life policy and construe its language protecting its subrogation
rights as a time-limited provision. We
decline to do so. The fact that the
reimbursement section begins with a statement that it is applicable “[i]f a
covered person is injured, and benefits are paid by this Plan” does not operate
as a time bar negating the broad reach of the subsequent subrogation
clause. We conclude that the reasoning
of WEA Insurance and Demmer is instructive, and we
construe the Bankers Life language as analogous.
American Family also
argues that Bankers Life has no claim for equitable subrogation. In light of the foregoing, this issue is
moot and will not be addressed. See
State ex rel. Wis. Envt'l Decade v. Joint Comm., 73 Wis.2d 234,
236, 243 N.W.2d 497, 498 (1976).
As a final issue,
American Family claims that the analysis that the Bankers Life policy language
prevails over its subrogation exclusion language “violates its freedom to
contract.” American Family claims that
“[t]o arbitrarily and capriciously give effect to the terms of the Bankers Life
policy while disregarding the terms of the American Family policy violates
American Family's constitutional right to contract.”
We do not address this
argument on several grounds. First,
this argument was not raised to the trial court, and therefore is waived. See Wirth v. Ehly, 93
Wis.2d 433, 443-44, 287 N.W.2d 140, 145-46 (1980). Second, as should be apparent from the foregoing analysis, the
law in Wisconsin does not “arbitrarily and capriciously” give effect to one
insurer's policy in contravention of another.
After examining the conflicting policies in the instant case, we conclude
that the subrogation rights outlined in the Bankers Life policy must
prevail.
By the Court.—Judgment
affirmed.
[2] Although the court granted the summary judgment motion, Bankers Life was required to await the outcome of the trial in order to determine whether its insured was made whole.
[3] In its first issue, American Family disputes the trial court's analysis, claiming that it “engaged in a comparison of the insurance policies without first determining that Bankers Life was even entitled to subrogation.” We find no error in the trial court's approach. While Bankers Life claims a contractual right of subrogation, were we to find that no contractual right existed, we would then be required to examine whether an equitable right of subrogation existed. Cf. Demmer v. American Family Mut. Ins. Co., 200 Wis.2d 94, 98, 546 N.W.2d 169, 170-71 (Ct. App. 1996). This is the same analysis which the trial court employed.