Opinion ID: 2039455
Heading Depth: 1
Heading Rank: 1

Heading: Failure to make necessary findings.

Text: Defendant claims that the trial court failed to make necessary findings on the issues of custodial care and whether the insurance was supplemental to Medicare. Although the insurance policy is clearly designed to supplement Medicare as well as other insurance benefits, there is no indication in the policy itself that the definitions of custodial care or skilled nursing care are dependent upon the so-called Medicare Act. [3] Thus, although the court could have used the definitions of the terms involved as developed in Federal cases interpreting the Medicare Act as persuasive authority, the finding that the contract was supplemental to Medicare was not necessary. Defendant also claims that the trial court was required to make a finding that it used Medicare regulations and guidelines to determine coverage under the policy in question. This claim is difficult to understand unless defendant is requesting a finding that the Medicare regulations are a part of the contract. It is uncontroverted that defendant did use such guidelines, but its claim is defective in two respects. First, the regulations introduced by defendant which may be relevant to the present case are those which define skilled nursing and personal services care, 20 CFR § 405.127 (1975). These regulations were not adopted until September 24, 1975, and were not a part of the contract which was originally issued in 1966. Secondly, even if the regulations had been adopted earlier and had been in effect at the time of the policy's issuance, the trial court should have found that they were not a part of the policy. Application of such detailed guidelines would result in restrictive coverage. The defendant, had it desired to include definitions found in the regulations, could have expressly done so. An insurance policy is to be construed liberally in favor of the insured, Weum v. Mutual Benefit Health & Accident Assn., 237 Minn. 89, 54 N.W.2d 20 (1952). The defendant cannot insist on the strict Medicare definitions of skilled nursing services. [4] The insurance policy at issue in the present case excludes coverage for custodial care services, and defendant's denial of benefits was based on this exclusion. The trial court, however, made no express findings on the question of whether the care provided Ms. Olson was custodial care. It found instead that she was in need of and was provided with skilled nursing care. If the court concluded that the terms skilled nursing care and custodial care were mutually exclusive, then the findings it actually made were impliedly a finding that the care given Ms. Olson was not custodial care. We believe this to be a reasonable interpretation of the trial court's findings. This interpretation is borne out by application of the principle that the denial of a proposed amended finding is equivalent to a contrary finding. Roberge v. Cambridge Cooperative Creamery Co., 248 Minn. 184, 195, 79 N.W.2d 142, 149 (1956); Kloster Madsen, Inc. v. Tafi's, Inc., 303 Minn. 59, 62, 226 N.W.2d 603, 606 (1975). Defendant's motion for amended findings included the following proposal: XVI. That the services provided to plaintiff after December 1, 1973, constitute custodial care. The court denied defendant's motion and thus found that the services did not constitute custodial care.