N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C UIT HALAYNE KASOFF,

Pla i ntiff-Appe lla

nt,
v. B ANKER S LIFE AND C ASUALTY C OM PANY,

De fe nda n t-Appe l le e . No. 14-56925 D.C . No. 2:13-c v-08081-GAF-JEM
M EM O R ANDUM *

Appe a l from

the Unite d

Sta t e s Distric t C ourt for the C e ntra l Distric t of C a lifornia Gary A. Fe e ss, Distric t Judge , Pre siding Argue d and Subm i tte d

Oc tobe r 3, 2016 Pa sa de n a , C a l ifornia B e fore : D.W . NELSON a nd PAEZ, C irc uit Judge s, a nd B UC KLO, ** Distric t Judge
. Ha la

yne Ka soff (“ Ka soff” ) a

ppe a ls the distric t

c o urt’ s grant of sum

m ary judgm e nt in fa

vor of B anke rs Life and C a s ua l ty C om pa ny (“ B anke rs” ). W e have 

# FIL ED OCT 26 2016 M OLLY C. DW Y ER, CLERK U
. S

. CO URT O F APPEALS

* This disposition is not a ppropria te for public a t ion a

nd is not pre c e de nt e xc e pt a s provide d

by Ninth C irc uit R

ule 36-3.

* * The Honora

ble Ela ine E. B uc k lo, Unite d Sta t e s Distric t Judge for the Northe rn Distric t of Illinois, sitting by de signa tion.jurisdic tion pursua n t to 28 U.S.C . § 1291. W e re vie w de novo a distric t c ourt’ s gran t of sum

m ary judgm e n t, s e e e .g. , Fe l dman v . Allstate

Ins. C o ., 322 F.3d 660, 665 (9th C i r. 2003), a

nd we re ve rse and re m and. This a ppe a l boils down to the

m e aning of the te rm

“ Any One Pe riod of Expe nse ” in Ka soff’ s long-te rm insura nc e polic y . As sta

te d by the distric t c ourt,

“ doe s ‘ Any

One Pe riod of Expe nse ’ re quire a six m onth [wa shout] pe riod only with re spe c t to injurie s tha t a re re late d to the c ove ra ge -trigge ring injury , a s [Ka soff] a sse rts, or doe s it a pply to a ny injury whe the r or not re lat e d to the
c ove ra ge -trigge ring injury , a s [B an ke rs] a sse rts.” The distric t c ourt a gre e d with B anke rs’ inte rpre tat ion a

nd found the polic y

provision una

m b iguous. W e c onc lude that the polic y

provision is a

m b iguous a nd, a s a re sult, c onstrue it a ga i nst B anke rs. W e a pply the substa

ntive la w of C a lifornia
. C

one stoga Se rv

s. C orp. v . Ex e c . Risk Inde m., Inc
. 312 F.3d 976, 980-81 (9th C ir. 2002). As the re are no m a te ria l dispute d fa c ts, a

nd “ [b] e c a

use [in C a lifornia ] the inte rpre tation of a n insura nc e polic y is a que stion of la

w , we m ust m a ke our own indepe nde nt de te rm inat ion of the m e aning of the re le v ant c o n tra c t la ngua ge .” Id. a t 981. Insura nc e polic ie s a

re subje c t to the “ ordina

ry rule s of c ontra c tua l inte rpre tation.” Bank

of the W e st v . Supe r ior C

ourt , 833 P.2d 545, 551-52 (C a l. 1992) (in ba

nk). The purpose of c ontra c t inte rpre tation is to “ give e ffe c t to the
2m

utua l inte ntion of thepa

rtie s” by looking a t the “ writing a lone .” C a l. C iv. C ode §§ 1636, 1639; se e also U nite d N at. Ins. C o. v . Spe c trum W

orldw i de , Inc
. , 555 F.3d 772, 776-77 (9th C ir. 2009). A polic y provision is a

m biguous if “ it is c a

pa ble of two or m ore c onstruc tions, both of whic h a re re a sona

ble .” W alle r v . Truc k

Ins. Ex c h., Inc ., 900 P.2d 619, 627 (C a l. 1995). W he n a n am biguity e xists, the provision should be

“ inte rpre t e d m ost strongly a ga inst the pa

rty who c a use d the
unc e rta inty

to e xist.” C a l. C iv. C o de § 1654. M ore ove r, in the c onte xt of insura nc e polic ie s, “ ‘ any

am biguous te rm s a

re re solve d in the insure d s’ fa vor,
c onsiste n t with theinsure ds’ re a sona ble e xpe c tations.’ ” E.M.M.I. Inc . v . Zuric h Am. Ins. C

o ., 84 P.3d 385, 389 (C a l. 2004) (quoting Safe c o Ins. C o. v . Robe rt S . 28 P.3d 889, 893 (C a l. 2001)). The te rm “ Any One Pe riod of Expe nse ” is a m biguous a s it ha s at le a st two
re a s ona ble c onstruc t ions. Se e W

alle r , 900 P.2d a

t 627. One re a sona

ble
c onstruc tion of this provision is tha t whic h B anke rs offe rs a

nd with whic h the distric t c o urt a gre e d: a

n insure d is e ligible for a ne w pe riod of e xpe nse only a fte r a six-m o nth wa shout pe riod during whic h she re c e ive s no long-te rm c are se rvic e s (i.e . hom e he a lth c are , re spite c are , pe rsona l c are ) re late d to the be ne fit-trigge ring injury . Unde r this inte rpre tation, Ka soff would not be c o ve re d for the kne e injury
a t issue in this litiga

tion be c a u s e she re c e ive s long-te rm c are se rvic e s re lating to a
3c hronic shoulde r injury (for whic h she ha s a lre a dy re c e ive d the m a xim

um be ne fits
a va ila ble unde r the polic y ). Anothe r re a sona ble c onstruc tion is tha

t whic h Ka soff offe rs: a n insure d is subje c t to a

six-m onth wa shout pe riod only with re spe c t to injurie s tha

t a re c a usa lly re lat e d to the initia l be ne fit-trigge ring injury . Unde r Ka soff’ s inte rpre tation, he r kne e injury should bec ove re d a

nd subje c t to a

se pa ra te pe riod of e xpe n s e be c a

use he r shoulde r and kne e injurie s a re c a usa lly unre l a te d. As the te rm

“ Any One Pe riod of Expe n se ” is a m biguous, under C a lifornia la w it m ust be c onstrue d in fa

vor of Ka soff, the insure d , c onsiste nt with he r
re a s ona ble e xpe c tations. Safe c o , 28 P.3d a t 895. In othe r words, would a
re a s ona ble insure d e xpe c t he r long-te rm c are polic y

to c o ve r e xpe nse s re late d to a n injury e ve n though she

ha s re a c he d the m a xim

um be ne fits for a

pre vious injury

and ha s not y e t sa

tisfie d the wa shout pe riod with re spe c t to tha t pre v ious injury ? Se e id . The answe r is y e s . Thus, we c onc lude tha t the distric t c ourt e rre d in its inte rpre tation of “ A ny One Pe riod of Expe nse .” S e e Safe c o , 28 P.3d a

t 895. Having c onc lude d tha

t B anke rs wa s e ntitle d to sum m ary judgm e nt on Ka soff’ s bre a c h

of c ontra c t c la i m , the distric t c ourt sum

m arily dism isse d Ka soff’ s
c la im s for bre a c h of the im plie d c ove na nt of good fa ith a

nd fa ir de a l ing,
c onve rsion, a

nd e lde r a buse . In light of our disposition, we re insta te those c la im s.

4For the a bove re a s ons, we re ve rse and re m and for furthe r proc e e dings
c onsiste n t with this disposition. R EVER SED and REM ANDED for furthe r proc e e d i ngs.

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