TERENCE C. KERN, District Judge.
Now before the Court is the Motion for Summary Judgment (Doc. 79) filed by Defendants Combined Underwriters Life Insurance Company ("Combined Underwriters"), Citizens, Inc., Citizens Insurance Company of America ("CICA"), Citizens National Life Insurance Company ("Citizens National"), Texas International Life Insurance Company ("TILIC"), and Actuarial Management Resources, Inc. ("AMR"). As set forth in prior orders, this case arises out of a dispute concerning claims submitted and benefits payable under a Cancer and Dread Disease Insurance Policy ("the Policy") issued to Plaintiff
Although the relationship among the Defendants is more relevant to Plaintiff's veil-piercing claims, the following details may be helpful to an understanding of the issues in this case. Combined Underwriters issued the Policy in 1991 to Plaintiff's former husband, under which Plaintiff was also an insured. Citizens, Inc. purchased Combined Underwriters in 2002, and gave the stock of Combined Underwriters to CICA, a subsidiary of Citizens, Inc. CICA designated Combined Underwriters to be its subsidiary and changed Combined Underwriters' name to Citizens National in 2004. Citizens National and TILIC entered into a "Coinsurance Reinsurance Agreement" in December of 2004 whereby TILIC assumed the role of a co-insurer and reinsurer for a group of insurance policies that included the Policy at issue here. Austin Insurance is the parent corporation of TILIC. TILIC hired (the now-dismissed) AMG to administer Plaintiff's claims.
Plaintiff has a family history of cancer and was first diagnosed herself with breast cancer in 1997. She submitted expenses to Combined Underwriters and received policy benefits. Plaintiff was again diagnosed with breast cancer in June of 2004.
From December 2004 to March 2005, Plaintiff had chemotherapy treatments. Plaintiff telephoned Citizens National to inquire about whether the drugs Neupogen or Neulasta would be covered under the Policy. A memorandum by the employee taking the call indicated that these drugs would be covered if used for definitive cancer treatment. The employee also requested that Plaintiff's doctor send a statement to the insurer. Plaintiff's doctor, Allen M. Keller, explained in a letter dated January 14, 2005, that he administered the Neupogen and Neulasta to her "to support bone marrow recovery so that chemotherapy can be given on the denser schedule." (Id., Ex. 8.)
Plaintiff submitted a claim in February 22, 2005. The bill for chemotherapy lists codes for chemotherapy treatments which differ from codes for Neupogen and Neulasta treatments, and the differing treatments were never given on the same day. After Plaintiff called the insurer to inquire as to whether the Neupogen would be
On March, 2, 2005, TILIC requested a medical review of the Neupogen/Neulasta issue by Medical Review Institute of America ("MRIA"). (Resp.Br., Doc. 111, Ex. 36.) On March 3, 2005, an internal medicine physician concluded that Neupogen/Neulasta would not be covered by the Policy. (Id., Ex. 37.) TILIC relied upon the MRIA physician review to support its denial of benefits for Neupogen and Neulasta. The insurer tendered a check to Plaintiff for $25,179.00 of the $82,811.36 in submitted expenses on March 2, 2005 and explained its decision in a letter to Plaintiff dated March 4, 2005.
On March 8, 2005, Plaintiff complained to the Oklahoma Department of Insurance ("DOI") about the denial of her claim for Neupogen and Neulasta and submitted a letter from her treating oncologist regarding the use of these drugs. The letter indicates that Plaintiff's chemotherapy program "is now considered standard therapy for women with her stage of breast cancer. . . . and cannot be administered in this fashion without all components of the program including the Neulasta." (Mot. Summ. J., Doc. 79, Ex. 15.) Nonetheless, the DOI responded again with a determination that "[b]ased upon the information contained in [TILIC's] letter, the claim would appear to have been processed in accordance with the terms of your policy." (Id., Ex. 16.)
On March 30, 2005, TILIC requested that MRIA provide an oncologist review of the Neupogen/Neulasta issue. On March 31, 2005, the reviewing oncologist authored a report in which the oncologist states that Neupogen and Neulasta, "are an integral part of the chemotherapy treatment program. Without either Neupogen or Neulasta chemotherapy doses often have to be reduced, cycles delayed, or both. These agents allow the use of full dose chemotherapy on schedule." (Resp.Br., Doc. 111, Ex. 43.) The physician also noted that supportive care medications are not excluded in the applicable policy provisions. The reviewer also disagreed with the previous review and stated: "This should be considered part of the chemotherapy regimen. It should be certified." (Id. at 2-3.)
TILIC did not disclose the report to Plaintiff or the DOI in the pending complaint process. Instead, TILIC faxed two questions challenging the findings of the MRIA physician and conducted a subsequent teleconference. There is some handwritten notation in the record indicating that someone did not want the conversation recorded. On April 4, 2005, the reviewing physician changed his opinion and concluded that, given "additional information from the carrier regarding the plan's coverage, Neupogen or Neulasta would not be a covered benefit as it does not directly destroy or modify cancerous tissue." (Id., Ex. 44 (emphasis added).) TILIC notified Plaintiff of the decision on April 16, 2005.
In May 2005, Plaintiff also submitted claims under the Policy for the drug Arimidex, which is a hormone therapy drug. Plaintiff's doctor prescribed the drug for her and she had the prescription filled at a pharmacy. TILIC denied the claim based on its determination that the drug was not
In 2000, 2001, and 2002, Combined Underwriters forwarded notices of certain insurance benefits made mandatory by the State of Oklahoma which were applicable to the Policy. The notices provided the following with respect to reconstructive breast surgery:
(Id., Ex. 7.)
On August 4, 2004, she underwent bilateral mastectomies. Plaintiff made an insurance claim for $25,338.55 on the Policy, but Citizens National tendered a check to her for only $4,203.75. Plaintiff called Citizens National in October 2005 to inquire as to the insurance coverage for her breast prosthesis and was told that the Policy covers "only the prosthesis" and "nothing else." (Id., Ex. 28.) Plaintiff filed a complaint with the DOI on November 3, 2004. Citizens National responded to the DOI's inquiry, and DOI responded with a letter to Plaintiff stating that, "[b]ased upon the information contained in [TILIC's] letter, the claim would appear to have been processed in accordance with the terms of your policy." (Mot.Sum. J. Doc. 79, Ex. 7.)
On June 12, 2005, Plaintiff submitted a claim under the Policy's breast prosthesis benefit for the second stage of her breast reconstruction performed on May 26, 2005. TILIC initially tendered a check for $3,007.64, which included payment only for the prostheses and their implantation. The payment represents a denial of $13,184.35 of the $16,191.99 submitted as expenses. Plaintiff points out that Ortiz initially erred in responding to an email by another TILIC employee as to whether surgery to both breasts would be covered, but the next day Ortiz sent an email acknowledging the Oklahoma law mandating insurance coverage for surgery to both breasts. (See Resp. Br., Doc. 111, Ex. 50.) TILIC made a supplemental payment on August 7, 2005, in the amount of $3,750.00 for the second stage reconstruction surgery of May 26, 2005.
Plaintiff again turned to the DOI, claiming that her breast prosthesis benefit covered all charges, including hospital confinement and anesthesia services, not just the actual cost of the breast prostheses and their implantation. TILIC responded to the DOI's investigation, explaining its view that the Policy covers in full only the actual charge for the prosthesis and the fee charged by the surgeon for implanting the prosthesis. However, the benefits payable under the Policy also included one day of hospital room benefit, an additional 15% for drugs and medicines billed by the hospital, and a miscellaneous hospital benefit of 10% of the room benefit for other hospital expenses. TILIC admitted that it had miscalculated her benefits based upon an inapplicable Policy limitation and she was due an additional payment for $2,131.85. The DOI responded to Plaintiff's inquiry by stating that it was in receipt of correspondence from TILIC and
On December 29, 2005, Plaintiff had a revision of the left breast reconstruction performed. Plaintiff submitted a claim on January 18, 2006 for those services, and TILIC tendered a check for $1,875.00 of the $5,259.13 in submitted charges.
The Policy was marketed as providing "benefits paid directly to [policyholder]," and "benefits paid in addition to all other coverage." (Resp.Br., Doc. 111, Ex. 3.) Plaintiff had a second supplemental cancer policy issued by American Fidelity Assurance Company ("American Fidelity"), and she had a primary health insurance policy through Blue Cross and Blue Shield of Oklahoma ("Blue Cross"). Blue Cross covered nearly all of her expenses except for approximately $1,750 per year for the same period. American Fidelity paid Plaintiff $126,831.61 in benefits under its policy from June 24, 2006 to May 8, 2006. Combined Underwriters and TILIC paid her $40,147.24 for the same period. Further, TILIC paid Plaintiff for her Neupogen, Neulasta, and Arimidex treatments after she filed her lawsuit. Plaintiff testified that she has suffered no economic loss from the denial of benefits by Combined Underwriters and TILIC, but TILIC representatives have testified that they would continue to deny similar future claims for Neupogen and Neulasta, and they have denied such claims to other Oklahoma policy holders. The parties dispute the relevancy and admissibility of the evidence relating to damages.
With regard to her bad faith claims, Plaintiff submits the deposition testimony of Citizens, Inc.'s Vice-President of Claims and Rule 30(b)(6) witness, Sarah Morris, TILIC claims underwriter Heike Cartwright, and TILIC auditor Susi Ortiz, who testified to various claim practices. Among other things, these individuals testified to the lack of formal training provided by Citizens, Inc. and TILIC to claims staff. She also submits the report of her expert witness, Jeffrey Gelona, to support her claim that Defendants breached their duty of good faith and fair dealing.
The "Schedule of Benefits" section of the Policy provides, in relevant part:
(Mot. Summ. J., Ex. 1, 4-6.) The Policy also provides, in its section on "Exceptions and Other Limitations": "C. We will not pay for any disease or incapacity that has been: caused; complicated; worsened; or, affected by cancer or a dread disease or as a result of cancer or dread disease treatment." (Id. at 7.)
Summary judgment is proper only if "the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c)(2). The party seeking to overcome a motion for summary judgment must make a showing sufficient to establish the existence of those elements essential to that party's case. See Celotex Corp. v. Catrett, 477 U.S. 317, 323-33, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986). The Court resolves all factual disputes and draws all reasonable inferences in favor of the non-moving party. See, e.g., Beard v. Banks, 548 U.S. 521, 529-30, 126 S.Ct. 2572, 2578, 165 L.Ed.2d 697 (2006); Turner v. Public Serv. Co. of Colorado, 563 F.3d 1136, 1142 (10th Cir.2009) (citation omitted). However, the party seeking to overcome a motion for summary judgment "must still identify sufficient evidence requiring submission to the jury. . . . She cannot avoid summary judgment merely by presenting scintilla of evidence to support her claim; she must proffer facts such that a reasonable jury could find in her favor." Turner, 563 F.3d at 1142 (citations omitted).
Under Oklahoma law, the interpretation and construction of insurance contracts constitutes an issue of law for the court to determine and resolve. E.g., Dodson v. St. Paul Ins. Co., 812 P.2d 372, 376 (Okla.1991); Torres v. Sentry Ins., 558 P.2d 400, 401 (Okla.1976) (citation omitted). Parties may contract for risk coverage at will and are bound by the policy terms to which they agree. Dodson, 812 P.2d at 376 (citing Wiley v. Travelers Ins. Co., 534 P.2d 1293, 1295 (Okla.1974)). The terms of the policy, "if unambiguous, clear, and consistent," are construed so as to give reasonable effect to all of its provisions, and these provisions are given their plain and ordinary meaning and import. Id. However, no "strained construction" or narrow focus upon any particular provision or term "will be indulged" so as to import a more favorable consideration to an insured. Id. To that end, courts do not rewrite policy language to extend coverage for a particular risk which is not intended to be covered. See BP Am., Inc. v. State Auto Property & Cas. Ins. Co., 148 P.3d 832, 835-36 (Okla.2005).
Defendants argue that Neupogen and Neulasta fall within the Policy's schedule of benefits because neither were administered to Plaintiff "for the purpose of modification or destruction of cancerous tissue. . . ." (Mot. Summ. J., Doc. 79, Ex. 1 at 4, § V, ¶ G.) Instead, they argue, Dr. Keller administered them to treat the side effects of chemotherapy which caused damage to her bone marrow and to increase her blood count. The coding for the treatment describes an injection for the long-term use of "other" high risk medications and not as the administration of a cytotoxic drug. Further, Defendants claim, coverage for the drugs must be denied because the Policy expressly states that no coverage is afforded for "any disease or incapacity that has been: . . . caused . . . by cancer or dread disease or as a result of cancer or dread disease treatment." (Id., Ex. 1, at 7, §§ VII, ¶ C.) Since the decrease in blood count was caused by chemotherapy, Defendants assert, the Policy excludes coverage for the Neupogen and Neulasta used to increase Plaintiff's blood count.
The Court finds the relevant language of the Policy ambiguous. Accordingly, it must be interpreted most favorably to the insured and construed strictly against the insurer. Defendants themselves describe the decrease in blood count as a "condition," not a "disease or incapacity" caused by chemotherapy. Further, Plaintiff's treating oncologist and the MRIA reviewing oncologist both reported that the Neupogen and Neulasta are part of a chemotherapy treatment regimen which permits the physician to give Plaintiff a full dose of chemotherapy on schedule. While administration of these drugs is considered supportive therapy, a reasonable person in the position of the insured would have understood that Neupogen and Neulasta were a necessary component to a technique "used for the purpose of modification or destruction of cancerous tissue." (Id., Ex. 1 at 4, § V, ¶ G.)
As Plaintiff indicates, similar language in other cases has been construed in favor of the insured. In du Mortier v. Massachusetts
Similarly, the Policy creates a reasonable expectation in the insured that coverage exists for Arimidex. Arimidex is a brand name for anastrozole, an oral antiestrogen. It interferes with the production of estrogen which causes many breast cancer tumors to grow. See, e.g., http://www.drugs.com/cons/arimidex.html. Plaintiff's treating oncologist prescribed the drug for her, and she had the prescription filled at a pharmacy. She testified that she "self-administered" it daily at home. (Mot.Summ. J., Ex. 2, Pl.Dep.216:2-217:12.)
Defendants argue the Arimidex is not covered because Plaintiff self-administered it. Defendants rely on the language in the Policy's Schedule of Benefits which states that the insurer will pay for "[c]hemical substances and their administration including hormonal therapy;" but "[t]reatment must be administered by a Radiologist or a Chemotherapist." (Mot. Summ. J., Ex. 1, p. 4, ¶ G.) They cite to a medical dictionary for the definition of "administration" which indicates that it means "the giving of a therapeutic agent." Taber's Cyclopedic Medical Dictionary, 46 (Venes ed., 19th ed. 1997). They also point to the use of the word "administer" in reference to an injection of insulin to a diabetic patient, Application of Severns, 335 P.2d 94, 95 (Okla.Crim.App.1959), or to the giving or receiving of the drug Rho-GAM to a woman with Rh-negative blood. Graham v. Keuchel, 847 P.2d 342, 351 (Okla.1993). These cases are inapposite if a reasonable person would expect the giving of medical treatment to include prescriptions for medication.
In further support of their arguments, Defendants cite to a Supreme Court case addressing the constitutionality of a Massachusetts law restricting access to contraceptives. Eisenstadt v. Baird, 405 U.S. 438, 461, 92 S.Ct. 1029, 1042, 31 L.Ed.2d 349 (1972). Defendants contend that the Court recognized "the distinction between contraceptives that are `administered' by a physician versus contraceptives that are `prescribed' by a physician and bought from a pharmacist." (Mot. Summ. J. Doc. 79, at 10.) A closer look at the case indicates, however, that the Court merely recited the Massachusetts law, which made it a criminal offense to distribute, sell, or give away contraceptive drugs but excepted "registered physicians who prescribe for and administer such articles. . . ." Eisenstadt, 405 U.S. at 461, 92 S.Ct. 1029.
Finally, Defendants cite to an article in the Tulsa World where the term "administer" is used in the context of medical treatment. Yet, the only sentence where the term is used merely states "Psychiatric services for children require highly specialized doctors to administer complicated programs and medicine, . . ." (Mot. Summ. J., Doc. 79, App. II., at 3, Joe Robertson, Is a Doctor in the House?, TULSA WORLD, Aug. 15, 1999.)
The Court is not persuaded by Defendants' narrow interpretation of the term "administer", nor by Defendants' argument that the Policy does not cover any hormonal therapy drug which can be "self-administered." Defendants' own claims personnel testified that the drug would have been covered if Plaintiffs' treating physician had placed it on her tongue, rubbed it on her, put it in her eye with an eye drop or sprayed it into her nose with a nasal spray. (Mot. Summ. J., Doc. 79, Ex. 5, Ortiz Dep., 116:1-120:2.) Defense counsel's questioning of Plaintiff at deposition indicates that they might have paid for the Arimidex if the physician had handed her the Arimidex pill instead of prescribing it for her, and that the cost would be less if it were prescribed instead of being "administered in the office." (Id., Ex. 2, Tomlinson Dep. 220:2-19.) The Court will not construe the Policy so narrowly as to prohibit coverage when a pill is prescribed for— and not handed to—a patient. In this instance, the insurer has created a reasonable expectation in the insured that coverage exists.
A reasonable person in the position of the Plaintiff would have understood the Policy to provide coverage for submitted charges related to her breast reconstruction. Defendants claim that the Policy covers only the actual charge or a prosthesis and the implantation of the prosthesis under paragraph N of the Schedule of Benefits section. (See Mot. Summ. J., Doc. 79, Ex. 1.) Accordingly, they paid only for the prosthesis and the surgeon's fee to implant it.
Defendants' rationale for denying the claim overlooks the Oklahoma Breast Cancer Patient Protection Act, which provides, in relevant part:
36 Okla. Stat. Ann. § 6060.5 (emphasis added). Section X of the Policy indicates that "Any provision of the policy which, on its effective date, is in conflict with the statutes of the state in which you reside on such date is hereby amended to conform to the minimum requirements of such statutes." (Mot. Summ. J., Doc. 79, Ex. 1, at 9.) It appears that the notices issued by Defendants in 2000, 2001, and 2002 were an effort to comply with paragraph F of the statute even though the statute is not specifically referenced in the notices. (See Resp. Br., Doc. 111, Ex. 7.)
Defendants contend that the Act merely requires the same coverage provided by the Policy for reconstruction of a cancerous breast be likewise afforded to the non-cancerous breast in order to create symmetry. This contention misconstrues the language of the statute, which requires coverage for inpatient care following a mastectomy and indicates that "any such reconstructive breast surgery (referring to reconstructive breast surgery performed as a result of a partial or total mastectomy) include coverage for all stages of reconstructive breast surgery performed on a non-diseased breast. . . ." 36 Okla. Stat. Ann. § 6060.5(D) (emphasis added). This implies that coverage for all stages of reconstructive surgery of the diseased breast must be provided as well.
Further, the Schedule of Benefits in the Policy provides that the insurer will pay for hospital confinement (¶ A), anesthesia up to 25% of the surgical benefit (¶ K), and miscellaneous hospital expenses up to 10% of the total benefit paid under the hospital confinement paragraph (¶ W). Defendants suggest in a footnote to their reply brief that Plaintiff received benefits for her breast reconstruction surgeries under other provisions of her policy, but they do not state which provisions. They also assert that Plaintiff has admitted receiving such benefits and they characterize her claim as a claim that the "other" charges should not have been subject to policy limitations. The Court does not find such admission or claim in her response brief. In any event, the statute controls, and Defendants obligated themselves to pay for all stages of reconstructive breast surgery performed on Plaintiff. Defendants' motion for summary judgment is denied as to Plaintiff's breach of contract claim.
"Every insurance contract carries with it the duty to act fairly and in good faith in discharging its contractual responsibilities." Garnett v. Gov't Employees Ins. Co., 186 P.3d 935, 944 (Okla. 2008). "A party prosecuting a claim of bad faith carries the burden of proof and must plead all the elements of the intentional tort." Id. The essence of the tort is the unreasonable, bad-faith conduct of the
"Before the issue of an insurer's alleged bad faith may be submitted to the jury, the trial court must first determine as a matter of law, under the facts most favorably construed against the insurer, whether the insurer's conduct may be reasonably perceived as tortious." See Garnett, 2008 OK 43, ¶ 22, 186 P.3d at 944. "If there is conflicting evidence from which different inferences may be drawn regarding the reasonableness of the insurer's conduct, what is reasonable is always a question to be determined by the trier of fact by a consideration of the circumstances in each case." Newport v. USAA, 11 P.3d 190, 195 (Okla.2000) (quoting McCorkle, 637 P.2d at 586-87); see Badillo v. Mid Century Ins. Co., 121 P.3d 1080, 1093 (Okla.2005).
Defendants argue that their denial of coverage for Neupogen and Neulasta was reasonable as they relied on the "plain language" of the Policy and the denial was based upon the evidence Plaintiff submitted with her claim. In particular, they point to (a) the letter from Plaintiff's treating physician which indicates that Neupogen and Neulasta were supportive care to support bone marrow recovery; (b) the phone conversation in which the physician's nurse indicated that Neupogen and Neulasta were used to increase blood count, (c) the coding for the treatment on the physician's bill which described the drugs as injections for long-term, high risk medication, and not for chemotherapy; and (d) the DOI's determination that Plaintiff's claim was "processed in accordance with the terms of [her] policy." (Mot.Summ. J., Doc. 79, Ex. 16.) Defendants do not rely on the fact that they sought a medical review from a MRIA physician regarding coverage for these drugs and eventually received one indicating that the Policy did not provide coverage.
Plaintiff argues that her physician's letters should have put Defendants on notice that the drugs were a necessary part of her chemotherapy regimen which resulted in increased destruction or modification of her cancerous tissue and, thus, should have been covered under the Policy.
Under the facts most favorably construed against the insurer, the insurer's conduct in denying coverage could reasonably perceived as tortious as there is some conflicting evidence from which different inferences may be drawn regarding the reasonableness of the insurer's conduct. Specifically, Defendants' disregard for the opinion of Plaintiff's treating oncologist, Defendants' interaction with the MRIA to obtain a medical review of the issue, together with statements by Defendant employees handling Plaintiff's claim as to their knowledge, or lack thereof, regarding the terms of the Policy are issues for the trier of fact to consider. The reasonableness of Defendants' actions presents a genuine issue of material fact. Defendants' motion for summary judgment in this regard is denied.
Similarly, Defendants argue that they relied on the language of the Policy which required Arimidex to be administered by a radiologist or chemotherapist and the fact that Plaintiff admitted that she self-administered the drug. Plaintiff's physician prescribed it for her and she had the prescription filled at a pharmacy. The Court has found that the Defendants' interpretation of the Policy with regard to the Arimidex was too narrow; the trier of fact could find that it was unreasonably so. Under the facts most favorably construed against the insurer, the insurer's conduct may be reasonably perceived as tortious. Accordingly, summary judgment on this issue is denied.
Defendants claim that Plaintiff breast reconstruction claim was not handled in bad faith because the applicable paragraph of the Policy, paragraph N, covers actual charges only for the prosthesis itself and the fee charged by the surgeon for implanting prosthesis. As discussed above, they contend that the paragraph does not afford benefits for additional charges for the hospital, anesthesiologist, or anything else associated with the breast reconstruction surgery. Defendants suggest elsewhere in their briefing that they may have relied on other paragraphs in the Policy to provide coverage, within certain limitations, for these additional charges. They also argue that the DOI agreed with them on this issue twice.
The Court does not rely on the DOI's responses to Plaintiff's complaints as any determination that the Defendants' interpretation is correct or reasonable. The Court has found that Defendants' interpretation of the applicable Policy provision was too narrow and in conflict with statutory law in Oklahoma. Given the statute, other provisions of the Policy, and Defendants' representations to Plaintiff, a reasonable fact-finder could deem Defendants' denial of coverage as to this claim a violation of the duty of good faith and fair dealing. Summary judgment will be denied.
Defendants argue that public policy requires summary judgment against Plaintiff because she has suffered no economic loss from the denials of benefits or the alleged improper handling of her claims. Defendants point out that she had two supplemental cancer policies and a primary health insurance policy. Her primary
Specifically, Defendants argue that it is against public policy for Plaintiff to seek damages against both American Fidelity and Combined Underwriters for the alleged failure to pay identical benefits for a single illness, where the treatment was actually paid for by the Blue Cross. In support of this argument, Defendants cite to an Oklahoma statute indicating that insurance contracts are for indemnity only, 36 Okla. Stat. § 102 (2001), and not for compensation "above-and-beyond" the loss suffered. Defendants cite to an Indiana case holding that property cannot be doubly insured and, if it is, the supplemental policy "is in effect a gambling contract and is void as against public policy." Loving v. Ponderosa Systems, Inc., 479 N.E.2d 531, 536 n. 1 (Ind.1985) (citations omitted). The court reasoned that gambling contracts are void because they have the "tendency to create a desire for the event insured against and furnish strong temptation to bring it about." Id. (citation omitted). It cannot be argued that health insurance policies are similar in this respect to property insurance policies, as no reasonable person desires the illness or injury that health insurance policies are designed to cover.
Defendants also reference a Mississippi case described in Time Ins. v. Sams, 692 F.Supp. 663, 671 (N.D.Miss.1988), "where the plaintiff bought ten separate policies of health and accident insurance. The court referenced in Sams voided the policies and found the `shocking overinsurance . . . obviously contrary to the purpose of insurance and to the public policy of Mississippi.'" Id. at 671. Defendants fail to point out that the Sams court distinguished the case quoted therein based on the number of policies involved and the type of coverage provided. The Sams court actually held that "the Mississippi Supreme Court, if called upon to so hold, would not rule that multiple coverages for accident and health losses violates the public policy of Mississippi." Id. at 670. The court reasoned, in part, that insurance carriers can draft other insurance or "coordination of benefits" clauses into their policies to guard against situations where an insured can recover more than his or her expenses. The defendants in Sams attempted to draft such a clause into the policy at issue, but the court found that the coordination of benefits language in the insured's contact was not adequate to provide the result the defendant insurer desired. Id. at 667. The court also found that the insurer's attempt to limit its liability under such language conflicted with a regulation promulgated by the Mississippi Commissioner of Insurance. Id. at 667-68
Defendants' argument in this case conflicts with regulations in Oklahoma regarding the coordination of benefits, i.e., where an insurance company reduces benefits otherwise payable under a policy because of the availability of other insurance coverage.
Id., 365:10-11-1. Oklahoma forbids the coordination of benefits unless an insurer includes a written disclosure in the policy informing the policyholder that benefits may be reduced to the extent of other applicable coverage. Id. at 365:10-5-3(B). It is undisputed that the Policy contained no such disclosure. "W[]here two or more insurance policies cover the same hazard and do not provide for coordination of benefits, each policy is primary, and each insurer must pay `all medical expenses that qualify for payment under the policy or plan.'" Nahom v. Blue Cross and Blue Shield of Ariz., Inc., 180 Ariz. 548, 885 P.2d 1113, 1119 (Ariz.Ct.App.1994) (citation and internal quotation omitted). The Court can find no clear authority indicating that the public policy of Oklahoma prohibits the recovery sought by Plaintiff in this case.
For the reasons stated herein, the Motion for Summary Judgment (Doc. 79) filed by Defendants Combined Underwriters, Citizens, Inc., CICA, National, and TILIC, and AMR is hereby DENIED.