Halayne Kasoff v. Bankers Life and Casualty Co., 662 F. App'x 526

Kasoff held a California-governed long-term care insurance policy from Bankers Life and Casualty Company and filed suit after denial of benefits for a knee injury.
Policy contained a term “Any One Period of Expense,” which imposes a six-month "washout" before a new period of benefits begins.
Bankers denied coverage for Kasoff’s knee because she was still receiving long-term care services for a preexisting shoulder condition for which she had already received maximum benefits, and the six-month washout had not elapsed.
District court granted summary judgment for Bankers, adopting Bankers’ reading that the washout applies to any services, whether related or unrelated to the triggering injury.
Ninth Circuit reviewed de novo under California law, found the term ambiguous between two reasonable constructions, and reversed and remanded, construing the ambiguity against the insurer and reinstating dismissed ancillary claims.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether “Any One Period of Expense” requires a six-month washout only for services causally related to the triggering injury, or for any services regardless of relation	Kasoff: washout applies only to services causally related to the initial benefit-triggering injury; unrelated new injuries get a new period of expense	Bankers: washout applies to any long-term care services (related or unrelated); no new period until six months of no services	The phrase is ambiguous; construed for the insured. Court reversed summary judgment for Bankers and remanded, adopting Kasoff’s reasonable construction on ambiguity

Feldman v. Allstate Ins. Co., 322 F.3d 660 (9th Cir. 2003) (standard of review for summary judgment)
Conestoga Servs. Corp. v. Exec. Risk Indem., Inc., 312 F.3d 976 (9th Cir. 2002) (California-law guidance that policy interpretation is a question of law)
Bank of the West v. Superior Court, 833 P.2d 545 (Cal. 1992) (ordinary contractual interpretation rules apply to insurance policies)
United Nat. Ins. Co. v. Spectrum Worldwide, Inc., 555 F.3d 772 (9th Cir. 2009) (look to the writing alone to determine mutual intent under California law)
Waller v. Truck Ins. Exch., Inc., 900 P.2d 619 (Cal. 1995) (policy provision is ambiguous if two reasonable constructions exist)
E.M.M.I. Inc. v. Zurich Am. Ins. Co., 84 P.3d 385 (Cal. 2004) (ambiguous insurance terms resolved in insureds’ favor)
Safeco Ins. Co. v. Robert S., 28 P.3d 889 (Cal. 2001) (insureds’ reasonable expectations guide resolution of ambiguous policy terms)