Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-88-01351/USCOURTS-ca10-88-01351-0/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 

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PI LB D 

UNITED STATES COURT OF APPEALS Ufiited St&tU;g v:.;ua of At;peals 

'f emh Cir::vit 

FOR THE TENTH CIRCUIT uov ,. (· 1089 

PROFESSIONAL INVESTORS LIFE INSURANCE 

COMPANY, 

Plaintiff-Appellant, 

v. 

EMPLOYERS REINSURANCE CORPORATION, 

Defendant-Appellee. 

ROBERT L. f-IOECKER 

) Clerk 

) 

) 

) 

) 

) No~ 88-1351 

) (D.C. No. 85-C-332-E) 

) (N.D. Okla.) 

) 

) 

ORDER AND JUDGMENT* 

Before McKAY, SEYMOUR, and TACHA, Circuit Judges. 

After examining the briefs and appellate record, this panel 

has determined unanimously that oral argument would not materially 

assist the determination of this appeal. See Fed. R. App. P. 

34(a); 10th Cir. R. 34.1.9. 

submitted without oral argument. 

The case is therefore ordered 

Plaintiff appeals from an adverse judgment entered by the 

district court following a bench trial of its suit on a 

reinsurance treaty issued by defendant. We concur in the district 

* This order and judgment has no precedential value and shall 

not be cited, or used by any court within the Tenth Circuit, 

except for purposes of establishing the doctrines of the law of 

the case, res judicata, or collateral estoppel. 10th Cir. R. 

36.3. 

Appellate Case: 88-1351 Document: 01019988543 Date Filed: 11/06/1989 Page: 1 
court's determination that plaintiff failed to establish a loss 

payable under the terms of the parties' agreement. 

Plaintiff contends that a $200,000 settlement paid to its own 

insured, a cancer patient who had brought an action against 

plaintiff in state ·court seeking policy limits and punitive 

damages for wrongful termination of a major medical policy issued 

by plaintiff and reinsured by defendant, gave rise to an 

enforceable claim against defendant for reimbursement under the 

parties' reinsurance treaty. The provisions of the reinsurance 

treaty pertinent to this case impose a reimbursement obligation on 

defendant only where plaintiff actually pays, settles, or 

satisfies a judgment for a claim for benefits under the reinsured 

policy. The documents and testimony submitted below establish 

that plaintiff's policy with its insured imposes an obligation 

only to pay for medical expenses as they are incurred; plaintiff's 

insured had no entitlement under the policy to claim, collect,· or 

settle for expected future medical expenses. Consequently, 

plaintiff's settlement with its insured did not fall within the 

pertinent provisions of the reinsurance treaty, because it did not 

involve a claim for incurred medical expenses 1 and, thus, did not 

resolve a claim for benefits payable under the reinsured policy. 

1 Actually, plaintiff did establish payment of some $8,700 for 

the incurred medical expenses of its insured, but, as the district 

court recognized, that sum fell far below the $20,000 retention on 

its reinsurance coverage. 

2 

Appellate Case: 88-1351 Document: 01019988543 Date Filed: 11/06/1989 Page: 2 
The judgment of the United States District Court for the 

Northern District of Oklahoma is AFFIRMED. 

ENTERED FOR THE COURT 

PER CURIAM 

3 

Appellate Case: 88-1351 Document: 01019988543 Date Filed: 11/06/1989 Page: 3