Opinion ID: 164315
Heading Depth: 3
Heading Rank: 4

Heading: Availability of clearer language

Text: 92 Ms. Fought next argues that there is certainly a clearer way to write a contract that would exclude coverage for complications from surgery. Indeed, she notes a district court case from this circuit that considered a contract with precisely that language: Pursuant to the Plan, long-term disability benefits ... are not payable for any[] ... [d]isability caused or contributed to by a Preexisting Condition or medical or surgical treatment of a Preexisting Condition.  Kaus v. Standard Ins. Co., 985 F.Supp. 1277, 1279 (D.Kan.1997) (emphasis added), aff'd, No. 97-3378, 1998 WL 778055 (10th Cir. Nov.5, 1998); see also Reinert, 15 F.Supp.2d at 595 (suggesting the redrafting of the exclusion to encompass all conditions relating to pre-existing illnesses so as to avoid similar claims). In addition, the exclusion might be drafted to cover bacterial infections. See, e.g., Lewin v. Metropolitan Life Ins. Co., 394 F.2d 608, 609 (3d Cir. 1968) (applying accident insurance policy). The district court acknowledged that the language may be clearer in Kaus  but it reasoned that the contract language here is broad enough to encompass the treatment received in this case. Aplt's App. at 15. 93 UNUM is a sophisticated party, and the plan's language is, on the whole, careful and thorough. The existence of policies, as in Kaus, that specifically deny coverage on the basis of complications from surgery lends support to the argument that it is unreasonable as a matter of law to conclude that the general language in Ms. Fought's contract encompasses the same result. UNUM had every opportunity to add the words or medical or surgical treatment of a Preexisting Condition, Kaus, 985 F.Supp. at 1279, but it did not do so. It is unreasonable to allow it to do so post facto, to the detriment of Ms. Fought and other insureds. 94 Given the Department's regulations invoking proximate cause, the illustration above, and the availability of clearer language, we conclude that the language of the exclusion provision in the contract should not be extended to the degree that UNUM attempts to do here. See 29 C.F.R. § 2590.701-3(a)(1)(i)(C), Example 4; Frerking, 760 F.Supp. at 881 (citing caselaw requiring a narrow interpretation of exclusion clauses).