JEFFREY ALLEN v. UNITED SERVICES AUTOMOBILE ASSOCIATION
No. 17-1282
UNITED STATES COURT OF APPEALS TENTH CIRCUIT
October 29, 2018
PUBLISH
John M. DeStefano, of Hagens Berman Sobol Shapiro LLP, Phoenix, Arizona (Robert B. Carey, of Hagens Berman Sobol Shapiro LLP, Colorado Springs, Colorado, on the briefs), for Plaintiff-Appellant.
Jeremy A. Moseley (John M. Vaught and Julian R. Ellis, Jr. with him on the brief), of Wheeler Trigg O‘Donnell LLP, Denver, Colorado, for Defendant-Appellee.
Before BRISCOE, SEYMOUR, and HOLMES, Circuit Judges.
HOLMES, Circuit Judge.
I
Mr. Allen was insured under a car insurance policy purchased by his wife, Ellen Allen, from USAA. As relevant here, the policy‘s coverage period ran from December 5, 2012 to June 5, 2013, though Ms. Allen obtained the policy years
In 2012, USAA sent the Allens a “Summary Disclosure Form” that purported to be “a basic guide to the major coverages and exclusions in your policy.” Id. at 222 (capitalization omitted). The disclosure form stated that it was “not a policy of any kind,” and instructed the Allens to “please read your policy for complete details” because “this summary disclosure form shall not be
In May 2013, within the policy‘s coverage period, Mr. Allen was involved in a car accident. Mr. Allen began suffering lower back pain shortly afterward. The policy provided coverage for up to $100,000 worth of medical payments within the one-year limitation period. According to a clinical assessment carried out about a year after the accident, Mr. Allen‘s pain “range[d] anywhere from mild to severe on a daily basis.” Id., Vol. III, at 625 (Ex. A-2 to Pl.‘s Resp. to Def.‘s Statement of Facts, filed Oct. 26, 2017). By June 2014, when the one-year limitation period on medical-payments coverage under Mr. Allen‘s policy had ended, USAA had paid out about $18,000 of the $100,000 coverage amount. Mr. Allen continued to receive medical treatment for problems stemming from the accident, but USAA refused to make further payments because the limitation period had been reached.
In May 2016, Mr. Allen brought a class action suit against USAA, on behalf of “all insureds of [USAA],” in federal district court in Colorado. Id., Vol.
USAA filed an Answer to Mr. Allen‘s complaint in September 2016. In December 2016, USAA moved for summary judgment, and the district court granted this motion in July 2017. The district court entered final judgment against Mr. Allen on July 10, 2017, and Mr. Allen timely appealed.
II
“We review a district court‘s summary-judgment order de novo,” and summary judgment “is appropriate when ‘the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.‘” Dullmaier v. Xanterra Parks & Resorts, 883 F.3d 1278, 1283 (10th Cir. 2018) (quoting
III
A
Mr. Allen first argues that the one-year time limit on medical-payments coverage is unenforceable because it violates Colorado‘s reasonable-expectations doctrine. More specifically, Mr. Allen points to the disclosure form USAA sent to his wife and him in 2012 that outlined the basic parameters of their coverage; he claims that, due to language in this disclosure form, he could have reasonably expected that there would be no time limit attached to medical-payments coverage under the policy.1
The 2012 disclosure form is a four-page-long document that USAA sent to the Allens. See Aplt.‘s App., Vol. III, at 743-46. The form is entitled “SUMMARY DISCLOSURE FORM” and states on its first page that “[t]his summary disclosure form is a basic guide to the major coverages and exclusions in your policy. It is a general description. It is not a policy of any kind.” Id. at 743. The disclosure form further directs the insured—in bolded, capital letters—to “PLEASE READ YOUR POLICY FOR COMPLETE DETAILS. THIS SUMMARY DISCLOSURE FORM SHALL NOT BE CONSTRUED TO REPLACE ANY PROVISION OF THE POLICY ITSELF.” Id. (bold-face font omitted). This text is easily the most prominent feature on the first page of the disclosure form.
Mr. Allen argues that the disclosure form makes the one-year limitation period unenforceable because it creates a reasonable expectation on the part of the insured that he or she will receive coverage for all reasonable medical expenses arising from an accident (up to the policy limit), regardless of when those expenses are incurred. As Mr. Allen puts it: “Common and necessary accident-related health care expenses will naturally arise more than a year after the accident—physical therapy, occupational therapy, surgical treatments used as a last resort ... or a reluctant patient‘s attitude or pain tolerance can all delay treatment” beyond the one-year mark. Aplt.‘s Opening Br. at 15.
Additionally, as noted supra, the form instructs readers that it is “not a policy of any kind” and tells them to “please read your policy for complete details.” Aplt.‘s App, Vol. III, at 743. It holds itself out as no more than “a basic guide to the major coverages and exclusions in your policy,” and thus as only “a general description” of the policy‘s terms. Id. (emphases added).
For these reasons, the district court was correct to conclude that Colorado‘s reasonable-expectations doctrine does not supply a means to circumvent the policy‘s one-year limitation period for medical-payments coverage. The 2012 disclosure form simply did not amount to a “deception.” Bailey, 255 P.3d at 1053.
Because the policy‘s exclusionary language was easily accessible and unambiguous, and because an objectively reasonable person would not, upon reading the 2012 disclosure form, have been deceived into thinking that it created a promise of time-unlimited medical-payments coverage, the district court was correct to reject Mr. Allen‘s reasonable-expectations theory.3 Put another way,
The Colorado Supreme Court has made clear that we are not to use the reasonable-expectations doctrine to expand coverage “on a general equitable basis.” Id. (quoting Johnson v. Farm Bureau Mut. Ins. Co., 533 N.W.2d 203, 206 (Iowa 1995)); see also Craft v. Philadelphia Indemnity Ins. Co., 343 P.3d 951, 960 (Colo. 2015) (noting that the reasonable-expectations doctrine is “a means of avoiding an unfair result where the insurer has engaged in some sort of deception” (emphasis added)). In the absence of a showing of deception, therefore, we hold that the reasonable-expectations doctrine does not avail Mr. Allen.
B
Mr. Allen advances a second argument for why the policy‘s one-year time limit on medical-payments coverage is unenforceable: specifically, he contends
We apply Colorado law in determining how best to interpret a Colorado statute in a case resting on diversity jurisdiction. See, e.g., Parish Oil Co., Inc. v. Dillon Companies, Inc., 523 F.3d 1244, 1248 (10th Cir. 2008) (“As we are sitting in diversity and construing a Colorado statute, we must give it the meaning it would have in the Colorado courts.“). Under Colorado law, the “primary goal of statutory interpretation is to ascertain and give effect to the legislature‘s intent.” Lewis v. Taylor, 375 P.3d 1205, 1209 (Colo. 2016). To do this, Colorado courts “look to the plain meaning of the statutory language and consider it within the context of the statute as a whole. If the statutory language is clear, [Colorado courts] apply it as such.” Id. (citing Denver Post Corp. v. Ritter, 255 P.3d 1083, 1088 (Colo. 2011)). Moreover, “[i]n the absence of statutory inhibition, an insurer may impose any terms and conditions [in an insurance agreement]
The MedPay statute requires that all automobile insurance policies issued in Colorado provide at least $5,000 of coverage “for medical payments ... for bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of [a] motor vehicle.”
Mr. Allen does not contest the fact that the MedPay statute is silent as to whether an insurer may include a time limit on medical-payments coverage in an
Our interpretation of the MedPay statute is informed by Coats v. Dish Network, LLC, 350 P.3d 849 (Colo. 2015), where the Colorado Supreme Court refused to add language to a statute that would have expanded the scope of activities protected under the statute. In Coats, the plaintiff-petitioner, Mr. Coats, was fired from his job after using medical marijuana—an activity that Colorado law permits but federal law prohibits. Mr. Coats argued that a Colorado statute,
Mr. Allen argues that subsection 635(1)(c) of the MedPay statute requires “time-unlimited coverage” in the event that an insurer “fails to offer the required [MedPay] coverage.” Aplt.‘s Opening Br. at 32 (emphasis omitted). He reasons therefore that the MedPay statute should be read to prohibit time limits of any sort. We are unpersuaded. This argument is belied by subsection 635(1)(c)‘s text, which states: “If the insurer fails to offer medical payments coverage or fails to maintain or provide proof that the named insured rejected medical payments coverage in the manner required by this section, the insured‘s policy shall be presumed to include medical payments coverage with benefits of five thousand dollars.”
Mr. Allen also argues that the MedPay statute‘s purpose and legislative history support reading the statute as prohibiting time limits on medical-payments coverage. However, we decline to venture beyond the statute‘s plain text, since we do not find the MedPay statute to be ambiguous (i.e., we do not think that the text of the MedPay statute is susceptible to more than one meaning, at least as regards the question presented in this case). Meardon v. Freedom Life Ins. Co. of Am., 417 P.3d 929, 934 (Colo. App. 2018) (stating that “we may not consider [a
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In sum, we hold that the one-year time limit in Mr. Allen‘s insurance policy is enforceable. This is so because we conclude, as a matter of law, that the 2012 disclosure form is not deceptive and because the plain language of the MedPay statute does not prohibit such time limits.7
IV
In conclusion, we AFFIRM the district court‘s order granting summary judgment in favor of USAA.
JEROME A. HOLMES
UNITED STATES CIRCUIT JUDGE
