Court Opinion

ID: 9715466
Source: CourtListenerOpinion
Date Created: 2023-08-26 06:06:22.080386+00
Date Added: 2024-06-11T18:23:35.032240
License: Public Domain

SHIRLEY S. ABRAHAMSON, J.
(concurring in part and dissenting in part). The parties have stipulated that *456the policy ‘in question contains no express subrogation provision. P. 442, swpra. Were such a provision contained in the policy, it probably would have been given effect. Associated Hospital Service, Inc. v. Milwaukee Automobile Mutual Insurance Company, 33 Wis. 2d 170, 147 N.W.2d 225 (1967).
The insurance policy before the court is a single group policy of insurance incorporating multiple coverages— life, accident and health, hospitalization and physicians service benefits insurance and medical expense insurance extended coverage. It is a participating contract under which the employer may receive dividends. This court has not previously analyzed such a policy in terms of the doctrine of equitable (a/k/a legal) subrogation which evolved in'an earlier era of insurance.
A primary function of the doctrine of equitable subrogation is to prevent an insurer from paying and an insured from receiving more than the parties bargained for in the contract of insurance. The determinative question in each case is whether the policy should be interpreted to mean that the insurer will reimburse the insured for losses not otherwise compensated or will reimburse the insured upon the occurrence of an event, notwithstanding that the loss associated with that event may be reimbursed from some other source. The indemnity/investment analysis of the policy used by the majority is a means of deciding this question.
The distinction between indemnity and investment contracts for purposes of determining legal subrogation is a tenuous one, and courts have been viewed as inept in applying it. Kimball and Davis, The Extension of Insurance Subrogation, 60 Mich. L. Rev. 841 (1962). This case demonstrates the futility of attempting to fit today’s multitude of policies into indemnity/investment *457boxes.1 Courts should not be reviewing each coverage in the myriad of multiple coverage health insurance policies to determine the insurance company’s right to subrogation.
On the facts presently before the court, I would hold that in the absence of an express subrogation clause, the insurance company has no subrogation rights. If the insurance company desires subrogation in this kind of policy, it should disclose its intent to assert subrogation rights through express policy language. Cf. Gross v. Lloyds of London Ins. Co., 121 Wis. 2d 78, 358 N.W.2d 266 (1984). When subrogation rights are expressly set forth in the policy, the premiums can then be calculated properly, and the opportunity for either the insured or the insurer to receive a windfall is minimized.
If the court were to adopt the result I reach, it should come as no surprise to the insurance industry. From our prior cases, insurance companies know: first, that certain express subrogation clauses used by insurance companies writing medical and expense payment coverage and medical payment coverage have been held *458valid;2 second, that a company’s failure to include an express subrogation clause puts the company at the risk of a court’s affixing the label “investment” to the policy, thereby deciding that the company has no subrogation rights; and third, that “this state follows a policy of strict construction of insurance policies, resolving ambiguities against the insurer and in favor of the insured.” P. 450, supra.
For the reasons set forth, I concur in part and dissent in part.

 As the insurer implies (Brief, p. 17.), and as the majority apparently holds (p. 440, supra), different provisions of the policy may dictate different resolutions of the indemnity/investment question necessary to a determination of equitable subrogation. The majority’s language that only portions of the policy are examined, and not the policy as a whole, pages 449, 450, supra, to determine the nature of the diverse coverages and the intent of the parties, if read literally, contravenes the generally accepted doctrine of contract interpretation. This language should not, I believe, be read literally. I believe it is the intent of the majority to state that it need not label the policy in toto as either an indemnity or an investment contract. Rather, it can consider each type of coverage in the policy independently, examining the policy provisions applicable to that coverage as well as the policy provisions applicable to all coverages.

 Associated Hospital Service, Inc. v. Milwaukee Automobile Mutual Insurance Co., 33 Wis. 2d 170, 174-75, 147 N.W.2d 225 (1967).