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Howisey v. Transamerica Life Insurance Co.

United States District Court, W.D. Washington, Seattle

November 30, 2017

MIKE HOWISEY, as attorney in fact for WALLACE E. HOWISEY, an incapacitated person, Plaintiff,
v.
TRANSAMERICA LIFE INSURANCE COMPANY, a foreign corporation organized under the laws of the State of Iowa,

          ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

          RICARDO S. MARTINEZ CHIEF UNITED STATES DISTRICT JUDGE

         I. INTRODUCTION

         This matter comes before the Court on Defendant Transamerica Life Insurance Company (“Transamerica”)'s Motion for Summary Judgment. Dkt. #40. Plaintiff Mike Howisey, as attorney in fact for his father Wallace E. Howisey, opposes this Motion, Dkt. #54, and has filed a parallel Motion for Partial Summary Judgment, Dkt. #47. The Court has determined that oral argument is unnecessary. For the reasons below, the Court GRANTS Defendant's Motion, DENIES Plaintiff's Motion, and STRIKES all other Motions as moot.

         II. BACKGROUND

         In 1995, Wallace E. Howisey purchased a long term care insurance policy (the “Policy”) from Bankers United Life Assurance Company (“Bankers United”), a predecessor of Transamerica. See Dkt. #41-1. The Policy provides certain base benefits, as well as additional benefits described in riders and endorsements that Plaintiff selected. See id. The base benefits include coverage for, inter alia, stays at a nursing home. Dkt. #41-1 at 5. Mr. Howisey also purchased the Home Health and Community Care Rider (“HHCC Rider”), which includes “Assisted Living Facility” benefits and other benefits. See Id. at 20-25.

         An explanation of the “Nursing Home Benefit” is contained in the main text of the Policy. Dkt. #41-1 at 10. It states that, “[a]fter satisfaction of the Nursing Home Elimination Period [of 60 days], We will pay the actual charges for confinement in a Nursing Home, up to the Maximum Daily Nursing Home Benefit shown in the Schedule for each day of a Nursing Home stay.” Id. The term “Nursing Home” is capitalized. According to the Policy, in order to qualify for the Nursing Home Benefit, three conditions must be satisfied:

(1) Your Physician must certify that Your treatment is Medically Appropriate; and
(2) the care or services must be provided in a Nursing Home; and
(3) the charges must be incurred while this Policy is in force.

Id. Again, the term “Nursing Home” is capitalized, leading the reasonable assumption that it is a defined term. Indeed, a “Nursing Home” is expressly defined in the Policy as:

A facility, or that part of a facility which:
(1) is licensed by the state as a nursing home; and
(2) is engaged in providing, in addition to room and board accommodations, nursing care and related services on a continuing inpatient basis; and
(3) provides, on a formal prearranged basis, a Nurse who is on duty or on call at all times; and
(4) has a planned program of policies and procedures developed with the advice of, and periodically reviewed by, ...

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