Opinion ID: 465282
Heading Depth: 1
Heading Rank: 2

Heading: Doctrine of Reasonable Expectations

Text: 11 Appellants next contend that the doctrine of reasonable expectations mandates that coverage be extended under policy 3636. They rely on the New Mexico Supreme Court's decision in Pribble v. Aetna Life Insurance Co., 84 N.M. 211, 501 P.2d 255 (1972). In Pribble, an Aetna agent promised that the policy at issue would cover the insured's medical expenses after two other policies had been fully used. A previous representation by the same Aetna agent had been honored by the company. Aware of this precedent and in reliance on the agent's specific promise about coverage of his medical care, the insured incurred substantial additional medical bills. Aetna then denied coverage. The New Mexico Supreme Court reversed summary judgment for the insurer, finding a genuine issue of material fact about the authority of the Aetna agent to revise the policy. 12 We conclude that Pribble is distinguishable from the instant case because the facts here do not give Mr. Bryant a reasonable expectation of coverage of the expenses incurred by his son. Nothing in the record suggests that Mr. Bryant placed Robert at St. Francis in reliance upon representations made by Woodmen or its agents. Indeed, Mr. Bryant had no conversations with his agent, Mr. Jackson, about Robert's treatment until after Robert had been admitted to St. Francis. Record, vol. 4, at 160. By that time, Mr. Bryant had already agreed to maintain his son at St. Francis for at least a school year and to pay for his son's expenses. Moreover, in the discussions between Mr. Jackson and Mr. Bryant, Mr. Jackson said nothing to Mr. Bryant about eligible medical expenses or about psychiatric care benefits. Mr. Bryant contends that a reasonable expectation arose because Mr. Jackson represented that policy 3636 was far superior to the major medical policy from which Mr. Bryant converted in 1981. This contention is without merit. The initial major medical policy did not cover any institutional treatment for mental and nervous conditions; accordingly, if Mr. Bryant formed any expectation based on this conversation, it had to be that policy 3636 provided no in-patient psychiatric coverage whatsoever. We conclude that Mr. Bryant can claim no coverage under that policy on the basis of the doctrine of reasonable expectations. 13 In light of our conclusion that policy 3636 provided no coverage for the care rendered at St. Francis, Mr. Bryant's argument that he is entitled to continued coverage under that policy is moot. Next, we turn to the issues raised by the trial court's rulings on the issues of fraud, bad-faith dealing, damages from emotional distresss and economic loss, and punitive damages.