Opinion ID: 1134320
Heading Depth: 1
Heading Rank: 1

Heading: does the mississippi insurance guaranty association cover major medical/health and accident insurance policies?

Text: The scope of protection of MIGA is set forth in Miss. Code Ann. § 83-23-105 (1972), which provides that: This article shall apply to all kinds of direct insurance except life, title, surety, disability, credit, mortgage guaranty, and ocean marine insurance. (emphasis added) The underlined portion of the above statute is critical to any determination of the bounds of MIGA's protection in that an exception must appear plainly from the express words of the statute, and where no exception is made in positive words, the presumption is that the Legislature intended none. State v. Heard, 246 Miss. 774, 151 So.2d 417 (1963). Consequently, MIGA by its own terms insures against the insolvency of all insurance companies omitting only those specifically excepted. The crux of the issue presented is whether or not a major medical insurance policy can be equated to disability insurance so as to fall under a specific exception to the MIGA resulting in no coverage of the claim in issue. In reviewing the disability exception of § 83-23-105, there must be given due regard to this Court's long-standing rule that where a statute is plain and unambiguous the rules of construction will not be resorted to. Heard, supra . The inquiry thus becomes whether disability insurance is an ambiguous term. In this regard, disability insurance is defined as insurance coverage purchased to protect an insured during periods of incapacity from working. Black's Law Dictionary 416 (5th ed. 1979). Disability insurance protects an insured against the loss of earning capacity. Couch, Encyclopedia of Insurance Law, § 1.18 (2d ed. 1984). Further, disability insurance insures against the inability to pursue a livelihood arising either from accident or illness. Appleman on Insurance, § 23 at p. 60. The Social Security Act makes provision for disability insurance benefits which afford coverage resulting from the  inability to engage in any substantial gainful activity by reason of any medically determined physical or mental impairment. 42 U.S.C. § 423. As can readily be seen, the common thread running through all of the above definitions is that disability insurance exists for the sole purpose of compensating an insured who, due to accident or illness, has suffered a loss of wage earning capacity. The majority opinion in the case sub judice would find that the term disability contains a latent ambiguity in that it is susceptible to more than one definition and meaning. In drawing this conclusion, the majority would draw from the comments to the National Association of Insurance Commissioners (NAIC) Model Bill, upon which MIGA is based, which equates and makes synonymous the terms disability and accident and health. This idea stems from the fact that the California Insurance Guaranty Act, upon which the NAIC uniform bill is based, excepted in its original form disability insurance which the California courts have interpreted as being synonymous with health and accident insurance. In regard to California's definition of disability it must be noted that Appleman, in his treatise at § 23 states that, Some states, such as California, use the term `disability insurance' as a generic term to embrace all forms of both accident and sickness insurance. This is not wholly accurate.  So too, the path the majority would follow is inaccurate. Additionally, the Mississippi Legislature never adopted any of the comments to the NAIC bill equating disability to accident and health. The above facts become important when it is remembered that there can be no construction of a statute unless such is ambiguous. Heard, supra . As seen previously, the great weight of authority defines disability in a uniform and concise manner which does not equate to the simple payment of medical expenses covered under a major medical insurance policy. Further, the MIGA under its own terms states that it should be construed liberally so as to provide a mechanism by which claimants or policyholders of an insolvent insurance company may avoid financial loss. See § 83-23-103 and § 83-23-107. When this matter is considered jointly with this Court's rule that an exception to a statute cannot be created by construction, Roberts v. Mississippi Republican Party Executive Committee, 465 So.2d 1050 (Miss. 1985), it becomes readily apparent that the sounder course to follow would be to give disability its universally understood meaning. In fact, this Court has long adhered to the principle that words as used in a statute will be given their ordinary and familiar meaning. Allgood v. Bradford, 473 So.2d 402 (Miss. 1985); Green v. Weller, 32 Miss. 650 (1856). One final matter needs to be laid to rest. The majority opinion looks to the passage of the Mississippi Life & Health Guaranty Association Act, Miss. Code Ann. § 83-23-201, et seq. (Supp. 1987) as an indication that the Legislature did not intend to insure health policies by enacting the MIGA. This rule of construction called pari materia, (and it is just a rule of construction) views the broad statutory scheme so that all statutes may be read as being harmonious with other statutes. As with any other rule of construction, pari materia is utilized only when a statute is found ambiguous. Hubbard v. McKey, 193 So.2d 129 (Miss. 1966). Use of this rule of construction to find legislative intent, as the majority opinion does, again hinges on first making the inaccurate finding that disability is ambiguous.