Opinion ID: 1687117
Heading Depth: 1
Heading Rank: 2

Heading: extended comprehensive medical benefits

Text: No benefits will be payable to you or your insured Dependent after insurance terminates, except that: (1) benefits will be payable for charges incurred or services performed before the termination of insurance; (2) if at the time insurance terminates you or your insured Dependent are Totally Disabled ... because of a disability which began while insured, you or your insured Dependent will be entitled to such benefits after termination of insurance as would have been payable under the Policy for the Injury or Sickness which caused the Total Disability except for the fact that insurance terminated; however, the extension of benefits will not apply after the earliest of the following dates: (a) the first date on which you or your insured Dependent are not Totally Disabled; (b) the date at the end of the period of time immediately following the date insurance terminated which is equal to the number of months that you were continuously insured immediately before termination of insurance; (c) the date you or your insured Dependent become covered or insured under any other group policy (whether issued by the Insurance Company or any other insurer) or any group basis service or prepayment plan; or (d) 90 days after insurance terminates. When Mrs. Newton sought extended coverage for her totally disabled son under this provision, United refused to extend coverage, contending that because Tracy was covered as a dependent under his father's Blue Cross-Blue Shield group policy, paragraph (c) precluded extended coverage under United's policy. Paragraph (c) is susceptible of being read to say that extended coverage terminates at a date in the future when the insured or the dependent becomes (sometime after termination of the policy) covered by another insurer. If it means there is no extended coverage for persons who are already insured by another insurer at the time of termination, as United contends, it would have been simple to say so. United created the ambiguity, so it must accept the construction most favorable to the insured. Employers Ins. Co. of Alabama, Inc. v. Jeff Gin Co., 378 So.2d 693 (Ala.1979); Alabama Farm Bureau Ins. Co. v. McCurry, 336 So.2d 1109 (Ala.1976). We hold that United was required to notify Mrs. Newton that the policy terminated on March 31, 1983, and that her dependent son is now entitled to the extended medical benefits provided for by the extended comprehensive medical benefits provision of the policy. We acknowledge that our treatment of the issues disregards to some degree the exact questions certified to us. However, we were expressly invited by Judge Pittman to respond in this manner. In his certification of the questions, Judge Pittman wrote: Our statement of these questions is not designed to limit the inquiry of the Supreme Court of Alabama. `[T]he particular phrasing used in the certified question is not to restrict the Supreme Court's consideration of the problems involved and the issues as the Supreme Court perceives them to be in its analysis of the record certified in this case. This latitude extends to the Supreme Court's restatement of the issue or issues and the manner in which the answers are to be given, whether as a comprehensive whole or in subordinate or even contingent parts.'  Martinez v. Rodriquez, 394 F.2d 156, 159 n. 6 (5th Cir.1968). CERTIFIED QUESTIONS ANSWERED. TORBERT, C.J., and MADDOX, FAULKNER, JONES, BEATTY, ADAMS and HOUSTON, JJ., concur. ALMON, J., not sitting.