Case No.: |
2006AP2320 |
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Complete Title of Case: |
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Zurich American Insurance Company, Plaintiff-Respondent-Cross-Appellant, Michels Corporation, Involuntary-Plaintiff, v. Wisconsin Physicians Services Insurance Corporation, Defendant-Appellant-Cross-Respondent. |
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Opinion Filed: |
November 14, 2007 |
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Submitted on Briefs: |
August 7, 2007 |
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Oral Argument: |
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JUDGES: |
Curley, P.J., Wedemeyer and Fine, JJ. |
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Concurred: |
Fine, J. |
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Dissented: |
Fine, J. |
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Appellant |
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ATTORNEYS: |
On behalf of the plaintiff-respondent-cross-appellant,
the cause was submitted on the briefs of Beth
Ermatinger and David J. Turek
of Gass Weber Mullins LLC, of |
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Respondent |
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ATTORNEYS: |
On behalf of the defendant-appellant-cross-respondent,
the cause was submitted on the briefs of Christine M. Witherill of Wisconsin Physicians Service
Insurance Corporation, of |
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2007 WI App 259
COURT OF APPEALS DECISION DATED AND FILED November 14, 2007 David R. Schanker Clerk of Court of Appeals |
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NOTICE |
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This opinion is subject to further editing. If published, the official version will appear in the bound volume of the Official Reports. A party may file with the Supreme Court a petition to review an adverse decision by the Court of Appeals. See Wis. Stat. § 808.10 and Rule 809.62. |
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Appeal No. |
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STATE OF WISCONSIN |
IN COURT OF APPEALS |
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Zurich American Insurance Company, Plaintiff-Respondent-Cross-Appellant, Michels Corporation, Involuntary-Plaintiff, v. Wisconsin Physicians Services Insurance Corporation, Defendant-Appellant-Cross-Respondent. |
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APPEAL
AND CROSS-APPEAL from an order of the circuit court for
Before Curley, P.J., Wedemeyer and Fine, JJ.
¶1 WEDEMEYER, J. Wisconsin Physicians
Services Insurance Corporation (“WPS”) appeals from a summary judgment granted
in favor of Zurich American Insurance Company on its subrogation claim. WPS claims that the trial court erred in ruling
that WPS must pay
BACKGROUND
¶2 This case involves the medical costs incurred by Troy Beebe,
who was employed at Michels Corporation through November 21, 2000. At the conclusion of his employment, Beebe
moved to
¶3 The pertinent facts in this case are undisputed. Beebe’s last day of employment with Michels was November 21, 2000. Due to an administrative error, however, Michels did not terminate his health care insurance coverage with WPS. Rather, Michels continued to pay monthly health care insurance premiums for Beebe to WPS for stop-loss coverage.
¶4 Approximately six months later, on May 5, 2001, Beebe was
catastrophically injured in a single-car accident in
¶5 On September 18, 2001, while in the midst of processing the
medical bills submitted by
On September 18, 2001, it came to our attention that due to an administration error your health care coverage was not appropriately cancelled when you terminated your employment. As a result you have enjoyed the benefit of coverage at no expense to yourself since December 2000. Please note on page two, paragraph one, your coverage expires October 1, 2001; however, a Federal law commonly referred to as COBRA allows you to extend Health Care coverage at your own expense.…
On the same date, Michels
instructed WPS to terminate Beebe’s regular health care plan coverage effective
October 1, 2001. On October 16, 2001,
Beebe elected COBRA coverage and the premium for two months of coverage was
paid for by
¶6 On November 2, 2001, WPS denied coverage for Beebe’s hospital
bills, stating that because Michels was delinquent in providing Beebe with his
COBRA continuation rights, no coverage existed under the stop-loss policy. On November 7, 2001, Beebe was released from
¶7 On December 1, 2001, Beebe’s COBRA coverage lapsed as no
further premium payments were made. In
December 2002,
¶8 On July 8, 2003,
¶9 On January 27, 2006, WPS objected to
DISCUSSION
¶10 In reviewing a grant of summary judgment, we employ the same
methodology as the trial court. Green
Spring Farms v. Kersten, 136
APPEAL
¶11 The
issue on appeal is whether WPS is obligated to reimburse Zurich for the
$350,000 it paid to settle the Craig Hospital suit against Michels related to
its ex-employee’s medical expenses. This
issue requires interpretation of the insurance policies contractual language,
which presents a question of law reviewed independently by this court. See Smith v. Atlantic Mut. Ins. Co.,
155
¶12 Thus,
we examine first the pertinent language of the insurance contracts at
issue. The health plan at Michels is
contained within a document entitled “Group Master Plan Document.” According to the terms of that document,
Michels’ health plan provides coverage to three groups: (1) current, full-time employees; (2) retired
employees who meet age and years of service requirement; and (3) individuals
who elect “continuation coverage.”
¶13 Coverage
ends under the Plan “on the earliest of the following dates” as pertinent
here: “The day immediately following the
last day of the calendar month a covered employee isn’t a full-time employee or
is not within the class of employees eligible under the Plan.”
“Continuation
coverage” is located in Section 11 of the Plan and provides in pertinent part:
All participants covered under the Plan who would otherwise lose coverage as the result of a “qualifying event” have the right to elect continued health care coverage.
A qualifying event is any one of the following events which, but for continuation of coverage, would result in the loss of health care coverage:
….
2. the termination of the covered employee (other than by the employee’s gross misconduct);
….
No employee, spouse or child will be considered a participant unless, on the date before the qualifying event, that individual was covered under the Plan.
¶14 The Plan next sets forth the procedure with respect to election of continuation coverage. First, the Employer must give notice: “Within 14 days of the Employer receiving notice to end coverage, the Employer must notify the participant.…” Then, the employee must elect coverage:
A participant must elect continuation coverage during the 60 day period:
1. beginning on the date coverage would otherwise terminate due to a qualifying event; or
2. beginning on the date the participant receives notice of his/her continuation rights.
If the participant elects to continue coverage within the 60 day period, the continuation coverage must be effective as of the date of the qualifying event.
(Emphasis added.) Generally a participant is entitled to eighteen months of continuation coverage, starting from the qualifying event.
¶15 The other insurance policy at issue here is the Stop-Loss Policy issued by WPS, which served as an “excess” policy to cover all amounts exceeding the self-insured components of the Michels’ health plan. Specifically, the WPS policy paid all “Plan Payments” incurred between March 1, 2001 and February 28, 2002, in excess of $40,000 per participant. “Plan Payment[s]” are defined to include all medical expenses covered by the Michels’ Health Plan:
“Plan Payment” means a health coverage expense for which charges for covered health care expenses are incurred during the Accumulation Period and for which payment is made within six months following the end of the Accumulation Period on behalf of an eligible employee … according to the terms and conditions of the Policyholder’s self-funded health plan as described in the Group Master Plan Document.[3]
Plan Payment was defined to exclude, as pertinent to this case “[e]xtra contractual costs or damages relating to the Plan.”
A. Continuation Coverage.
¶16 WPS makes essentially three arguments: (1) the Michels’ Group Master Plan coverage ended for Beebe on November 30, 2000, and because he never elected continuation coverage for the period from December 1, 2000 through October 1, 2001, the Plan does not apply; (2) that Michels’ payment of Beebe’s premiums during this time constituted “extra-contractual costs”; and (3) WPS does not cover claims made during the “continuation coverage” time period of October 1, 2001 through December 1, 2001 because Michels’ COBRA notice to Beebe was not timely made.
¶17 The language in the policies at issue here is plain and unambiguous. The facts in this case complicate the interpretation of the policies. Thus, we must determine under the undisputed facts and circumstances herein, whether Beebe was a covered participant under the Plan, such that he was covered under the Michels’ health plan after he was no longer employed by Michels, but before he was notified of his COBRA rights and elected continuation coverage.
¶18 The language of the Michels policy set forth above clearly
states that health coverage will end on the first day “following the last day of the calendar month a
covered employee isn’t a full-time employee or is not within the class of
employees eligible under the Plan.”
Applying that language to the facts here, then because Beebe ceased
full-time employment on November 21, 2000, his coverage would end December 1,
2000 unless he was within a class of employees eligible under the Plan.
¶19 As
noted above, there are three classes or groups covered by the Michels’
Plan: current full-time employees,
retirees and COBRA/continuation participants.
The third category is the class at issue here. WPS argues that Beebe did not fit into the
COBRA class between December 1, 2000 and October 1, 2001 because he did not
elect COBRA coverage until October 2001.
The clear policy language requires us to reject WPS’s argument.
¶20 First,
based on the Plan’s language, Beebe was eligible for continuation
coverage. Section 11.1 of the Plan
specifically states that “[a]ll participants covered under the Plan who would
otherwise lose coverage as the result of a ‘qualifying event’ have the right to
elect continuation coverage” as long as the participant was covered by the
health plan on the day before the “qualifying event.” It is undisputed in this case that Beebe was
covered by the health plan the day before his qualifying event, which was his
last day of employment. Thus, Beebe was
eligible for continuation/COBRA coverage.
¶21 Second,
once the eligibility has been confirmed, Section 11.1 provides that the
participant can elect continuation coverage within one of two sixty-day
election periods:
A participant must elect continuation coverage during the 60 day period:
1. beginning on the date coverage would otherwise terminate due to a qualifying event; or
2. beginning on the date the participant receives notice of his/her continuation rights.
Based on the clear language of this provision, Beebe had to elect continuation coverage either within sixty days of his termination or within sixty days of his notice of his continuation rights. Again, the facts in this case are undisputed: Beebe was not given notice of continuation rights such that he could have elected to participate in the COBRA health plan on his last day of work at Michels. In fact, he was not given notice of his continuation rights until ten months after the qualifying event (his termination). Thus, Beebe could not elect coverage under sub. 1. It is further undisputed that Beebe elected continuation coverage within sixty days of receiving notice. According, Beebe complied with sub. 2. above by electing coverage within sixty days of receiving notice.
¶22 WPS contends that Michels’ payment of health premiums for the ten months between termination and notice/election constituted an “extra-contractual” action by Michels to provide insurance coverage to Beebe, and any “extra-contractual” conduct does not obligate WPS’s Stop-Loss policy. WPS argues that Michels’ error in failing to give timely notice should not obligate WPS to provide coverage. We conclude based on the language of the policies and the interrelationship with COBRA principles, that WPS’s contention is incorrect.
¶23 Section 11.1 of Michels’ health Plan incorporates the COBRA legislation into its written terms, as required by federal law. See 29 U.S.C. § 1161. Based on the incorporation, the employer’s health plan is obligated to cover the employees’ expenses even when the notice of COBRA is deficient or tardy. See Middleton v. Russell Group, Ltd., 483 S.E.2d 727, 732 (N.C. Ct. App. 1997) (concluding that right to elect coverage is tolled until notice is received).[4] In response, WPS cites Kidder v. H&B Marine, Inc., 932 F.2d 347 (5th Cir. 1991) and the unpublished case of Uthell v. Mid-Illinois Concrete, Inc., No. 05-4034-JLF, 2006 WL 3590288 (S.D. Ill. Dec. 11, 2006). In these cases, the issue involved which party was responsible to provide the COBRA notice and the courts ruled it was the employer, not the insurer, who was responsible. These cases are not applicable to the particular facts in the instant case.
¶24 Further, as noted by the trial court, there is nothing in the language of the WPS policy that excludes, limits, or conditions its coverage based on Michels providing timely election notice to a plan participant: “There is no ‘or else’ language attached to the statement of the insured’s duty to notify plan participants of their right to elect COPRA continuation.” If WPS wanted to limit or exclude stop-loss coverage on the basis of untimely election notice, it could have and should have written that exclusion into its policy. See Mikula v. Miller Brewing Co., 2005 WI App 92, ¶27, 281 Wis. 2d 712, 701 N.W.2d 613 (“If the Acuity policy intended to exclude coverage for liability arising from the additional insured’s own negligence, it should and could have spelled out as much.”).
¶25 The key issue in this case is whether Beebe’s election relates back to the date of termination or whether continuation coverage starts on the date of election. WPS argues that COBRA coverage does not relate back and therefore it is not responsible for any health care costs between Beebe’s termination date and the date he elected continuation coverage. Michels argues that because Beebe elected coverage in a timely manner in accord with Section 11.1 sub. 2., the continuation coverage relates back to the qualifying event.
¶26 The plain language of the Plan answers this question. Within Section 11.1, the Plan states: “If the participant elects to continue
coverage within the 60 day period, the continuation coverage must be effective as of the date of the qualifying event.” Thus, based on this language, once Beebe
elected continuation coverage, it was retroactive back to the qualifying
event—his termination. This language is
mandated by COBRA, which requires the employer’s plan to provide continuation
coverage “for at least the period beginning on the date of the qualifying
event.” See 29
¶27 Applying the foregoing to the instant case, because Beebe timely elected to receive continuation coverage, it related back to his date of termination. Thus, Beebe was covered under Michels’ health plan as a continuation participant from November 21, 2000 through December 1, 2001. Likewise, because he was covered under Michels’ health plan, he was also covered by WPS’s Stop-Loss Policy.
¶28 We are also not persuaded by WPS’s argument that the letter sent to Beebe notifying him that Michels had continued paying health insurance premiums for him after termination and advising him of his COBRA rights constitutes a definitive statement that between December 1, 2000 and October 1, 2001, Beebe was not a COBRA participant, but was the beneficial recipient of gratuitous health care coverage by a former employer. We are not convinced that such a conclusion is required based on the letter. The policy language applied to the pertinent case law is determinative of how to characterize the time period, not the Michels letter. Moreover, at the time the letter was drafted, Beebe had not yet elected continuation coverage. Until he did, coverage could not revert back to the qualifying event.
¶29 Based on the foregoing, we conclude that the untimely notice
did not eliminate WPS’s obligations under the plain language of its policy,
and, once Beebe received notice and timely elected continuation coverage, his
coverage was retroactive to the date of the qualifying event. Under these circumstances, Michels’ group
health Plan provided coverage for all the medical expenses incurred at
B. Subrogation Issue.
¶30 WPS also argues that principles of subrogation prohibit
recovery by
¶31
¶32 Generally speaking, a person seeking subrogation must have
“superior equity” over the other party. See id.
at 163. This principle does not apply to
cases involving two insurance companies if both insurance companies have
fulfilled their contractual obligations to the insured. Employers Health Ins. v. General Cas. Co. of
Wis., 161
¶33 Here, as decided above, WPS was obligated to pay Beebe’s health
insurance costs according to the language of its policy. It failed to do so. As a result, its insured, Michels, was sued
by
¶34 We conclude that
CROSS-APPEAL
¶35
A. Prejudgment Interest.
¶36
¶37 This issue involves interpretation of Wis. Stat. § 628.46(1).[6] As such, the issue presents a question of
law, which we review independently. Racine
Harley-Davidson, Inc. v. State of
¶38
¶39 Subrogation, based on the facts and circumstances here, does
not permit recovery of 12% interest.
Legal subrogation gives indemnity only, and an insurer who possesses a
cause of action for subrogation cannot recover beyond the amount actually
dispersed by it. D’Angelo v. Cornell Paperboard
Prods. Co., 19
¶40 Under the undisputed facts in this case,
B. Imaging Costs.
¶41
¶42 Again, our standard of review is de novo as this involves the interpretation of the costs statute, Wis. Stat. § 814.04(2), which
permits reimbursement for “photocopying.”
This is clearly a circumstance where the law has not kept pace with technology. By use of the term “photocopying,” the Legislature seems to have intended that prevailing parties recover the costs of reproducing documents. However, the term of art chosen by the Legislature, “photocopying,” is not really up to the task. … [N]ot all “copies” get reproduced on paper. Indeed, in the current era both bench and bar are striving to be “paperless.” Some law firms and court systems are ahead of others, and the elite tend to reproduce documents in electronic form rather than on paper.
So, the question becomes, can the word “photocopy” be stretched enough to cover “copies” of documents reproduced in electronic media rather than on paper? I do not think so, for two interrelated reasons.
The trial court then went on to
set forth its two reasons, the first of which is that case law requires that
the costs statute be narrowly construed.
See Kleinke v. Farmers Co-op. Supply & Shipping, 202
¶43 We agree with and adopt as our own the trial court’s analysis
on this issue. As the statute currently
reads, “photocopying” must be narrowly construed to include only hard copy
photocopies, rather than electronic imaging.
Although both serve essentially the same ultimate purpose, they are not
physically the same. Thus, unless the
legislature revises the statute to add electronic reproduction/imaging to the
statute as an item of cost, imaging costs do not fall within the costs statutes
and the trial court properly excluding this item of costs from what
CONCLUSION
¶44 In sum, we affirm on both the appeal and the cross-appeal. We conclude that the trial court correctly
ruled that WPS must reimburse
By the Court.—Order affirmed.
No. |
2006AP2320(CD) |
¶45 FiNE, J. (concurring in part; dissenting in part). I join in the Majority opinion except for its resolution of the PDF-costs issue. It is paradigm we apply statutes as they are written. State ex rel. Kalal v. Circuit Court, 2004 WI 58, ¶44, 271 Wis. 2d 633, 662, 681 N.W.2d 110, 123–124. The word “photocopying” has two discrete parts: (1) photo, and (2) copying; that is, making a copy using light.[8] There is no dispute that a method of making PDF files is by using a photocopy machine—a scanner, much like a xerographic scanning bed.
¶46 There is also no dispute that Zurich American made the PDF copies for which it seeks costs by scanning paper documents. Rather than transmitting the resulting light-generated electronic impulses into a print head, Zurich American’s device transmitted the impulses to a CD. In short, Zurich American took a “photo” of the documents (using its scanner) and then copied them to a CD; that is a “photocopy” no matter how “narrow” the word is read. I would grant Zurich American its request for $460.18 for “photocopies” as an item of costs under Wis. Stat. § 814.04(2). Accordingly, I respectfully concur in part and dissent in part.
[1] All references to the Wisconsin Statutes are to the 2005-06 version unless otherwise noted.
[2]
[3] Although this section required payment “within six months” this term was never enforced and WPS acknowledged that it paid claims under the Stop-Loss Policy regardless of whether Michels fronted the payment to the health care provided. WPS does not rely on the timing of the payments to dispute coverage under its policy, and thus, we need not address this portion of the policy in our opinion.
[4] Michels cites several unpublished foreign cases for the same proposition: Collins v. Strategic Health Care Mgmt. Servs., Inc., 1992 WL 92099, at *5 (N.D. Ill. Apr. 28, 1992); Emilien v. Stull Technologies Corp., 70 Fed. Appx. 635, 641 (3d Cir. 2003); and L.A. Gear California, Inc. v. General Am. Life Ins. Co., 1997 WL 702247, at *1 (9th Cir. Nov. 10, 1997). We acknowledge, but do not rely on these decisions.
[5] There is no claim or argument that awarding the 5% prejudgment interest was erroneous. Accordingly, our opinion addresses only the contested issue of whether the 12% prejudgment interest was appropriate.
[6]
Timely payment of claims. (1) Unless otherwise provided by law, an insurer
shall promptly pay every insurance claim.
A claim shall be overdue if not paid within 30 days after the insurer is
furnished written notice of the fact of a covered loss and of the amount of the
loss. If such written notice is not
furnished to the insurer as to the entire claim, any partial amount supported
by written notice is overdue if not paid within 30 days after such written
notice is furnished to the insurer. Any part
or all of the remainder of the claim that is subsequently supported by written
notice is overdue if not paid within 30 days after written notice is furnished
to the insurer. Any payment shall not be
deemed overdue when the insurer has reasonable proof to establish that the
insurer is not responsible for the payment, notwithstanding that written notice
has been furnished to the insurer. For
the purpose of calculating the extent to which any claim is overdue, payment
shall be treated as being made on the date a draft or other valid instrument
which is equivalent to payment was placed in the
[7] We also note that this case is dissimilar from Kontowicz v. American Standard Insurance Co. of Wisconsin, 2006 WI 48, 290 Wis. 2d 302, 714 N.W.2d 105 as Kontowicz involved a third party claim, which is specifically referred to within Wis. Stat. § 628.46. The instant case is a subrogation case, which is not referred to within the statute.
[8] The Online Etymology Dictionary gives the origin of the word “photocopy”:
photocopy (v.): 1924 in the sense of “make a photographic
reproduction,” from photo- “light” + copy (q.v.). The usual modern meaning arose 1942 with the
advent of xerography. The noun is
recorded from 1934. Photostat (1911) was a type of copying machine (trademark
Commercial Camera Company,
http://www.etymonline.com/index.php?term=photocopy.