Dalpaos-Lawrence v. Guideone America

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES CO URT O F APPEALS
June 15, 2007
FO R TH E TENTH CIRCUIT Elisabeth A. Shumaker
Clerk of Court
PAM ELA D ALPAOS-LAW RENCE,
Plaintiff-Appellee,
v. No. 06-7073
(D.C. No. CIV-04-500-FHS)
GUIDEONE AM ERICA INSURANCE (E.D. Okla.)
COM PA NY, an Iowa corporation,
Defendant-Appellant.
OR D ER AND JUDGM ENT *
Before L UC ER O, Circuit Judge, BROR BY, Senior Circuit Judge, and
M cCO NNELL, Circuit Judge.
Defendant-appellant GuideOne America Insurance Co. (GuideOne), an
Iowa corporation, appeals from the district court’s grant of summary judgment to
plaintiff-appellee Pamela Dalpaos-Lawrence, a citizen of Oklahoma.
M s. Dalpaos-Lawrence claimed that GuideOne breached its insurance policy by
*
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument. This order and judgment is
not binding precedent, except under the doctrines of law of the case, res judicata,
and collateral estoppel. It may be cited, however, for its persuasive value
consistent w ith Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
refusing her coverage following a motorcycle accident. On appeal, GuideOne
argues that the district court erred in determining that M s. Dalpaos-Lawrence was
entitled to loss of income benefits under the policy and attorneys’ fees. W e
affirm.
I.
“W e review de novo the district court’s grant of summary judgment,
viewing the record in the light most favorable to the party opposing summary
judgment. Summary judgment is appropriate if there is no genuine issue of
material fact and the moving party is entitled to judgment as a matter of law.”
S. Hospitality, Inc. v. Zurich Am . Ins. Co., 393 F.3d 1137, 1139 (10th Cir. 2004).
(citation omitted); Fed. R . C iv. P. 56(c). “Because this is a diversity case, we
rely on the substantive law of Oklahoma and apply federal procedural law.”
Ahrens v. Ford M otor Co., 340 F.3d 1142, 1145 (10th Cir. 2003).
II.
The relevant facts are essentially uncontested. M s. Dalpaos-Lawrence
married Bobby Dalpaos on November 19, 1997. In 2000, an automobile insurance
policy that was issued to M r. Dalpaos by Progressive Specialty Insurance Co.
through its insurance agent was “rolled over” into a similar insurance policy
provided by GuideOne. Renewal policies were evidently then issued every six
months thereafter. M r. Dalpaos and M s. Dalpaos-Lawrence lived together at
216 Creek Avenue in Hartshorne, Oklahoma, from 1996 until December 2001
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when they briefly separated. They reconciled in January 2002 before permanently
separating in February 2002.
In June of 2002 a renewal automobile insurance policy with M r. Dalpaos as
the named insured was issued by GuideOne. The policy was effective from
June 17, 2002, until D ecember 17, 2002. Aplt. App., Vol. II at 428. On
November 10, 2002, M s. Dalpaos-Lawrence was involved in a motorcycle
accident in Oklahoma. She sustained numerous injuries including a broken leg,
was unable to work for approximately two years, and was unable to successfully
complete her job assignments when she returned to work in 2005. GuideOne
denied coverage under the policy and M s. Dalpaos sued.
The issue before the district court was whether M s. Dalpaos-Lawrence was
covered by the “loss of income benefits coverage” added to the policy by an
“additional benefits endorsement.” Id., Vol. I at 135. The additional benefits
endorsement not only added loss of income benefits coverage to Part B of the
policy, it also provided in pertinent part that:
“Insured” as used in this Part [B] means:
1. You or any “family member”;
a. W hile “occupying”; or
b. As a pedestrian when struck by:
a motor vehicle designed for use mainly on public roads . . . .
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Id., Vol. I at 135. The term “family member” is defined in the policy as, in
pertinent part: “a person related to you by blood, marriage or adoption who is a
resident of ‘your’ household.” Id., Vol. I at 117. As used in the policy, the terms
“you” and “your” refer to “[t]he ‘named insured’ shown in the Declarations” and
“[t]he spouse if a resident of the same household.” Id. Even if the spouse is not a
resident of the same household as the named insured, coverage may be provided.
The policy also states:
If the spouse ceases to be a resident of the same household during the
policy period or prior to the inception of this policy, the spouse will
be considered “you” and “your” under this policy but only until the
earlier of:
1. The end of 90 days following the spouse’s change of
residency;
2. The effective date of another policy listing the spouse as a
named insured; or
3. the end of the policy period.
Id. The district court held that M s. Dalpaos-Lawrence was an “insured” for the
purposes of loss of income benefits coverage. It held that although
M s. Dalpaos-Lawrence was not a “family member” because she was not a resident
of M r. Dalpaos’s household, she did qualify as a “you” or “your” under the policy
and was therefore covered.
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The district court also had to decide whether two exclusions in Part B of
the policy applied to the loss of income benefits coverage. Part B’s “exclusions”
section states, in pertinent part:
W e do not provide M edical Payments Coverage for any “insured” for
“bodily injury”:
1. Sustained while “occupying” any motorized
vehicle having few er than four wheels.
....
5. Sustained while “occupying,” or when struck by, any
vehicle (other than “your covered auto”) which is:
a. Owned by you; or
b. Furnished or available for your regular use. 1
Id., Vol. I at 121-22. The district court held that although the additional benefits
endorsement amended Part B of the policy, it made no change to the exclusions
section including the particular exclusions at issue. The exclusions, therefore,
continued to explicitly apply only to “M edical Payments Coverage.” The district
court awarded summary judgment and attorneys’ fees to M s. Dalpaos-Lawrence
and GuideOne filed its appeal. 2
1
The motorcycle on which M s. Dalpaos-Lawrence was riding at the time of
the accident was not owned by her but was available for her regular use so it was
clear that if either exclusion applied, coverage would be denied.
2
The parties stipulated to the dismissal of M s. Dalpaos-Lawrence’s bad faith
claim with prejudice.
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III.
GuideOne’s first argument is that the district court erred in determining
that M s. Dalpaos-Lawrence was a “you” under the policy and, therefore, was an
“insured” for purposes of loss of income benefits coverage. It argues that because
M s. Dalpaos-Lawrence ceased to be a resident of the same household as
M r. Dalpaos during the policy period that ended June 16, 2002, her coverage
would have ended either (1) sometime in M ay 2002 (at the end of 90 days
following the date in February 2002 that M r. Dalpaos moved out of the home at
216 Creek Avenue in Hartshorne, Oklahoma) or (2) on June 16, 2002 (the end of
the policy period).
A.
GuideOne first argues that M s. Dalpaos-Lawrence ceased to be an insured
sometime in M ay 2002, at the end of 90 days following the date in February 2002
that M r. Dalpaos moved out of the home at 216 Creek Avenue in Hartshorne,
Oklahoma. The policy states:
If the spouse ceases to be a resident of the same household during the
policy period or prior to the inception of this policy, the spouse will
be considered “you” and “your” under this policy but only until the
earlier of:
1. The end of 90 days following the spouse’s change of residency.
2. The effective date of another policy listing the spouse as a named
insured; or
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3. the end of the policy period.
Aplt. App., Vol. I at 117. The district court first determined that this provision
was not ambiguous. It then held that the first of these three cutoffs did not apply
to M s. Dalpaos-Law rence because she (as the “spouse”) had not “changed” her
residence when her husband moved out.
GuideOne agrees that the provision is not ambiguous, but argues that the
court misinterpreted the plain language of the provision. It argues that the district
court placed too much emphasis on the physical structure at 216 Creek Avenue
where the couple lived. GuideOne argues that the parties agree that M s. Dalpaos-
Lawrence “cease[d] to be a resident” of her husband’s “household” in February of
2002, and that if she was no longer a resident of her husband’s household she
must be considered a resident of some other “household.” GuideOne reasons that
M s. Dalpaos-Lawrence therefore experienced a “change in residency” no matter
who initiated that change. W e agree that this is one reasonable interpretation of
this policy provision.
But we believe that the district court’s interpretation is also reasonable and
that the language of the policy provision is therefore ambiguous. W hether
language in an insurance policy is ambiguous is a question of law. Wynn v.
Avemco Ins. Co., 963 P.2d 572, 575 (Okla. 1998). This court has held that under
Oklahoma law “[t]he test to be applied in determining whether a word or phrase is
ambiguous is whether the word or phrase is susceptible to two interpretations on
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its face. The test is applied from the standpoint of a reasonably prudent lay
person, not from that of a lawyer.” Haberman v. Hartford Ins. Group, 443 F.3d
1257, 1265 (10th Cir. 2006) (citation and internal quotation marks omitted).
Although M r. Dalpaos and M s. Dalpaos-Lawrence were no longer members of the
same household after he moved out, this does not necessarily mean
M s. Dalpaos-Lawrence had a “change of residency” at that time. One is generally
a “resident” of a physical place such as a house, a city, or a state. The district
court’s determination that M s. Dalpaos-Lawrence’s “residency” did not change
because she continued to live at 216 Creek Avenue was also a reasonable
interpretation of the policy provision. Since the policy provision is susceptible to
two interpretations on its face, it is ambiguous.
Oklahoma law recognizes that “insurance contracts are contracts of
adhesion because of the uneven bargaining position of the parties.” Spears v.
Shelter M ut. Ins. Co., 73 P.3d 865, 868 (Okla. 2003) (internal quotation marks
omitted). Further, for “many years” Oklahoma courts have applied the rule that
“in the event of ambiguity or conflict in the policy provisions, a policy of
insurance is to be construed strictly against the insurer and in favor of the
insured.” Id. As noted by both parties in this case, Oklahoma adopted the
“doctrine of reasonable expectations” in M ax True Plastering Co. v. United States
Fidelity & Guaranty Co., 912 P.2d 861, 864 (Okla. 1996). In that case the
Oklahoma Supreme Court stated that “[t]he standard under the doctrine is a
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‘reasonable expectation’; and courts must examine the policy language
objectively to determine whether an insured could reasonably have expected
coverage.” 912 P.2d at 865 (footnote call number omitted).
Thus, the Oklahoma Supreme Court held in Spears that “[u]nder the
reasonable expectations doctrine, when construing an ambiguity or uncertainty in
an insurance policy, the meaning of the language is not what the drafter intended
it to mean, but what a reasonable person in the position of the insured would have
understood it to mean.” Spears, 73 P.3d at 868. It further held that it was:
clear [from] M ax True Plastering Co. . . . that if an insurer desires to
limit its liability under a policy, it must employ language that clearly
and distinctly reveals its stated purpose. After M ax True Plastering
Co., . . . unclear or obscure clauses in an insurance policy will not be
permitted to defeat coverage which is objectively reasonably
expected by a person in the position of the insured.
Id.
Examining the ambiguous language of the policy’s definition of “you” and
“your” objectively, we hold that an insured could reasonably have expected that
the phrase “[t]he end of 90 days following the spouse’s change of residency,”
would only apply if the spouse and not the named insured moved. As recognized
by the district court, if GuideO ne had wanted to have made the language more
clear “it most certainly could have done so by simply phrasing the time frame as
90 days from ‘the spouse’s or named insured’s change of residency.’” Aplt. A pp.,
Vol. III at 741 n.6.
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B.
GuideOne’s next contention is that even if M s. Dalpaos-Lawrence did not
cease being an insured in M ay of 2002, coverage nevertheless ceased on June 16,
2002, because “[i]t was undisputed . . . that the insurance policy (in effect at the
time [M s. Dalpaos-Lawrence] ceased to be a resident of the same household as
[M r.] Dalpaos) had a policy period ending on June 16, 2002.” A plt. Opening Br.
at 26. The district court rejected this argument, holding that “[t]he insurance
policy was in effect from June 17, 2002, to December 17, 2002. Consequently,
the ‘end of the policy period’ as stated under the third time frame becomes
December 17, 2002.” Aplt. App., Vol. III at 741. The court further held that
“[b]ecause Defendant has chosen to reissue its policy at six-month intervals, new
policy periods are initiated and previous policy periods expire.” Id. at 741 n.7.
GuideOne argues, citing Connecticut and M issouri state cases and a case
from this court applying Colorado law, that “[i]t is black-letter law that the
renewal of an insurance policy constitutes a separate contract to be governed by
general contract principals.” 3 Oklahoma courts have also held that “the renewal
of an insurance policy is a new contract.” Wynn v. Avemco Ins. Co., 963 P.2d
3
W e recognize, however, that in Government Employees Insurance Co. v.
United States, the case cited by GuideOne, this court acknowledged that “[w]hen
a renewal policy is issued, it is presumed, unless a contrary intention appears, that
the parties intended to adopt in the renewal policy, the terms, conditions and
coverage of the expiring policies.” 400 F.2d 172, 175 (10th Cir. 1968) (internal
quotation marks omitted).
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572, 574 (O kla. 1998); see also Bowling v. Aetna Life Ins. Co., 55 P.2d 1023,
1025-26 (Okla. 1936) (citing with approval cases from other states holding that
accident policies are contracts for specific periods of time and that if they are
renewed, the renewal constituted a separate and independent contract). Oklahoma
courts have also spoken of renewal policies as being separate from original
policies. See Wynn, 963 P.2d at 574 (“[I]t is presumed, unless a contrary
intention appears, that the parties intended that the renewal policy cover the same
terms, conditions, and exceptions as the original policy.”) (internal quotation
marks omitted); Kirkpatrick v. Allstate Ins. Co., 859 P.2d 532 (Okla. Civ. App.
1993) (“W hen a renewal policy is delivered by the insurance company to the
insured upon expiration of a policy, without a request by the insured, it is merely
an offer or proposal which must be accepted by the insured before a contract of
insurance is effected.”).
Consequently, we agree with the district court that the insurance policy at
issue was the renewal policy running from June 17, 2002, to December 17, 2002.
Since M s. Dalpaos-Lawrence ceased to be a resident of M r. Dalpaos’s household
prior to the inception of the renew al policy she w as considered a “you” or “your”
under the policy until the earliest of the three possible cutoffs. 4 In the case of the
4
W e do not address whether our construction of the policy terms might lead
to an absurd result. GuideOne has not properly presented such an argument to
this court. See Anderson v. U.S. Dep’t of Labor, 422 F.3d 1155, 1174 (10th Cir.
2005) (“The failure to raise an issue in an opening brief waives that issue.”).
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third cutoff, the “end of the policy period” would be December 17, 2002. The
district court’s judgment with respect to this point is affirmed.
IV.
GuideOne’s final argument is that the exclusions found in Part B of the
policy applied to loss of income benefits coverage. GuideOne argues that because
the additional benefits endorsement changed the title of Part B from “M edical
Payments Coverage” to “M edical-Income Protection,” “all exclusions in that part
were applicable to claims for income protection coverage.” Aplt. Opening Br. at
32. W e affirm this point for the reasons set forth by the district court in its order
granting summary judgment. The endorsement made no change to the exclusions
section of Part B, leaving the exclusions applicable only to the “M edical
Payments Coverage” and not the added loss of income benefits coverage.
V.
As we have affirmed the district court’s rulings regarding GuideO ne’s
previous claims, we need not address its argument regarding the attorneys’ fee
aw ard. The judgment of the district court is AFFIRMED.
Entered for the Court
W ade Brorby
Senior Circuit Judge
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