Peterson

Peterson v. American Life & Health Insurance

Good Law
48 F.3d 404·19 Employee Benefits Cas. (BNA) 1326·1995 U.S. App. LEXIS 2795·95 Cal. Daily Op. Serv. 1117
United States Court of Appeals for the Ninth CircuitFebruary 15, 1995No. 93-55973California3,543 words

Opinion

Lead Opinion

Fletcher, J.

George Peterson appeals the district court’s grant of summary judgment in favor of the defendants in his suit for benefits under a health insurance policy. We have jurisdiction and affirm.

I. BACKGROUND

Peterson is a partner in Quivira Marine Service Center (“Quivira”). Quivira applied to American Life and Health Insurance Co. (“American”) for a short-term group policy through the Pacific Southwest Association of Small Employer Firms (“PSA”) to provide health insurance for three persons: Peterson, his partner, and their employee. The American policy was intended to provide coverage while Quivira secured a long-term policy with another insurer. Quivira moved coverage for Peterson’s partner and the employee to another insurer as intended; Peterson, however, remained on the American policy because he failed a physical examination required by the new insurer.

After Peterson’s partner and employee were removed from the American policy, Peterson underwent emergency quintuple coronary bypass surgery. American denied Peterson’s claims for expenses associated with the surgery on the basis of an exclusion in the policy stating that no benefits are payable for “[a]ny condition of the…

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