Redlands Community Hospital v. New England Mutual Life Insurance

Insurance Code section 10119 requires an insurer to cover, “from and after the moment of birth,” the newborn infant of any covered family, but is silent as to the duration of such coverage. In this case, we hold that such unconditional coverage extends for 31 days after the birth. We also hold, because the insured here did not apply for coverage for her newborn twins until 49 days after their birth, which application was denied by the insurer, New England Mutual Life Insurance Company, on medical grounds, that the trial court properly granted the insurer’s motion for summary judgment. Such motion was brought by the insurer in the underlying action filed against it by Redlands Community Hospital seeking payment for the 35 days the twins remained in the hospital after the “covered” 31-day period.

Factual and Procedural Background

On September 27, 1989, Rebecca Rivas (Rivas) gave birth to premature twins at Redlands Community Hospital (plaintiff). The twins were hospitalized until December 2, 1989. When the twins were born, Rivas was an employee of Dura Plastic Products, Inc. (Dura) in Beaumont, and was insured under a group benefit plan provided by Dura and underwritten…