Atkinson, et al v. Gem Ins. Co., et al

Atkinson, et al  v. Gem Insurance Co., et al

IN THE UTAH COURT OF APPEALS

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Sharon Atkinson and Gene Atkinson,

Plaintiffs and Appellants,

v.

Gem Insurance Company; Premier

Medical Network; Sara Meadowcroft; and Does 1 to 20, inclusive,

Defendants and Appellees.

MEMORANDUM DECISION

(Not For Official Publication)

Case No. 971491-CA

F I L E D

(December 10, 1998)

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Third District, Salt Lake Department

The Honorable Homer F. Wilkinson

Attorneys: John Farrell Fay, Park City, for Appellants

Kevin Fife and Jeffrey R. Oritt, Salt Lake City, for Appellees

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Before Judges Greenwood, Jackson, and Orme.

GREENWOOD, Judge:

Appellants Sharon and Gene Atkinson challenge the trial court's conclusion that their insurance policy unambiguously excludes from coverage hospital charges incurred in connection with the removal of Mrs. Atkinson's abscessed teeth. We affirm.

"The determination of whether a contract is ambiguous is a

question of law." See Breuer-Harrison, Inc. v. Combe, 799 P.2d 716, 729 (Utah Ct. App. 1990) (citation omitted). Consequently, when a trial court grants summary judgment based upon a determination that an insurance contract is unambiguous, "we accord the trial court's interpretation no particular weight, reviewing its interpretation under a correction-of-error standard." Id.

Appellants argue that the dental portion of their insurance policy, which excludes "hospital charges incurred in conjunction with dentistry," is ambiguous and that the policy should therefore be construed in their favor. We disagree. An insurance contract may be ambiguous "(1) because of vague or ambiguous language in a particular provision or (2) because two or more contract provisions, when read together, give rise to different or inconsistent meanings, even though each provision is clear when read alone." U.S. Fidelity & Guar. Co. v. Sandt, 854 P.2d 519, 523 (Utah 1993). In this case, the exclusion challenged by appellants is clear, both internally and when read in connection with other portions of the dental policy.(1) When read alone, "a person of ordinary intelligence" would understand that hospital charges incurred in connection with a dental procedure, such as the one performed on Mrs. Atkinson, would be excluded from coverage because the exclusion includes any hospital charges which are in any way related to dentistry. See Nielsen v. O'Reilly, 848 P.2d 664, 666 (Utah 1992). Furthermore, although tooth extractions and oral surgery are included as "Covered Eligible Expenses," the "Limitations" section of the policy specifically excludes from coverage hospital charges incurred in conjunction with dentistry, notwithstanding the aforementioned list of covered expenses. Thus, the trial court did not err in holding, as a matter of law, that the insurance policy was unambiguous. Furthermore, because no ambiguity exists in the policy, we do not construe the policy in favor of the insured. See Alf v. State Farm Fire & Cas. Co., 850 P.2d 1272, 1274 (Utah 1993).

Appellants urge us to interpret their insurance policy using the doctrine of reasonable expectations. However, the Utah Supreme Court has unequivocally rejected that doctrine. See Sosa v. Paulos, 924 P.2d 357, 362 n.2 (Utah 1996). Instead, an unambiguous insurance policy is "'merely a contract between the insured and the insurer and is construed pursuant to the same rules applied to ordinary contracts.'" First American Title Co. v. J.B. Ranch, Inc., 343 Utah Adv. Rep. 6, 7 (Utah 1998) (citation omitted). In other words, an insurance policy is construed "'according to its usual and ordinary meaning.'" Id. (citation omitted). Here, the ordinary meaning of the exclusion in the insurance policy excludes any hospital charges incurred in connection with dentistry. Mrs. Atkinson's surgery was a dental procedure, even though her medical condition prompted her health care providers to perform the procedure in a hospital setting, and therefore, hospital charges were excluded from coverage under the policy.(2)

In sum, the trial court was correct in granting summary judgment based upon the finding that the insurance contract unambiguously excluded hospital charges for Mrs. Atkinson's surgery as a matter of law. Therefore, the denial of coverage and the grant of summary judgment are affirmed.

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Pamela T. Greenwood, Judge

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WE CONCUR:

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Norman H. Jackson, Judge

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Gregory K. Orme, Judge

1. Although there might be some way in which Mrs. Atkinson's abscessed teeth could have affected her heart condition, the surgery in this case was performed as a dental procedure and as such, only the dental portion of the policy is relevant to our analysis.

2. Because an interpretation of the ordinary meaning of the policy is dispositive, we do not address appellant's challenge to the grant of summary judgment on the grounds that it was premature or their argument that certain facts remained in dispute.