Court Opinion

ID: 9481990
Source: CourtListenerOpinion
Date Created: 2023-08-05 08:37:14.875735+00
Date Added: 2024-06-11T17:48:42.171372
License: Public Domain

BRIGHT, Senior Circuit Judge,
dissenting.
I respectfully dissent. As the saying goes, “Ask the wrong question and you will get the wrong answer.”
*507Contrary to Provident’s assertion, the question presented is not “when did the illness begin?” Rather, the question to be answered is “when [did] sufficient symptoms exist[ ] to allow a reasonably accurate diagnosis of the case[?]” State Nat’l Life Ins. Co. v. Stamper, 228 Ark. 1128, 312 S.W.2d 441, 442 (1958). Presented with the proper question, the answer is obvious: symptoms sufficient to allow a reasonably accurate diagnosis did not exist until the time when the doctors actually diagnosed Kirk as having bacterial endocarditis, well after the inception of coverage.
In Stamper, the parties disputed coverage under a policy which became effective in July 1954. The insured had a small bony growth or knot on the back of her head for most of her life which had caused no ill effects. In August of 1955, approximately a year after coverage began, however, the insured began to suffer pain in the neck and shoulders due to an increase in the size of the bony growth and sought medical attention. The question presented was whether the cause of the insured’s sickness originated prior to thirty days following the effective date of coverage. Stamper, 312 S.W.2d at 442. If so, the policy excluded coverage.
The trial court found for the insured and the Arkansas Supreme Court affirmed. Id. After setting forth the standard quoted by the majority, see supra p. 505, the court concluded that: “it appears conclusive that [the insured] did not have any condition causing disability which manifested itself within thirty days from the effective date of the policy.” Stamper, 312 S.W.2d at 442. Thus, although the bony growth existed prior to coverage, it did not qualify as a pre-existing condition because it did not manifest itself as a problem until after coverage began.
In contrast, the Arkansas Supreme Court has affirmed the denial of coverage where the symptoms did not increase after coverage began. See Lincoln Income Life Ins. Co. v. Milton, 242 Ark. 124, 412 S.W.2d 291 (1967). In Milton, the insured purchased her policy in July 1965. At that time, the insured’s unknown condition of an abnormal and underactive thyroid made her “feel bad” and had interfered with her menstrual cycle for over a year. Later, in November 1965, the insured sought hospitalization and was diagnosed as suffering from a thyroid deficiency.
The insurance company denied coverage and the Arkansas Supreme Court upheld its actions. Id. 412 S.W.2d at 292. According to the court, the company properly denied the claim where there was “no indication that [the insured’s] affliction changed for the worse between the issuance of the policy in July and her hospital confinement in November.” Id. (emphasis added).
In reaching its conclusion, the Milton court distinguished Stamper and similar cases favoring the policyholder as follows:
In those cases, and in many others to the same effect, the insured had some supposedly trivial infirmity or abnormality when the policy took effect. Later on, however, the condition changed for the worse and for the first time either actually became, or became diagnosable as, a sickness or disease falling within the coverage of the policy. The insured’s right to protection under the contract was properly upheld.

Id.

This case presents a record of an illness appearing to be relatively minor in scope, controlled and apparently healed by antibiotics. Kirk’s more severe symptoms from his condition, as the insured’s in Stamper, did not manifest themselves to Kirk or his doctors until June or July of the first policy year, a month or more after the inception date of the policy. Thus, the precondition fell within the language of Stamper as “latent, inactive, and ... not discovered” at the time or before the policy began. Stamper, 312 S.W.2d at 442.
The crucial factual findings made by the district court indicate that Dr. Henry Kirby, Kirk’s treating physician, saw Kirk several times in March preceding the issuance of the policy, diagnosed the illness as an infection and prescribed antibiotics. The illness subsided during the next two months. No one has alleged that Dr. Kirby acted negligently or incompetently in failing to order an echocardiogram earlier. *508This evidence establishes that sufficient symptoms did not exist prior to July 1988, to allow a reasonable diagnosis of bacterial endocarditis. Kirk’s condition requiring hospitalization and surgery simply did not manifest itself as the problem until July 1988, when the symptoms warranted conducting an echocardiogram and such disclosed the precise illness.
The majority errs by relying on the 20/20 hindsight of the doctors who saw Kirk in July 1988. See supra p. 506 (“In Dr. Barlow’s opinion, Kirk's medical history indicated that the infection had probably been present for about three months prior to surgery_ Dr. Monson testified that based upon the medical history given to her by Kirk and his wife, Kirk had been sick for approximately three months.”) The issue turns on when a reasonable diagnosis could have been made, not when, with the benefit of subsequent testing, a doctor can ascertain the illness began. Certainly, with the incubation period of some diseases, a doctor could determine how long the disease has been present even though, at the date of onset, the disease was virtually undetectable.
Accordingly, I believe the record establishes that Kirk’s infection did not manifest itself until after the policy was issued and thus I would reverse and award Kirk proper insurance benefits.