Zevin v Aetna U.S. Healthcare

[*1] Zevin v Aetna U.S. Healthcare 2005 NYSlipOp 50749(U) Decided on May 19, 2005 Appellate Term, Second Department Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on May 19, 2005
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS
PRESENT: May 19, 2005 SUPREME COURT OF THE STATE OF NEW YORK APPELLATE TERM : 9th and 10th JUDICIAL DISTRICTS PRESENT : RUDOLPH, P.J., McCABE and TANENBAUM, JJ.
2004-1013 N C

DAVID ZEVIN, Appellant,

against

AETNA U.S. HEALTHCARE and JOHN W. ROWE, M.D., Respondents.

Appeal by plaintiff from a small claims judgment of the District Court, Nassau County (N. Janowitz, J.), entered on November 12, 2003, in favor of defendants dismissing the action.

Judgment unanimously affirmed without costs.

In this small claims action seeking reimbursement for certain benefits pursuant to an individual medical insurance policy, substantial justice was done between the parties in accordance with the rules and principles of substantive law (UDCA 1804, 1807).

Contrary to plaintiff's contention, the clauses of the insurance contract at issue are unambiguous and subject to only one reasonable interpretation (see Chimart Assoc. v Paul, 66 NY2d 570 [1986]), i.e., that 30 non-emergency mental health visits are within the scope of coverage, will be reimbursed subject to the applicable deductible, coinsurance and copayment terms, and, explicitly, that visits for which the reimbursement is applied to the $1,000 deductible will still count toward the total number of visits for which reimbursement may be sought. Plaintiff's extrinsic evidence consisting of a brochure (which specifically states that it is for informational purposes only and that it is not a contract) and proffered testimony that defendants' counsel allegedly found the policy difficult to understand, may not be used to create an ambiguity where none exists (see Intercontinental Planning v Daystrom Inc., 24 NY2d 372, 379 [1969]). Contracts are to be read as a whole to determine their purpose and intent (see e.g. W.W.W. Assocs. v Giaconteri, 77 NY2d 157, 162 [1990]). [*2]

We have reviewed plaintiff's remaining contentions and find them to be without merit.
Decision Date: May 19, 2005