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Connell v. Guarantee Trust Life Ins. Co.

The insurer was not entitled to summary judgment on the plaintiff's claim for medical benefits because a jury could reasonably conclude that her treatment did not relate to a pre-existing condition.

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This case arises out of the denial of insurance benefits to Caroline Connell by Guarantee Trust Life Insurance Company. The trial court granted summary judgment to Guarantee Trust, and Caroline and John Connell appeal. Because we conclude that genuine issues of material fact exist as to whether Caroline Connell had a preexisting condition excluding her from coverage, we reverse the trial court’s order insofar as it grants summary judgment to Guarantee Trust on the Connells’ breach of contract claim.

In September, 1994, Guarantee Trust issued a non-renewable blanket student accident policy to Georgia State University for the 1994-1995 school year. The following September, Guarantee Trust issued another policy for the 1995-1996 school year. Students could obtain insurance under the policies by applying for coverage and paying the required premiums. John Connell, a graduate student, and his wife Caroline Connell paid the premiums for coverage under these policies. On May 2, 1995, Mrs. Connell, pregnant at the time, discovered blood in her urine and underwent a KUB radiological x-ray that revealed kidney stones in her left kidney. Mrs. Connell received treatment for the kidney stones in May, 1996 and submitted claims for coverage for this treatment, which were denied. The Connells then filed this breach of contract action against Guarantee Trust seeking to recover benefits payable under the policies as well as bad faith penalties. Guarantee Trust answered and moved for summary judgment. The trial court granted the motion without explanation, and this appeal followed.

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