*1 job transfer claim be- immunity on cognizable is no constitutional
cause there claim, transfer prison On
violation.
however, the violation of a constitutional Any fur- properly alleged. has been
right immunity into inquiry qualified
ther If court. properly before this
issue is qualified wish to establish
the defendants claim,
immunity prison as to the transfer court for
they must ask district
ruling. summary AFFIRMED judgment RE- part, part, VACATED ap- proceedings
MANDED further
propriate.
CITIZENS INSURANCE COMPANY AMERICA, Plaintiff-
OF
Appellant,
MIDMICHIGAN HEALTH CONNECT- PLAN, NETWORK Defen
CARE
dant-Appellee.
No. 05-1237. Appeals,
United States Court of
Sixth Circuit.
Argued: Jan. 2006.
Decided and Filed: June *2 Goldenbogen, L.
ARGUED: Robert Huron, Miller, Garan Lucow Port Michi- Lubben, gan, Appellant. Craig H. Mil- ler, Johnson, Cummiskey, Kalama- Snell & zoo, Michigan, for ON BRIEF: Appellee. Miller, Saylor, Daniel S. Lucow De- Garan troit, Michigan, Craig H. Appellant. Miller, Johnson, Lubben, &Snell Cummis- Kalamazoo, key, Michigan, for Appellee. McKEAGUE, Before: MOORE and POLSTER, Judges; Circuit District Judge.* * Polster, Judge The Honorable Aaron United States District Northern District Dan J., As a re-
McKEAGUE,
Medical Center.
opinion
delivered the
POLSTER,
J.,
court,
injuries,
alleg-
D.
sult Bradshaw’s
$135,565.11
expenses
in medical
joined.
paid
es
priority.
brought
this ac-
out
697-698),
MOORE,
(pp.
delivered
J.
*3
for
ex-
payment
tion to recover
these
separate dissenting opinion.
penses.
McKEAGUE,
Judge.
Circuit
summary
a
Citizens filed motion
Insurance
Plaintiff-appellant, Citizens
56,
judgment pursuant
to Fed.R.Civ.P.
(“Citizens”) appeals
Company of America
that
cover
seeking a declaration
Citizens’
court’s denial of its motion for
the district
age
secondary
MidMichigan
was
to the
and the declaration
summary judgment,
accordingly,
was entitled
plan,
Citizens
in priority
that
is first
for the
payment
for the
to reimbursement
expenses incurred as a
payment of medical
parties agree
claims. The
Bradshaw’s
accident. For the
result of
automobile
priority dispute arising
between an
follow,
holding
reasons that
of the
policy
and a no-fault
is re
plan
ERISA
reversed, and the
is
district court is
case
pursuant
solved
to federal common law.
proceedings
consistent with
remanded
Apple
v. Thorn
See Auto Owners Ins. Co.
ruling.
this
(6th Cir.1994).
Inc.,
Valley,
3. The
amended its
Plan
Inc.,
Valley,
(citing
Citizens, slip-op at 11. B(1 (italicized )(a), material JA at 107 added). asserts that the district Citizens erred, language argues and In order to decide which inter in payment of no-fault benefits excludes correct, we must consider both pretation is instance, MidMichigan pro- this because language underly and the intent expenses, medical
vides similar benefits for
ing
provision.
See Firestone Tire and
plan
group
listed
Bruch,
101, 112-13,
v.
489 U.S.
Rubber Co.
Further,
clause.
Citizens
Exclusions
948,
(1989);
109 S.Ct.
In to Citizens’ contracting par reflects the intent of the disability just one in ties.”). dent or insurance” interpreta The rules of contract from plans a series of excluded the federal tion that have evolved under policy, under the Citizens’ priority disputes in common law ERISA incompatible arguments. asserts two Michigan applied mirror those First, that “accident MidMichigan argues University Regents courts. See of of disability only type insurance” is the Agency Rent- Michigan Employees v. of plan (6th Cir.1997). excluded: A-Car, policy’s “A construction of a clearly limited to bene- Id. technical
That exclusion is would defeat a language under an ‘accident or dis- reasonable payable fits .... coverage is not favored ability’ argues expectation duty Accordingly, an insurer has a to ex language ‘expressly ... that this covers policy; in its argument press clearly the limitations group plans’ but liberally construed ignores ambiguity the fact covers will be disability insurance,’ strictly against of the insured and ‘group accident or in favor interpreting Id. ERISA plans. all the insurer” When group beyond plans, language while the gone courts have bursement plan provisions, true, not. if did While this is actual even drafted,” the district court erred when it failed to “clumsily to ascertain the under- ‘Yet, interpret the remainder of the Exclusions paramount lying intent. Court’s provision here. The Exclusions clause also construing plan language responsibility expenses excludes for medical underly- is to ascertain and effectuate “service, benefit, Auto- otherwise ing intent.” Travelers Ins. Co. v. Co., reimbursement, salary or continuance F.Supp. Ins. 800-01 Owners (W.D.Mich.1997); plants].” MidMichigan’s argument first accord Allstate Ins. Co. Co., policy expressly fails because the no-fault Vogt Mfg. Supp 147 F. 2d Knape & (W-D.Mich.2001). plans other than “accident or excludes dis-
ability plans, though insurance” even Policy Language type district court failed determine the A. the remainder of the Exclusions The Exclusions clause excludes clause intended to exclude. expenses payable of benefits for medical individual, by “any group blanket or acci- MidMichigan’s argument second con- service, insurance, bene- phrase dent tends that the “accident or disabili- fit, reimbursement, salary continuance ty” qualify is meant to each of the terms (excluding provided contrast, Medicare argues that follow. In government).” Citizens’ no- the federal that the reminder of the clause is a serial B(l)(a), fault insurance Exclusions excluded. In listing types knot, Looking plain language at 107. at the attempt linguistic JA to unravel this n we clause, analysis. we find that Mid- Ac begin grammatical of the Exclusions with a *6 Michigan’s argument first that the clause A cording Dictionary Legal to Modern disability adjective limited to “accident or insur- a Usage, qualifies is each that noun ignores separated by ance” the remainder of the clause. in a way the same should be cautious[,] policy If the was intended to exclude For “a re example, comma. Garner, Bryan for medical benefits otherwise A. A person.” served Dic (Ox disability Usage under “accident or insur- tionary Legal Modern ed.1995). ance,” Press, would have University the exclusions clause ford 2d phrase stating. yields interpre at the so Presum- application ended of this rule in or- in ably, MidMichigan urged by takes this stance tation Citizens. Under this language to track the of the district is a terpretation, der the Exclusions wherein the court noted that opinion, listing qualified that are “specifically adjectives. adjectives the clause references accident These in preceding Citizens, insurance, disability slip op. clude; disability or insurance.” accident or ser however, reimbursement, vice, benefit, salary court did not at 11. The district disability that or insur- interpretation indicate “accident continuance. This would only plans excluded. properly plan, ance” were exclude a as Citizens argues. motorcy- The district court relied on the However, adjective to when one is intended Liability provision
cle Limit of order phrase containing to a noun anoth- interpret meaning qualify of the clause here. adjective, MidMichigan argues out is doing, pointed In so the court er here, separate comma is used to policy language motorcycle provision case no adjectives. Id. In the no-fault hospitalization, the two specifically referred or phrase “accident disabili- surgical provision, medical or insurance or reim- service, benefit, “insurance, secondary coverage.” Ap- medical Br. of ty” precedes reimbursement, position, at 22. To bolster its Citi- salary pellant or continuance requires terms. to the separating no comma zens refers statute plan” with rule, disability” Michigan or no-fault insurers to offer their this “accident Under qualifier option electing for the re- policy considered holders would be the noun coordinated when adjectives, qualifying premium all duced other Thus, they would exclude an have health and accident cover- “plan”. other disability plan, Comp. 500.3109a age. accident or Mich. Laws disability personal pro- an acci- providing service states: “an insurer accident offer, disability plan, an accident benefits shall at dent or tection insurance rates, premium or an reduced de- disability appropriately reimbursement salary reasonably continuance related accident or ductibles and exclusions MidMichigan argues. coverage to other health and accident on plan, as that it issued the insured.” Citizens states Hence, analysis pure grammatical compli- rate Bradshaw’s reduced readings. plausible results in two “Con statute, evidencing with its intent ance subject ambiguous tract if it is to coordinate benefits with Bradshaw’s interpretations.’.’ Boyer to two reasonable coverage, namely other available health Douglas Components Corp., 986 F.2d Further, quotes MidMichigan. Cir.1993) (6th (citing Smith v. Group Ins. v. American Transamerica Indus., ABS 846-47 n. Community Mutual Ins. Co. support Cir.1989)). lan Having found its assertion that the clause was meant subject guage of the no-fault its to other health subordinate grammatical interpretations, to two wtf' insurance carriers: of contract turn to “traditional methods By mandating that no-fault insurers of- ambiguity, in interpretation to resolve ap- coordination of fer benefit clauses drawing cluding presump inferences rates, propriately Legisla- reduced introducing extrinsic evidence.” tions and expressed ture a clear intent Boyer, F.2d at 1005. primary no-fault insurer not have liabili- ty circumstances when the Policy Underlying B. Intent *7 to insured elects coordinate benefits. that the Citizens claims no-fault a that Although health insurance carrier “expressly policy issued to Bradshaw was may sec- coordinates benefits become purposes as ‘excess’ for of medi identified ondary to a carrier other than a no-fault thus, to apply cal benefits and does not the carrier, no-fault carrier cannot under the coverage extent that other available ex primary. circumstances be at 17. Appellant ists.” Br. of The record Mich.App. 437 N.W.2d Policy contains a “Certification of Cover (1989) (Br. 3). at Appellant of n. Citizens, age” signed Pamela Martin of that district court policy argues which certifies that issued to Citizens Medical Per erred when it rendered a restrictive read- provided Excess Bradshaw clause, Injury ing Protection. JA at 89. Citi to its Exclusions because the sonal provision policy that the Exclusions was issued as a reduced rate excess zens claims law, policy, compliance Michigan in to in with policy the no-fault was “intended the Transamerica court. interpreted by of ac effectuate Ms. Bradshaw’s choice policy, no-fault with states that “the district court un- quiring a coordinated Citizens in- appropriately necessarily required reduced to reflect that the premiums that it in very ‘medical’ or ‘health’ the fact demonstrated the terms elude when: plan” to reach Defendant’s that it policy order same knew what to coverage use if it intended to exclude envi- manifestly clause Exclusions group benefits or ‘similar benefits under a medical sions that medical payable by variety a of plan.” Appellee benefits’ will Br. of be MidMichi- of be an ‘plan[s],’ any might one which argues gan interpre- further that Citizens’ individual, group plan. Sev- blanket requires tation to the court redraft listed; plans eral are and while accident provision, omitting the Exclusions accident one, disability the clause insurance disability “qualifying language.” and service a reim- plan, also includes a MidMichigan does not address Citizens’ salary a bursement continuation is a MidMichigan contention “benefit notably, a benefit most definition, plan” by its own nor does it Appellant Br. of at 23-24. explanation offer an of the Medicare ex- asserts that the Citizens ception within the Exclusions clause, encompassed by the Exclusions MidMichigan’s support would inter- is, by MidMichigan plan its because In pretation response of the clause. definition, group plan.”5 own “benefit assertion no-fault Citizens’ statute Further, argues poli- if policy, underpins issuance of Mid- cy only exclude payment intended to § Michigan avers that 500.3109a does not pay- that were expenses medical otherwise plans, plans reach ERISA and that ERISA “accident and able various pre- with a coordination of clause benefits plans,” insurance medical and § empt 500.3109a. be ex- were intended to cluded, be no reason for Citi- there would Exclusions clause the Citi- While zens to the Medicare qualifying include clarity, model of zens’ no-fault is no language. Medicare is defined as find that the intent of the clause was to we elderly “health program” for the expenses exclude medical If and certain disabled individuals.6 variety “plans,” including a “benefit “health insurance” were not intended plan.” provided Bradshaw a re- encompassed by to be the Exclusions rate and she duced coordinated instance, be clause the first would same, availability elected the based on unnecessary exempt Medicare benefits expenses for medical from from its reach. MidMichigan plan. Bradshaw’s The Mich- found that assertions, igan Appeals has Court
In Mid- response to Citizens’ no-fault insur- legislature give intended to Michigan claims that fails to application “unrestrained of 3109a to ers otherwise *8 accident whatev- “surgical” coverage health and under a “medical” or payable from Ins. Group, er source.” Transamerica 437 plan, motorcycle unlike the limit added). (emphasis at 29 We find liability provision policy. its “Citi- N.W.2d by provision that was argument zens’ is further undermined the Exclusions plans any following ....” MidMichigan itself Plan or of the Mid- defines “Benefit Description, Michigan Summary JA 278. purposes Plan plan Plan” in document for its own pro- of coordination of benefits. The relevant plan. provision vision states: "Benefit This Site 6. See The Official U.S. Government Medicare, www.medicare.gov/Pub- People will coordinate medical benefits a bene- with lications/pubs/pdf/10116.pdf. plan fit The term means 696 range of medi- of medical
intended to exclude broad disavow keeping a no- benefits otherwise covered under coverage plans, cal and Bradshaw fault the coordination of provide intent to benefits with Citizens’ plan given of each their full rate no-fault clauses are a coordinated reduced effect, plan § and is not automat consistent with 3109a.7 ERISA ically secondary. deemed See Great-West Moreover, that Citizens’ assertion Annuity Company & Insurance v. Life pro- Exclusions exception Medicare to the 202 Company, Allstate Insurance F.3d its to otherwise ex- evinces intent vision Cir.2000); Dayton see also and clude health medical insurance Dept. Hudson Store Co. v. Auto-Owners a health insur- plans is valid. Medicare is Co., 953 F.Supp. Ins. 179-80 not accident or ance (W.D.Mich.1995)(“[T]he Apple Thorn Val MidMichigan’s interpreta- plan. Under ley preemption court cautioned that ‘does tion, by Medicare not reached would be necessarily plan not mean that the ERISA provision Exclusions if the Rather, prevail.’ must conflict be of medical were provisions tween COB be should resolved otherwise “accident law.”). Here, federal common disability” so be no plans, there would properly that district found MidMi exempt Mid- reason Medicare benefits. ehigan’s plan expressly did not disavow plausible has Michigan offered no other coverage, and therefore the coordination of explanation for the inclusion of the Medi- plan benefits clauses between the and the language. care Thus, policy did conflict. the holding Further, we find that MidMichi Apple Valley inapplicable of Thorn here. gan’s argument ERISA are not agree alsoWe with Citizens’ assertion by § the law reached 500.3109a misstates plan,” ais “benefit en- pre-empts in this area. An plan ERISA compassed by the Exclusions clause. Mid- 500.3109a, § neces however this does not Michigan plan defines itself as a benefit sarily plan pre mean ERISA will clause8, its coordination of benefits priority Ap vail in a Thorn dispute. See statutory language Employee of the Valley, F.3d ple at 374. The Thorn Act, ERISA, Security Retirement Income Apple Valley court found that “when a § 1001 et seq. 29 U.S.C. refers to insurance policy qualified traditional and a regulates plans.” as “benefit See plan conflicting contain coordina ERISA 1001(a). U.S.C. clauses, tion terms of the of benefits including Having clause ERISA its COB found that the intent un given full derlying must be effect.” Id provision clearly Exclusions added). However, (emphasis in instances militates in favor interpreta of Citizens tion, expressly when ERISA does not we find that properly exclud- wrongly bearing parties. 7. The dissent claims we consider in mind intent the intent of the than the rather give court must effect to the "[T]he intent parties analysis. of the We intent in our manifestly language, de informs disagree. parties The intent clear. hypothetical spite shortcomings technical Bradshaw elected coordinated ambiguities language.” Allstate Insur enjoyed the benefit auto- of reduced no-fault Co., Knape, Supp ance 2d 147 F. *9 premiums mobile insurance she was because (W.D.Mich.2001). plan. covered under Citizens another the to issued coordinated in order ef- 6, supra. 8. See n. election, required fectuate Bradshaw's un- provision § interpret der 500.3109a. We the required zens would not be to make any medical benefits for a series payment ed of plan.” payments payable Mid- that were under MidMi- including a “benefit plans, of plan. chigan’s group-benefit plan. Because MidMi- Under the Michigan is such second, reading, only type in full force at the time distributive chigan’s plan was individual, blanket, injury, group and the did not of of Bradshaw’s medical that would be excluded would expressly coverage disavow for be disability-benefit plans, no- accident-or payable under a and benefits otherwise deny personal-injury- is Citizens could not fault we find protection coverage coverage by on in for of Bradshaw’s based priority first MidMichigan’s health-benefit Two claims.9 interpretation
rules of contract instruct us IV. CONCLUSION ambiguity against to resolve this Citizens. reasons, we For the aforementioned First, law, common the law that federal court’s denial of REVERSE district contract, governs interpretation of this RE- summary judgment plaintiff, for adopted longstanding has rule of con proceedings consis- MAND this case ambiguities struction that lan contract finding. with this tent drafter, guage against are resolved case, Regents Citizens. Univ. MOORE, Judge, dissenting. Circuit v. Employees Agency Mich. Rentr-A-Car majority that the lan- agree I with the Ass’n, Hosp. 339-40 guage personal-injury-protec- of Citizens’s Cir.1997); see also (Second) Restatement provision ambiguous. tion exclusions (1981). § Citizens had of Contracts However, rules of contract because two opportunity to draft a us to resolve the ambi- construction direct in clearly coverage excluded where the Citizens, I guity against we are believe sured was covered a health-benefit to conclude that compelled Citizens plan. See Restatement (Second) of Con coverage on plan does (explaining 206 cmt. a tracts MidMichigan plan. Accord- basis “[wjhere party one chooses the terms of a I ingly, respectfully dissent. contract, likely provide he is to more care fully of his own interests majority highlighted protection The has the ambi- for the party” than those of the other and “is guity personal-injury-protection ex- likely party other provision of Citizens’s excess no- also more than the clusions uncertainties of policy. phrase or dis- have reason to know of fault “accident fact, In has demon ability” meaning”). can be read to “insurance,” doing pre modify only capable term that im- strated that it was it, cisely limit-of-liability provision that in its mediately follows or it can be read to regarding injuries operat “in- sustained while modify subsequent each of the terms: surance,” “benefit,” “service,” ing motorcycle, explicitly excludes “reimburse- ment,” coverage are “salary continuance.” Joint where (“J.A.”) (Citizens Policy through surgical a “medical or at 107 Appendix (Citi 16). first, plan.” J.A. at 107 nondistributive or reimbursement at Under 17). Moreover, individual-, blanket-, Cit group- Policy zens because reading, all posi stronger bargaining included within Cit- izens had “the would be exclusions, tion” and alone determined and thus Citi- izens’s remand, that accrued of Bradshaw’s claims 9. On the district court will have January if the amendment determine that date. after priority MidMichigan's plan affects the *10 698 ],” disability-benefit plan, would the accident-or contract[ of its “standardized
terms coverage under the Citizens drafter not exclude against the rule of construction precedents re- plan.1 Because this court’s force here. applies with additional Re- interpretation garding the rules of contract (Second) of Contracts statement understanding of the exclu- dictate this cmt. a. unnecessary it is to look to provision, sions Second, precedent, by which prior our parties.2 respectfully I the intent of the bound, instructs that “an insurer arewe dissent. limita- duty express clearly the has a “any policy,” and thus tions its liberally in will be construed
ambiguity strictly against
favor of the insured and Regents the
the insurer.” Univ. Mich., (emphasis at add- F.3d 339-40 GILES, Petitioner-Appellant, Earl omitted). ed) (internal quotation marks v. Therefore, ambigui- we must construe the limitations of the Citizens ty as to the SCHOTTEN, Warden, James Citizens, policy against the insurer. Respondent-Appellee. Because these rules of construction di- No. 04-3708. ambiguity in rect us to construe the Citi- Appeals, United States Court provision against Citi- zens’s exclusions Sixth Circuit. zens, I that we must read “accident believe disability” modifying each of the 16, Argued: Sept. 2005. it, including that follow “benefit.” terms Decided and Filed: June 2006. reading provision, the Under MidMichigan’s insured’s which is a health-benefit not an suggestion, ing provision,” Maj. Op. (emphasis Contrary majority’s at 693 to the read- clause,” added), ing Maj. that it does not reach so and "the intent of the added), does not render the Medi- health-benefit Op. (emphasis at 695 rather than the meaningless. language The inclusion of care Wulf, parties," "intent of the F.3d language "excluding Medicare benefits added). majority (emphasis This leads provided by government” in Citi- the federal Citizens, the intent of the drafter of focus on simply means that zens’s exclusions provision, giving while short shrift to the where an accident or a results in contract, party intent of the other to the Medicare, paid by Citizens will reim- insured, Jacqueline a one- Bradshaw. Such burse Medicare for the cost of the benefits. inquiry produce sided cannot an accurate as- parties. sessment of the intent of the More- necessary
2. Even if it were to consider over, although majority that "[t]he claims majority parties, intent of the errs in its clear,” parties Maj. Op. intent of the at 696 ascertaining parties’ approach to intent. parties’ majority's view of the intent n. prior majority acknowledges that our The " conjecture is based on mere rather than the interpreting precedent '[w]hen instructs that " ” pre- of the contract or evidence contract,’ we 'look not at the lan parties. majority The credits sented guage, but also for additional evidence " self-serving statements that Citizens made re- contracting parties,’ reflects the intent garding its own intent in its brief to this court Majority Opinion (“Maj. Op.”) (quoting at 692 evidence, Quantum any supporting ex- without either Corp., Chem. Wulf language. (6th Cir.1994)) added). The trinsic or from the contract (emphasis instruction, majority's basis for the conclusion as to Brad- majority how misconstrues this ever, supported. underly- not evident or "the intent shaw's intent as one to consider