Opinion
NO. 4:01-CV-0263-A
September 4, 2001
MEMORANDUM OPINION and ORDER
Came on for consideration the motion of plaintiffs, Lisa Edens, Billy Edens, and Lacy Edens ("Lacy"), for partial summary judgment. The court, having considered the motion, the response of defendants United Benefit Life Insurance Company ("UBL"), Central Reserve Life Insurance Company ("CRL"), and Ceres Group, Inc. ("Ceres"), the record, the summary judgment evidence, and applicable authorities, finds that the motion should be denied.
I. Plaintiff's Claims
On March 13, 2001, plaintiffs filed their original petition in the 48th Judicial District Court of Tarrant County, Texas. The action was brought before this court by notice of removal filed March 30, 2001. On August 9, 2001, having obtained leave of court, plaintiffs filed their first amended complaint.
Among other things, plaintiffs seek to recover benefits under a group health insurance policy issued by UBL. The claim for benefits arose out of an August 23, 1998, accident when a car driven by Lacy struck a guardrail, severing her left leg and causing other serious injuries. Plaintiffs allege that coverage was wrongfully denied based on a test report that showed that Lacy had a serum alcohol level of 0.81. Pls.' Am. Compl. at 5.
II. Grounds of the Motion
Plaintiffs seek partial summary judgment declaring that the two insurance policy exclusions relied upon are ambiguous and that they should be given a meaning that plaintiffs propose.
III. Undisputed Facts
The following facts are established by the undisputed summary judgment evidence:
Effective January 1, 1990, UBL issued its group policy number 1001 (the "policy") to the American Association of Consumer Benefits. The policy pays for losses resulting from sickness or injury while the policy is in force. The policy expressly provides, under the heading "SECTION III-EXCLUSIONS AND LIMITATIONS":
A. Benefits will not be paid or coverage provided for any loss resulting directly or indirectly from or by the following:
. . .
5. Voluntary use of drugs, narcotics, hallucinogens, or alcohol unless ordered by a Physician or except as provided in Section I, Benefits, Paragraph I;
. . .
11. Any loss to which a contributing cause was the Insured Person's being engaged in an illegal occupation or illegal activity;
12. Any loss sustained or contracted while an Insured Person is intoxicated, or under the influence of any narcotic unless administered on the advice of a Physician. . . .
On May 1, 1997, UBL issued its certificate of insurance number 055091249 under the policy to Billy Edens. The certificate also covered Lisa, his wife, and their children, Cory and Lacy. The certificate provides, in Section VII, titled "EXCLUSIONS AND LIMITATIONS":
A. What Charges Are Not Covered? Benefits will not be paid or coverage provided for any loss resulting directly or indirectly from or by the following:
. . .
2. Any intentionally self-inflicted Injury or death; voluntary use of drugs, narcotics, hallucinogens, or alcohol unless ordered by a Physician or except as provided in Section IV, Benefits, paragraph O; any loss sustained or contracted while an Insured Person is intoxicated, or under the influence of any narcotic unless administered on the advice of a Physician; . . . any loss to which a contributing cause was the Insured Person's being engaged in an illegal occupation or illegal activity. . . .
At approximately 8:00 a.m. on August 23, 1998, a car driven by Lacy struck a guardrail at full speed. The impact turned her car sideways and the guardrail entered the driver's side and amputated Lacy's lower left leg. Alcohol was in the car at the time of the wreck. According to the paramedics' report, Lacy smelled of alcohol. Lacy admitted that she had consumed alcohol prior to the accident. At approximately 9:30 a.m., Lacy's serum alcohol level was found to be .081 grams per milliliter. Coverage was denied as a result of Lacy's alcohol consumption prior to the accident.
IV. Applicable Summary Judgment Principles
A party is entitled to summary judgment on all or any part of a claim as to which there is no genuine issue of material fact and as to which the moving party is entitled to judgment as a matter of law. FED. R. CIV. P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986). The moving party has the initial burden of showing that there is no genuine issue of material fact. Anderson, 477 U.S. at 256. The movant may discharge this burden by pointing out the absence of evidence to support one or more essential elements of the non-moving party's claim "since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial."Celotex Corp. v. Catrett, 477 U.S. 317, 323-25 (1986). Once the moving party has carried its burden under Rule 56(c), the non-moving party must do more than merely show that there is some metaphysical doubt as to the material facts. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). The party opposing the motion may not rest on mere allegations or denials of pleading, but must set forth specific facts showing a genuine issue for trial.Anderson, 477 U.S. at 248, 256. To meet this burden, the nonmovant must "identify specific evidence in the record and articulate the `precise manner' in which that evidence support[s] [its] claim[s]."Forsyth v. Barr, 19 F.3d 1527, 1537 (5th Cir. 1994). An issue is material only if its resolution could affect the outcome of the action. Anderson, 477 U.S. at 248. Unsupported allegations, conclusory in nature, are insufficient to defeat a proper motion for summary judgment. Simmons v. Lyons, 746 F.2d 265, 269 (5th Cir. 1984).
The standard for granting a summary judgment is the same as the standard for a directed verdict. Celotex Corp., 477 U.S. at 323. If the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no genuine issue for trial. Matsushita, 475 U.S. at 597.
V. Law Applied to the Facts
Plaintiffs first contend that the "voluntary use of alcohol" and the "intoxication" exclusions are in conflict, because one exclusion is far more restrictive than the other. They urge that the exclusions should be interpreted together to mean that coverage is excluded only if the loss results directly or indirectly from an insured person being intoxicated as a result of voluntary use of alcohol, and not from simply any use of alcohol at all. Pls.' Mot. For Partial Summ. J. at 3-4. Plaintiffs' interpretation, however, would render meaningless the voluntary use of alcohol exclusion.
Under Texas law, the interpretation of an insurance contract is governed by the same rules that apply to contracts generally. Forbau v. Aetna Life Ins. Co., 876 S.W.2d 132, 133 (Tex. 1994). Each part of the contract should be given effect, id., and an interpretation of the policy is unreasonable if it would strip a provision of meaning.Canutillo Indep. Sch. Dist. v. Nat'l Union Fire Ins. Co., 99 F.3d 695, 706 (5th Cir. 1996). A contract is not ambiguous if it can properly be given certain legal meaning or interpretation. Matador Petroleum Corp. v. St. Paul Surplus Lines Ins. Co., 174 F.3d 653, 657 (5th Cir. 1999). Although any ambiguity is construed in favor of the insured, the court will not strain to find ambiguities in the policy. Id. The fact that the parties disagree as to coverage does not create an ambiguity. Jarvis Christian Coll. V. Nat'l Union Fire Ins. Co., 197 F.3d 742, 746-47 (5th Cir. 1999).
In this case, the exclusions are overlapping, but that does not render them ambiguous. See Eulich v. Home Indem. Co., 503 S.W.2d 846, 849-50 (Tex.Civ.App.-Dallas 1973, writ ref'd n.r.e.). Voluntary use of alcohol can cover a variety of situations, including conditions that develop over time, such as cirrhosis of the liver. To require a condition of intoxication would render meaningless the voluntary use of alcohol exclusion. Thus, the construction plaintiffs urge is unreasonable. Canutillo, 99 F.3d at 706.
As a second ground of the motion, plaintiffs contend that the term "intoxication" is ambiguous because it is not defined in the policy or the certificate. However, the mere absence of a policy definition does not give rise to a finding of ambiguity. Potomac Ins. Co. v. Jayhawk Med. Acceptance Corp., 198 F.3d 548, 551 n. 3 (5th Cir. 2000). Rather, the term "intoxicated" has a commonly understood meaning and is neither ambiguous nor defective. See El Chico Corp. v. Poole, 732 S.W.2d 306, 312-13 (Tex. 1987); Campos v. State, 623 S.W.2d 657, 659 (Tex.Crim. App. 1981). Thus, the court is not giving "intoxication" the definition plaintiffs urge.
VI. ORDER
For the reasons discussed herein,
The court ORDERS that plaintiffs' motion for partial summary judgment be, and is hereby, denied.