Title: O'DONNELL v. BLUE CROSS BLUE SHIELD OF WYOMING

State: wyoming

Issuer: Wyoming Supreme Court

Document:

O'DONNELL v. BLUE CROSS BLUE SHIELD OF WYOMING2003 WY 11276 P.3d 308Case Number: 02-251Decided: 09/09/2003
APRIL 
TERM, A.D. 2003

 

                                                                                                            

 

DIXIE 
M. O'DONNELL,

 

Appellant(Plaintiff) 
,

 

v.

 

BLUE 
CROSS BLUE SHIELD

OF 
WYOMING,

 

Appellee(Defendant) 
.

 

Appeal 
from the District Court of Natrona County

The 
Honorable David B. Park, Judge

 

Representing 
Appellant:

Stephen 
R. Winship of Winship & Winship, P.C., Casper, 
Wyoming.

 

Representing 
Appellee:

John 
B. "Jack" Speight and Amanda Hunkins of Speight, McCue & Assoc., P.C., 
Cheyenne, Wyoming.  Argument by Ms. 
Hunkins.

 

Before 
HILL, C.J., and GOLDEN, LEHMAN, KITE, and VOIGT, JJ.

 

 

            
HILL, Chief Justice.

 

[¶1]      Dixie O'Donnell 
(O'Donnell) appeals a district court decision holding that a waiver she signed 
excluding a cervical spine condition from coverage under a health insurance 
policy issued by Blue Cross Blue Shield of Wyoming (Blue Cross) was valid and 
enforceable.  O'Donnell challenges 
the validity of the waiver in light of endorsements adopted to conform her 
policy to provisions of the Health Insurance Portability and Accountability Act 
of 1996 (HIPAA), 42 U.S.C.A. §§ 300gg through 300gg-91 (2003).  O'Donnell also contends that Blue Cross 
should be estopped from denying coverage because it breached an affirmative duty 
to inform her of alternative coverage available through the Wyoming Health 
Insurance Risk Pool, Wyo. Stat. Ann. §§ 26-43-101 through 26-43-113 (LexisNexis 
2003).

 

[¶2]      We 
affirm.

 

[¶3]      O'Donnell raises 
the following issues in her brief:

1.                  
Whether 
the definition and treatment of "preexisting condition exclusion," as provided 
in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") (42 
U.S.C. § 300gg(b)(1)) includes waivers or other permanent exclusions of health 
conditions?

 

2.                  
Whether 
the inclusion of HIPAA's definition and treatment of "preexisting condition 
exclusion" through Appellee's endorsement to Appellant's health insurance policy 
should be construed so as to supercede her earlier waiver as to coverage of any 
back condition she suffers?

 

3.                  
Whether 
the HIPAA endorsement to Appellant's health insurance policy created an 
ambiguity as to the coverage of Appellant's back surgery 
bills?

 

4.                  
When 
Appellee is the exclusive administrator of the Wyoming Health Insurance Pool 
("WHIP") and charged thereby with the duty of publicizing this expanded health 
insurance coverage to Wyoming residents, did Appellee, as Appellant's health 
insurer and the WHIP administrator, have a duty to Appellant to inform her that 
health insurance coverage was available through WHIP for the health condition 
that Appellee excluded from the existing health insurance coverage it provided 
to Appellant?

 

Blue 
Cross sets out the following statement of the issues:

Was 
summary judgment properly granted in favor of Blue Cross Blue Shield of Wyoming 
by the district court upon Appellant's claims of a violation of the Health 
Insurance Portability and Accountability Act of 1996 (HIPAA) [42 U.S.C. § 300gg, 
et seq.], namely the provision applying to coverage of preexisting 
conditions, as well as Appellant's claims of promissory/equitable estoppel, 
reasonable expectations doctrine, fraud and bad faith[?] In turn, was 
Appellant's Motion for Partial Summary Judgment properly 
denied[?]

 

[¶4]      In February 
1994, O'Donnell obtained an individual health insurance policy from Blue 
Cross.  O'Donnell had been treated 
for a cervical spine injury in 1991. As a condition of providing insurance to 
O'Donnell, Blue Cross required her to waive coverage for any treatment related 
to her cervical spine.  The waiver 
form provided:

 

I 
understand and agree that Dixie is not to be covered under my 
application for Blue Cross and Blue Shield service now or in the future for the 
treatment of Cervical Spine and/or secondary complications or any 
condition related thereto.

 

(Emphasis 
in original.)  O'Donnell signed and 
returned the waiver to Blue Cross. 

 

[¶5]      The cover letter 
to O'Donnell's policy stated:  
"There is a twelve (12) month waiting period for any condition considered 
to be preexisting which is explained in the section entitled, What We Will Not 
Pay For  General Limitations and Exclusions.'"  That section 
provided:

 

[W]e 
will not pay for any of the following services, supplies, situations, 
hospitalizations or related expenses:

* 
* *

            
PRE-EXISTING CONDITIONS: Any disease or physical condition manifesting 
itself in such a manner as would cause an ordinarily prudent person to seek 
medical advice, diagnosis, care or treatment, or for which medical advice, 
diagnosis, care or treatment was recommended or received during the six (6) 
months immediately preceding the effective date of coverage, or relating to a 
pregnancy which existed on the effective date of coverage, will NOT be covered 
as a benefit under this Agreement for a period of twelve (12) months following 
the subscriber's effective date of coverage.

 

The 
policy definition of "preexisting conditions" paralleled the statement set out 
in the limitations section.

 

[¶6]      In June 1995, 
Blue Cross issued an endorsement to O'Donnell's policy intended to clarify 
existing contract language.  
Included in the endorsement was the addition of a definition for "waiver 
of coverage:"

 

A 
waiver of coverage is a written amendment to the application which permanently 
eliminates coverage for the particular disease or medical condition set forth in 
the written waiver signed by the subscriber.

 

O'Donnell 
has denied receiving this endorsement.

 

[¶7]      Blue Cross 
amended O'Donnell's policy in June 1997 through another endorsement.  The purpose of the endorsement was to 
ensure that the policy complied with the provisions of HIPAA.  The amendment included a modification to 
the exclusion of preexisting conditions:

 

Pre-existing 
Conditions:  Any condition, (whether 
physical or mental), regardless of the cause of the condition, for which medical 
advice, diagnosis, care or treatment was recommended or received within the six 
(6) month period immediately preceding the effective date of coverage, will not 
be covered as a benefit under this Agreement for a period of twelve (12) months 
following the subscriber's effective date of coverage. A pregnancy existing on 
the effective date of coverage is considered a pre-existing 
condition.

 

In 
determining whether this pre-existing condition exclusion period applies to an 
eligible subscriber, Blue Cross Blue Shield of Wyoming will credit the time an 
eligible subscriber was previously covered by creditable coverage, provided 
there was not a significant break (90) days) in coverage from the previous 
credible coverage.  Waiting periods 
applicable under this individual health plan shall not be considered in 
determining if a significant break in coverage has 
occurred.

 

The 
definition of "preexisting conditions" was also modified to reflect the 
amendment to the policy.  The 
endorsements incorporated the provisions of HIPAA relating to preexisting 
condition exclusions located in the Group Market Reforms section of that 
Act.  See 42 U.S.C. §§ 
300gg(a); 300gg(b)(1)(A) and 300gg(c)(1) & (2).

 

[¶8]      In 1999, 
O'Donnell underwent a cervical disc fusion.  O'Donnell submitted bills for her 
surgery to Blue Cross, which denied payment because the charges were "incurred 
for a condition that has been excluded from your coverage."  O'Donnell subsequently filed suit 
against Blue Cross.  O'Donnell 
raised three issues: whether the waiver was still valid after the 1997 amendment 
to her policy; whether Blue Cross had an affirmative duty to inform her of the 
availability of alternative insurance coverage for excluded medical conditions 
through the Wyoming Health Risk Insurance Pool (WHIP); and, whether any 
statements or actions by Blue Cross provided a basis for applying promissory or 
equitable estoppel to preclude Blue Cross from denying coverage for her 1999 
surgery.1  The parties filed cross-motions for 
summary judgment.  After a hearing, 
the district court granted Blue Cross' motion.  The district court held that the waiver 
was valid under Wyoming law and not affected by the 1997 amendment to her 
policy.  The court concluded that 
HIPAA was not applicable to O'Donnell's policy under the circumstances and did 
not affect the validity of the waiver.  
The court also found that Blue Cross did not owe a duty to inform 
O'Donnell of the alternative insurance available from WHIP.  O'Donnell has appealed the district 
court's ruling.

 

[¶9]      Our standard for 
reviewing summary judgments is well established:

Summary 
judgment is appropriate when no genuine issue as to any material fact exists and 
the prevailing party is entitled to have a judgment as a matter of law.  A genuine issue of material fact exists 
when a disputed fact, if it were proven, would have the effect of establishing 
or refuting an essential element of the cause of action or defense which the 
parties have asserted.  We examine 
the record from the vantage point most favorable to the party who opposed the 
motion, and we give that party the benefit of all the favorable inferences which 
may fairly be drawn from the record.  
We evaluate the propriety of a summary judgment by employing the same 
standards and by using the same materials as were employed and used by the lower 
court.  We do not accord any 
deference to the district court's decision on issues of 
law.

 

Mathewson 
v. City of Cheyenne, 
2003 WY 10, ¶4, 61 P.3d 1229, ¶4 
(Wyo. 2003) (quoting Anderson v. Two Dot Ranch, Inc., 2002 WY 105, ¶10, 
49 P.3d 1011, ¶10 (Wyo. 2002)).  
This is an appeal from a disposition of cross-motions for summary 
judgment.  When a district court 
grants one party's motion and denies the other party's motion and the court's 
decision completely resolves the case, both the grant and the denial of the 
motions for summary judgment are subject to appeal.  McLean v. Hyland Enterprises, 
Inc., 2001 WY 111, ¶17, 34 P.3d 1262, ¶17 
(Wyo. 2001).  Our review encompasses 
the entire case, including the grant and the denial of the cross-motions for 
summary judgment.

 

[¶10]   Resolution of the issues before us 
in this case also requires the application of our rules for interpreting 
insurance contracts, which we recently set out in detail:

 

An 
insurance policy constitutes a contract between the insurer and the 
insured.  Evans v. Farmers 
Insurance Exchange, 2001 WY 110, ¶8, 34 P.3d 284, ¶8 (Wyo. 2001); Helm v. 
Board of County Commissioners, Teton County, Wyoming, 989 P.2d 1273, 1275 
(Wyo. 1999).  As with other types of 
contracts, our basic purpose in construing or interpreting an insurance contract 
is to determine the parties' true intent.  
Polo Ranch Company v. City of Cheyenne, 969 P.2d 132, 136 (Wyo. 
1998).  We must determine intent, if 
possible, from the language used in the policy, viewing it in light of what the 
parties must reasonably have intended. Sinclair Oil Corporation v. Republic 
Insurance Company, 929 P.2d 535, 540 (Wyo. 1996).  The nature of our inquiry depends upon 
how clearly the parties have memorialized their intent.   Evans, 2001 WY 110, ¶ 8, 34 P.3d 284.   Where the 

contract 
is clear and unambiguous, our inquiry is limited to the four corners of the 
document.  Id.; Sierra 
Trading Post, Inc. v. Hinson, 996 P.2d 1144, 1148 (Wyo. 
2000).

 

            
We interpret an unambiguous contract in accordance with the ordinary and 
usual meaning of its terms.  St. 
Paul Fire and Marine Insurance Co. v. Albany County School District No. 1, 
763 P.2d 1255, 1258 (Wyo. 1988).  
The parties to an insurance contract are free to incorporate within the 
policy whatever lawful terms they desire, and the courts are not at liberty, 
under the guise of judicial construction, to rewrite the policy.  Hulse v. First American Title Company 
of Crook County, 2001 WY 95, ¶37, 33 P.3d 122, ¶37 (Wyo. 2001); St. Paul 
Fire and Marine Insurance Co., 763 P.2d  at 1258.  It is only when a contract is ambiguous 
that we construe the document by resorting to rules of construction. 
Evans, 2001 WY 110, ¶9, 34 P.3d 284; Sinclair Oil Corporation, 929 P.2d  at 539; Martin v. Farmers Insurance Exchange, 894 P.2d 618, 620 
(Wyo. 1995).  Whether a contract is 
ambiguous is a question for the court to decide as a matter of law.  Evans, 2001 WY 110, ¶9, 34 P.3d 284; Martin, 894 P.2d  at 620.

 

            
A contract is ambiguous if indefiniteness of expression or double meaning 
obscure the parties' intent.  
Evans, 2001 WY 110, ¶9, 34 P.3d 284; Hansen v. Little Bear Inn 
Company, 9 P.3d 960, 964 (Wyo. 2000).  
Ambiguity cannot be created by the subsequent disagreement between the 
parties regarding the meaning of a contract.  Farmers Insurance Exchange v. 
Dahlheimer, 3 P.3d 820, 826 (Wyo. 2000); Frost Construction Company v. 
Lobo, Inc., 951 P.2d 390, 394 (Wyo. 1998).  If the meaning of a provision in a 
contract is not readily apparent, the court may resort to competent evidence of 
extraneous circumstances to determine the parties' intent.  Wilder v. Cody Country Chamber of 
Commerce, 868 P.2d 211, 216 (Wyo. 1994).  Reviewing courts are free to make a 
determination as to the existence of ambiguity whether or not the parties agree 
one way or the other and whether or not the trial court has reached a conclusion 
one way or the other.  
Examination Management Services, Inc. v. Kirschbaum, 927 P.2d 686, 
689 (Wyo. 1996); Amoco Production Company v. Stauffer Chemical Company of 
Wyoming, 612 P.2d 463, 465 (Wyo. 1980).

 

Principal 
Life Insurance Company v. Summit Well Service, Inc., 
2002 WY 172, ¶¶17-19, 57 P.3d 1257, ¶¶17-19 (Wyo. 2002).

 

[¶11]   O'Donnell contends that the 1997 
endorsement incorporated the Group Market requirements of HIPAA into her 
policy.  O'Donnell argues that since 
that section of HIPAA does not permit exclusions that permanently deny coverage 
of a preexisting health condition, the waiver excluding coverage of her cervical 
spine condition was no longer effective.  
She further contends that the continuing validity of the waiver would 
offend the public policy considerations underlying HIPAA by allowing health 
insurance companies to eviscerate Congressional intent to restrict denial of 
coverage for preexisting health conditions.  O'Donnell also argues that the 
endorsement's adoption of HIPAA's Group Market rules, insofar as they relate to 
coverage of previously excluded health conditions, in conjunction with the 
failure of Blue Cross to explicitly state that "waivers" would not be affected 
by the endorsement, rendered the insurance policy in question uncertain and 
ambiguous with respect to coverage for her cervical spine condition requiring 
the application of the "reasonable expectations" doctrine and a liberal 
interpretation of the policy in her favor. 

 

[¶12]   We begin by attempting to ascertain 
the parties' intent from the language of the policy.  As a condition of coverage, O'Donnell 
signed the waiver precluding her cervical condition from the scope of the 
policy:

 

I 
understand and agree that Dixie is not to be covered under my 
application for Blue Cross and Blue Shield service now or in the future for the 
treatment of Cervical Spine and/or secondary complications or any 
condition related thereto.

 

(Emphasis 
in original.)  The term "waiver" was 
not defined in the policy until 1995 when Blue Cross issued an endorsement 
stating it was "a written amendment to the application which permanently 
eliminates coverage for the particular disease or medical condition set forth in 
the written waiver signed by the subscriber."  Although O'Donnell denied receiving the 
1995 endorsement, she does not contest the validity of the waiver at the time 
she signed it.  The concept of 
"wavier" has an established meaning in Wyoming law and "parties to a contract 
are presumed to enter into their agreement in light of existing principles of 
law."  Union Pacific Resources 
Company v. Texaco, Inc., 882 P.2d 212, 222 (Wyo. 1994) (citing Black 
& Yates, Inc. v. Negros-Philippine Lumber Company, 32 Wyo. 248, 231 P. 398, 401 (1924)).  A waiver is "the 
intentional relinquishment of a known right that must be manifested in some 
unequivocal manner."  Jensen v. 
Fremont Motors Cody, Inc., 2002 WY 173, ¶16, 58 P.3d 322, 327 (Wyo. 2002) 
(citing Baldwin v. Dube, 751 P.2d 388, 392 (Wyo. 1988)).  The language of the waiver is clear and 
unambiguous:  The parties intended 
that the policy would not cover any treatment for O'Donnell's cervical spine or 
any related conditions "now or in the future."  While the policy also included a 
standard clause on the coverage of preexisting conditions, the structure of the 
policy clearly indicates intent by the parties to treat the cervical spine 
condition differently from any other preexisting conditions O'Donnell may have 
had.  In other words, the policy 
considered the preexisting conditions clause applicable to other conditions 
exclusive of O'Donnell's cervical spine.  
To conclude that the preexisting conditions clause in the policy had any 
relation to the cervical spine condition would render the existence of the 
waiver superfluous in clear contravention of the parties' explicit intent 
otherwise.

 

[¶13]   As the district court noted, since 
the preexisting conditions clause had no relevance to the waiver, the 1997 
endorsement that modified the definition of a preexisting condition had no 
effect on "the coverage status for treatment of [O'Donnell's] cervical spine 
condition because the waiver precluded any coverage for that condition  
regardless of whether it was a preexisting condition under the policy."  An amendment or modification to an 
agreement leaves intact those provisions of the original agreement not expressly 
or impliedly superseded.  Tejani 
v. Allied Princess Bay Company, 204 A.D.2d 618, 612 N.Y.S.2d 227, 228-29 
(N.Y.A.D. 2 Dept. 1994); 17A C.J.S. Contracts § 408 (1999).  The 1997 endorsement to the policy 
clearly did not expressly supersede the waiver.  Since the waiver was originally intended 
to operate separately from the preexisting conditions clause, there is no basis 
for finding an implied repeal of the waiver.

 

[¶14]   The 1997 endorsement to O'Donnell's 
policy that amended the definition of a preexisting condition tracks the 
language found in HIPAA at 42 U.S.C. § 300gg(a).  This section of HIPAA applies to group 
insurance policies.  O'Donnell 
contends that the incorporation of the definitional language for preexisting 
conditions into her policy indicates an intent by Blue Cross to adopt all of the 
provisions relating to group policies.  
From that proposition, she argues that the section of HIPAA in question 
precludes use of waivers or exclusions to permanently deny coverage of a 
preexisting health condition and, accordingly, the waiver is no longer 
valid.  O'Donnell's argument fails 
for several reasons.  First, as we 
have already noted, the preexisting conditions clause of her policy is separate 
from the waiver and has no effect on it.  
Thus, the adoption of a new definition for preexisting conditions based 
on HIPAA is irrelevant to the validity of the waiver.

 

[¶15]   Second, O'Donnell's policy is an 
individual, not a group, policy.2  The policy was not purchased through an 
employer or any other group.  
O'Donnell purchased it on her own initiative.  With respect to individual policies, the 
relevant portion of HIPAA provides:

 

(a)   Guaranteed 
availability

(1)   In 
general

Subject 
to the succeeding subsections of this section and section 300gg-44 of this 
title, each health insurance issuer that offers health insurance coverage (as 
defined in section 300gg-91(b)(1) of this title) in the individual market in a 
State may not, with respect to an eligible individual (as defined in subsection 
(b) of this section) desiring to enroll in individual health insurance coverage 

(A)    decline 
to offer such coverage to, or deny enrollment of, such individual; 
or

(B)    impose 
any preexisting condition exclusion (as defined in section 300gg(b)(1)(A) of 
this title) with respect to such coverage.

(2)   Substitution 
by State of acceptable alternative mechanism

The 
requirement of paragraph (1) shall not apply to health insurance coverage 
offered in the individual market in a State in which the State is implementing 
an acceptable alternative mechanism under section 300gg-44 of this 
title.

 

42 
U.S.C. § 300gg-41(a)(1) & (2).  
HIPAA bans the imposition of any preexisting condition exclusion in an 
individual health insurance policy unless a state has implemented an acceptable 
alternative mechanism under the Act.  
Wyoming has implemented such an alternative mechanism through WHIP at 
Wyo. Stat Ann. §§ 26-43-101 through 26-43-113. WHIP provides coverage for 
persons who have been denied coverage for preexisting conditions.  § 26-43-103(a)(iii).  The implication of this statutory design 
is that exclusions of preexisting conditions are permissible in Wyoming under 
HIPAA because of the enactment of "an acceptable alternative mechanism."  There is nothing in HIPAA or WHIP that 
prohibits an insurance provider from utilizing a waiver to accomplish that 
objective.  Indeed, to find 
otherwise would render the referenced provision of HIPAA meaningless for there 
would be no reason for a program like WHIP to even exist.

 

[¶16]   We have found the language of the 
waiver and the policy to be unambiguous.  
Accordingly, O'Donnell's argument for the application of the "reasonable 
expectations" doctrine, which considers the reasonable expectations of the 
person applying for the insurance, is unavailing:

 

Where 
insurance contract terms are clear and unambiguous, the "reasonable 
expectations" of the contracting parties are irrelevant to contract construction 
issues.  A rule of construction that 
considers the reasonable expectations of the parties is of no assistance where 
the policy terms are clear and unambiguous.  We hold that the contract terms here are 
clear and unambiguous, and rules of construction such as the doctrine of 
reasonable expectations are inapplicable.

 

Ahrenholtz 
v. Time Insurance Company, 
968 P.2d 946, 950 (Wyo. 1998) (quoting Pribble v. State Farm Mutual 
Automobile Insurance Company, 933 P.2d 1108, 1113-14 (Wyo. 
1997)).

 

[¶17]   In an alternative argument, 
O'Donnell contends that Blue Cross owed an affirmative duty to disclose the 
availability of alternative insurance coverage for her cervical spine condition 
through WHIP.  O'Donnell asserts 
that there is a special relationship between an insured and an insurer, and that 
where an insured has inadequate coverage for a particular peril and where the 
insurer is aware of that circumstance but fails to advise the insured of the 
lack of coverage or alternative available coverage that could have prevented the 
loss, then the insurer is liable for any loss.  O'Donnell also contends that Blue Cross 
had a particular duty to advise her about the existence of WHIP arising out of 
Blue Cross' status as administrator of that program.  Since Blue Cross breached this duty by 
not informing her of the alternative coverage, O'Donnell argues that Blue Cross 
should be estopped from denying coverage for her cervical spine surgery under 
her policy.

 

[¶18]   Among cases from other 
jurisdictions, O'Donnell cites to our decision in Darlow v. Farmers Insurance 
Exchange, 822 P.2d 820 (Wyo. 1991).  
In that case, the insured argued that the insurer violated its duty of 
good faith and fair dealing by intentionally failing to inform the insured of 
available policy benefits and misrepresenting the insured's rights under the 
policy.  Id., at 827.  We held that:

 

[T]he 
duty of good faith and fair dealing includes informing an insured as to coverage 
and policy requirements when it is apparent to the insurer that (1) there is a 
strong likelihood that its insured only can be compensated fully under her own 
policy and (2) the insured has no basis to believe that they must rely upon 
their policy for coverage.

 

822 P.2d  at 828 (citing Gatlin v. Tennessee Farmers Mutual Insurance Company, 
741 S.W.2d 324, 326 (Tenn. 1987)).  
In that case, we concluded that the insurer had not violated its duty 
because the insured knew and understood the terms of the policy.  We also noted that the insured had never 
requested an explanation of the medical benefits payments under the policy so 
there was no occasion for the insurer to advise the insured of those rights 
under the policy and, hence, no violation of any obligation to inform the 
insured.  Id., at 
828-29.

 

[¶19]   O'Donnell misconstrues the nature 
of the duty identified in Darlow and the cases she cites from other 
jurisdictions.  The duty set forth 
in those cases and in Darlow requires an insurer to inform an insured of 
the scope of coverage provided in the policy.  The duty is specific to the particular 
policy issued.  In certain 
circumstances, this duty may encompass an affirmative obligation on the part of 
the insurer when it is aware that certain activities of the insured may result 
in exposure to risks not covered under the current insurance policies.  In its essence, the duty requires an 
insurer to clearly inform an insured not only what is covered by the policy but 
what is not.  The duty does not 
include a requirement to inform an insured of alternative coverage available 
from the insurer or third parties.  
The insurer must only inform the insured of the scope of coverage 
provided in the policy, and it is incumbent upon the insured to act on that 
information.  If an insured knows 
and understands the terms of the policy, then there can be no violation of the 
duty.  822 P.2d  at 828-29.  The cases from other jurisdictions cited 
by O'Donnell are consistent with this proposition.  See, e.g., Louwagie v. State 
Farm Fire and Casualty Company, 397 N.W.2d 567 (Minn. App. 1986) (remanded 
for trial on question of the liability of insurer for selling policy to insured 
that did not provide coverage for workers' compensation where it was alleged 
that insurer knew at the time the policy was purchased that insured sought such 
coverage); United Farm Bureau Mutual Insurance Company v. Cook, 463 N.E.2d 522 (Ind. App. 1 Dist. 1984) (insurer breached duty to exercise 
reasonable care by failing to inform insured that insurance policy did not cover 
project after insured inquired about coverage); Campbell v. Valley State 
Agency, 407 N.W.2d 109 (Minn. App. 1987) (remanded for trial on question 
whether insurer breached duty to inform insured on the adequacy of coverage 
offered under the policy).

 

[¶20]   Like the insured in Darlow, 
O'Donnell knew and understood her policy.  
There is no question that she was aware that her policy did not cover her 
cervical spine condition.  Within 
this context, it is irrelevant that Blue Cross is the administrator of 
WHIP.  Since it is unquestioned that 
O'Donnell knew her condition was not covered, there simply was no violation by 
Blue Cross of any obligation to inform her.  822 P.2d  at 
828-29.

 

CONCLUSION

 

[¶21]   The waiver signed by O'Donnell 
excluding coverage of her cervical spine condition was not invalidated by the 
subsequent amendments to her insurance policy.  The district court's decision is 
affirmed.

 

FOOTNOTES

 

  1The district court ruled that O'Donnell had not established a sufficient 
factual basis to support her claims of promissory or equitable estoppel.  O'Donnell did not address the district 
court's ruling on this claim in her appellate brief.  Generally, an issue not raised or 
supported with cogent argument in an appellant's brief is considered waived. 
Doctors' Company v. Insurance Corporation of America, 864 P.2d 1018, 1028 
(Wyo. 1993).  Although Blue Cross 
addressed this issue in its brief, we consider the claim waived and will not 
address it.

 

  2HIPAA 
differentiates between "individual health coverage" and "group health 
coverage."  Individual health 
coverage "means health insurance coverage offered to individuals in the 
individual market."  42 U.S.C. § 
300gg-91(b)(5).  The "individual 
market" is defined as "the market for health insurance coverage offered to 
individuals other than in connection with a group health plan."  42 U.S.C. § 300gg-91(e)(1)(A).  In contrast, group health coverage is 
defined as insurance obtained in connection with a plan offered by an 
employer.  42 U.S.C. § 
300gg-91(a)(1) & (b)(4).  There 
is no question that O'Donnell obtained her insurance policy as an individual and 
not through an employer.