Opinion
No. 1:03-cv-0415.
October 22, 2004
MEMORANDUM
Plaintiffs, Chattanooga-Hamilton County Hospital Authority d/b/a/ Erlanger Health System ("Erlanger") and Richard E. Haston ("Haston"), the Administrator ad litem of Ronald D. White, Jr.'s ("White") Estate, filed this action against Alliant Health Plans, Inc. ("Alliant"), seeking payment for medical expenses rendered by Erlanger to White following a traffic accident on January 22, 2003. Erlanger moves for summary judgment on its sole claim of the Complaint, a contract claim based on the Erlanger Health System Participating Network Agreement ("The Agreement") executed by Erlanger and Alliant. [Court File No. 20]. Alliant opposes this motion [Court File No. 25] and Erlanger has filed a reply [Court File No. 26]. For the reasons expressed below, Erlanger's motion for summary judgment will be GRANTED. I. Standard of Review
The plaintiffs' Complaint contains two counts. In the first, Haston brings an ERISA claim alleging that the medical expenses incurred by White are covered under an Alliant health insurance plan provided by White's employer, Curbs Plus, Inc. This first claim is not at issue in the pending summary judgment motion. [Court File No. 21 at 1-2]. The only claim at issue in this motion is the second claim of the Complaint, Erlanger's lone claim.
Summary judgment is appropriate where no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. FED. R. CIV. P. 56(c); Shah v. Racetrac Petroleum Co., 338 F.3d 557, 566 (6th Cir. 2003). In ruling on a motion for summary judgment, the Court must view the facts contained in the record and all inferences that can be drawn from those facts in the light most favorable to the non-moving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986); Shah, 338 F.3d at 566; Nat'l Satellite Sports, Inc. v. Eliadis Inc., 253 F.3d 900, 907 (6th Cir. 2001). The Court cannot weigh the evidence, determine the credibility of witnesses, or determine the truth of any matter in dispute. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986).
The moving party bears the initial burden of demonstrating that no genuine issue of material fact exists. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). To refute such a showing, the non-moving party must present some significant, probative evidence indicating the necessity of a trial for resolving a material, factual dispute. Celotex, 477 U.S. at 322. A mere scintilla of evidence is not enough. Anderson, 477 U.S. at 252; Shah, 338 F.3d at 566; McLean v. Ontario, Ltd., 224 F.3d 797, 800 (6th Cir. 2000). "Evidence suggesting a mere possibility" of a factual dispute is not enough to preclude summary judgment. Shah, 338 F.3d at 566; Gregg v. Allen-Bradley Co., 801 F.2d 859, 863 (6th Cir. 1986).
The Court's role is limited to determining whether the case contains sufficient evidence from which a jury could reasonably find for the non-moving party. Anderson, 477 U.S. at 248, 249; Nat'l Satellite Sports, 253 F.3d at 907. While the Court draws all reasonable factual inferences in the light most favorable to the non-moving party, it may grant summary judgment if the record taken as a whole could not lead a rational, objective jury to find for the non-moving party. Matsushita, 475 U.S. at 587; McKinnie v. Roadway Express, Inc., 341 F.3d 554, 557 (6th Cir. 2003).
II. Facts
On January 22, 2003, Ronald D. White was the driver in a single-car accident. [Court File No. 20, Exhibit C]. According to the Tennessee Uniform Traffic Crash Report completed by the investigating officer, White "started into curve [sic] and lost control and struck a power pole." [ Id.]. White was taken to Erlanger, where he was treated for his injuries until he died on March 7, 2003.
At the time of the accident, White was driving on a suspended driver's license. In December 2001, White received a citation for running a stop sign. [Court File No. 20, Exhibit D at 2]. White failed to pay the citation and on July 30, 2002, the Tennessee Department of Safety sent White a notice, warning that White's driver's license would be suspended in thirty days unless he paid the citation. [ Id. at 1]. Finally, on April 22, 2003, approximately six weeks after White died, the Tennessee Department of Safety sent White another notice, informing White that his driver's license was revoked, suspended or cancelled for failure to pay the citation. [ Id. at 3].
Based on the Erlanger Health System Participating Network Agreement ("The Agreement"), Erlanger was a preferred provider offering services to individuals insured by Alliant. [Court File No. 20, Exhibit A]. White was insured by an Alliant Health Group Plan provided by his employer, Curbs Plus, Inc. [Court File No. 20, Exhibit B]. In accordance with the Agreement, Erlanger submitted to Alliant White's medical bills totaling $449,475.00. Alliant has denied Erlanger's claim and refuses to pay any portion of the bill. III. Analysis
Alliant refuses to pay any portion of White's medical bill because, it contends, this case falls within an exclusion in White's insurance plan. According to Alliant, Part IX, paragraph 35 of the Exclusions section of the Plan eliminates its duty to pay for White's medical bills. The paragraph provides in pertinent part: "Alliant shall not be liable for any loss to which a contributing cause was the insured's . . . violation of any law or regulation. . . ." [Court File No. 20, Exhibit B]. Alliant argues that a contributing cause to White's automobile accident was driving on a suspended license, a violation of law.
Initially, the Court notes that, for purposes of this summary judgment motion, the parties agree on a significant number of issues. First, and perhaps most importantly, the facts of the case are not in dispute. Both parties agree that White was driving on a suspended license at the time of the automobile accident on January 22, 2003, in violation of the law and that he received adequate notice of this suspension via the Tennessee Department of Safety notification dated July 30, 2002. [Court File No. 20 at 4-5; Court File No. 25 at 2; Court File No. 26 at 1]. Further, the parties agree that Georgia law governs the interpretation of White's health insurance plan with Alliant. [Court File No. 20 at 5-6; Court File No. 25 at 2; Court File No. 26 at 1]. Finally, the parties agree that the Court reviews Alliant's interpretation of the relevant insurance provision de novo. [Court File No. 20 at 6-11; Court File No. 25 at 2; Court File No. 26 at 1].
Indeed, the parties agree that the sole issue in this summary judgment motion is whether White's driving on a suspended driver's license constitutes a contributing cause to his automobile accident on January 22, 2003. [Court File No. 20 at 5; Court File No. 25 at 4; Court File No. 26 at 1]. Erlanger contends that White's driving on a suspended license is not causally connected to his automobile accident, citing various state court cases finding that a suspended driver's license was not the proximate cause in a tort action. [Court File No. 20 at 11-13]. Alliant, on the other hand, contends that White's driving on a suspended license is a contributing cause to the accident because, if White had been in compliance with the law, he would not have been driving and, therefore, no accident would have occurred. [Court File No. 25 at 4-7].
Generally, the construction of a contract is a matter of law for the Court. GA. CODE ANN. § 13-2-1 (2004); Knott v. Knott, 589 S.E.2d 99, 101 (Ga. 2003). Accordingly, the construction of an insurance contract is a matter of law for the Court. Ga. Farm Bureau Mut. Ins. Co. v. Wilkerson, 549 S.E.2d 740, 742 (Ga.Ct.App. 2001) ; Barnes v. Greater Ga. Life Ins. Co., 530 S.E.2d 748, 749 (Ga.Ct.App. 2000) (citing Jenkins v. Lanigan, 396 S.E.2d 28, 30 (Ga.Ct.App. 1990). Because there are no genuine disputes of material fact and the sole issue is construction of the insurance provision, this case is ripe for decision on summary judgment.
When an insurance company seeks to invoke an exclusion contained within its policy, the insurer bears the burden of showing that the facts come within the exclusion. Richards v. Hanover Ins. Co., 299 S.E.2d 561, 564 (Ga. 1983); S. Trust Ins. Co. v. Dr. T's Nature Prods. Co., 584 S.E.2d 34, 36 (Ga.Ct.App. 2003) (citing S. Guar. Ins. Co. v. Duncan, 206 S.E.2d 672, 674 (Ga.Ct.App. 1974)). Exclusions in insurance contracts are to be strictly construed against the insurer and in favor of coverage. S. Trust Ins. Co., 584 S.E.2d at 36 (citing Richards, 299 S.E.2d at 563); York Ins. Co. v. Williams Seafood of Albany, Inc., 544 S.E.2d 156, 157 (Ga. 2001) (citing Richards, 299 S.E.2d at 563).
An insurance policy provision absolving the insurer of liability where a contributing cause of the insured's injury is a violation of law requires that the violation of law have a causal connection with the injury. Liberty Nat'l Life Ins. Co. v. Morris, 208 S.E.2d 637, 644-45 (Ga.Ct.App. 1974) (citing Nat'l Life Accident Ins. Co. v. Sutherland, 12 S.E.2d 183, 185-86 (Ga.Ct.App. 1940); N.C. Mutual Life Ins. Co. v. Evans, 143 S.E. 449, 450 (Ga.Ct.App. 1928)); accord LEE R. RUSS THOMAS F. SEGALLA, 10 COUCH ON INSURANCE 3d §§ 140:25-140:39 (1998). "[T]he insurance company is not absolved from liability unless the death of the insured is the reasonable and legitimate consequence of the unlawful act." Evans, 143 S.E. at 450. "[T]he mere fact that the accident occurred while the insured was engaged in a violation of the law does not exonerate the insurer, but, to avoid liability, it must further establish that the violation of law was the cause of, or had some causative connection with, the accident. . . ." Sutherland, 12 S.E.2d at 186 (quotation omitted); accord Morris, 208 S.E.2d at 644-45.
Though the violation of law must have some causal connection with the accident, the violation of law need not be the sole proximate cause of the accident. Sutherland, 12 S.E.2d at 186-87. The Sutherland court interpreted a policy provision which exempted the insurer from liability if the insured's death was sustained in connection with his violation of law. The court held that, to be exempt, the insurer must show "that the insured was engaged in a violation of law, not necessarily the proximate cause of his death, but one which had some causative connection with his death or from which the death of the insured was a reasonable consequence." Id. at 187.
In the instant case, the provision at issue exempts Alliant from liability if a contributing cause of the accident is the insured's violation of law. [Court File No 20, Exhibit B]. This provision, read in light of Sutherland, does not require that the violation of law be the sole proximate cause of the accident. However, Alliant must still prove a causal connection between the accident and the violation of law. See Sutherland, 12 S.E.2d at 187-90.
The Court finds that Alliant has not satisfied its burden of proving this causal connection. Specifically, Alliant has not proven that driving on a suspended license was a contributing cause to White's accident. Instead, the Court finds that there is not a sufficient causal connection between the accident and White's driving on a suspended license. According to the police report, the accident occurred as White "started into curve [sic] and lost control and struck a power pole." [Court File No. 20, Exhibit C]. This accident would have occurred whether White was driving on a suspended license or a valid license. Consequently, driving on a suspended license was not a contributing cause to White's accident.
In arguing that driving on a suspended license is causally connected to White's accident, Alliant cites Burnette v. Georgia Life and Health Ins. Co., 379 S.E.2d 188 (Ga.Ct.App. 1989). In Burnette the plaintiff was a passenger in a car which crossed the centerline and struck another vehicle. Id. The Burnette court held that crossing the centerline was causally connected to the automobile accident, and the insurer was exempt from liability under a violation-of-law clause. Id. at 189.
This Court finds, however, that Burnette is not directly relevant to the case at bar. Burnette is different from the instant case in one significant respect: the violation of law in Burnette was crossing the centerline; the violation of law here is driving on a suspended license. There is no doubt that the violation of law in Burnette was causally connected to the automobile accident: the accident would not have occurred but for crossing the centerline. However, in the instant case, the same cannot be said: White's accident would have occurred whether he drove on a suspended license or a valid license. Accordingly, Burnette is not relevant to the present inquiry.
The violation of law at issue in Burnette — crossing the centerline — is akin to other violations of traffic laws held to be causally connected to an automobile accident. Courts have held that speeding or driving while intoxicated are causally connected to a resulting accident and exempted the insurer from liability in these scenarios. Barnes v. Greater Georgia Life Ins. Co., 530 S.E.2d 748 (Ga.Ct.App. 2000); Jefferson Pilot Life Ins. Co. v. Clark, 414 S.E.2d 521 (Ga.Ct.App. 1991); Sutherland, 12 S.E.2d at 188-90; COUCH, supra, § 140:37. The accidents at issue in each of these situations would not have occurred but for the respective violation of traffic law. However, these violations of traffic laws are significantly different than the violation at issue in the instant case. See, e.g., COUCH, supra, § 140:37. Unlike speeding, driving while intoxicated, or crossing the centerline, White's violation of law did not contribute to his automobile accident: White's accident would have occurred whether he was driving on a suspended license or a valid license.
The other two cases presented by Alliant are inapposite to the instant case. These cases are neither controlling on this Court nor relevant to the instant inquiry. Simpson v. Safeco Life Ins. Co., an unpublished decision by the United States Court of Appeals for the Fourth Circuit, held that a minor's possession of a handgun — a violation of South Carolina law — was causally connected to his death; the minor died when he accidentally shot himself with the handgun. 26 Fed. Appx. 268, 269-70, 2002 WL 80651 (4th Cir. Jan. 22, 2002). Whether a minor's possession of a handgun is causally connected to accidentally shooting himself sheds no light on whether driving on a suspended license is causally connected to an automobile accident. Accordingly, Simpson is not relevant to the present inquiry.
Alliant's second case is similarly inapposite to the instant action. Richardson v. Colonial Life Accident Ins. Co., a decision by the Missouri Court of Appeals, held that a bank robbery, in which the insured participated, was causally connected to his death; the insured died when the insured's accomplice shot the insured during the division of the robbery proceeds. 723 S.W.2d 912, 914 (Mo.Ct.App. 1987). Whether commission of a bank robbery is causally connected to such a death is not relevant to the instant inquiry.
Neither party cites, nor is the Court aware of any case from Georgia, or any other jurisdiction, deciding whether driving on a suspended license is causally connected to a subsequent automobile accident in an insurance context. Given the dearth of case law on this issue, the Court finds support in the Georgia cases holding that failure to have a valid driver's license is not causally connected with the automobile accident in a tort action. Aycock v. Peaslee-Gaulbert Paint and Varnish Co., 5 S.E.2d 598, 598-99 (Ga.Ct.App. 1939); accord Xpress Cargo Sys., Inc. v. McMath, 481 S.E.2d 885, 886 (Ga.Ct.App. 1997); Butts v. Davis, 190 S.E.2d 595, 596-97 (Ga.Ct.App. 1972); Fielding v. Driggers, 190 S.E.2d 601, 602 (Ga.Ct.App. 1972); Cambron v. Cogburn, 157 S.E.2d 534, 536 (Ga.Ct.App. 1967); Ga. Power Co. v. Jones, 188 S.E. 566, 571-72 (Ga.Ct.App. 1936). As Alliant correctly asserts, these decisions were rendered in the proximate cause inquiry of a tort action. Because the present inquiry is in an insurance context and does not require that driving on a suspended license be the proximate cause of the accident, these decisions are not dispositive. However, because these are the only decisions to consider the causal connection between an automobile accident and driving without a valid license, the Court finds them to support the decision in the instant case.
The Court finds that driving on a suspended license is not a contributing cause to White's accident. Accordingly, the policy exclusion at issue is inapplicable and does not exempt Alliant from liability. Erlanger's motion for summary judgment [Court File No. 20] on its sole claim of the Complaint will be GRANTED.
The Court's decision granting Erlanger's summary judgment motion may dispose of Haston's lone claim, the only remaining claim of the Complaint. Nonetheless, the parties SHALL NOTIFY the Court of the status of Haston's claim by November 19, 2004.
A separate judgment will enter.
JUDGMENT
In accordance with the accompanying memorandum opinion, Erlanger's motion for summary judgment on its sole claim of the Complaint pursuant to FED. R. CIV. P. 56 [Court File No. 20] is GRANTED. Erlanger shall recover its costs of this action.
Further, the parties SHALL NOTIFY the Court of the status of Haston's lone claim by November 19, 2004.
SO ORDERED.