Milburn v. Life Investors Insurance Company of America

511 F.3d 1285 (2008)

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Milburn v. Life Investors Insurance Company of America

United States Court of Appeals for the Tenth Circuit
511 F.3d 1285 (2008)

  • Written by Liz Nakamura, JD

Facts

Zella Milburn (plaintiff) purchased a long-term care insurance policy from Life Investors Insurance Company of America (LIICA) (defendant). Subsequently, Milburn moved into The Village on Lee, a licensed assisted-living facility in Oklahoma. The Village provided Milburn with daily personal care, medication assistance, and intermittent nursing care. Milburn submitted a claim for coverage to LIICA. LIICA denied the claim, stating that it only covered licensed nursing facilities, not assisted-living facilities. LIICA’s policy stated that it covered nursing facilities (1) that were licensed to primarily provide nursing care to inpatient residents; and (2) that provided 24-hour skilled nursing services, such as licensed nursing homes. LIICA’s policy did not specifically define “nursing facility.” By contrast, as an assisted-living facility, the Village was only licensed to provide unscheduled, intermittent nursing care to residents. Because the Village was not licensed to primarily provide skilled nursing care and therefore fell outside the policy’s coverage requirements, the district court rejected Milburn’s coverage claim. Milburn appealed.

Rule of Law

Issue

Holding and Reasoning (Per curiam)

Concurrence (Henry, J.)

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