Henry R. Seawell, III and Kathryn D. Seawell v. Colonial Life & Accident Insurance Company

Mobile, Alabama insurance law lawyers represented the Plaintiff who sued on bad faith breach of insurance contract theories.



In 2002, the Seawells purchased a supplemental cancer insurance policy from Colonial.1 The policy is intended to

supplement traditional health insurance policies and cover additional costs of cancer treatment.



The parties contest the meaning of the part of the policy that provides a benefit for oral chemotherapy drugs. The provision reads: "Oral chemotherapy will be limited to the cost of the prescription for the day you have the prescription filled, up to the report amount shown in the Schedule Page.” The Schedule Page then

shows:



RADIATION

/CHEMOTHERAPY

THE AMOUNT CHARGED UP TO

$400/DAY; ORAL CHEMOTHERAPY

LIMITED TO $1200/MONTH



Kathryn was diagnosed with metastatic breast cancer in late 2016. She takes an oral chemotherapy drug called Ibrance once daily for twenty-one days, followed by seven days off. She usually fills her prescription once every twenty-eight days and receives a twenty-one-day supply.



Each month, the retail price for Kathryn's Ibrance exceeds $10,000. The Seawells' health insurance covers most of the cost— her copay for a monthly prescription is typically no more than $10.



Kathryn submits a claim to Colonial each time she fills her prescription, typically once but sometimes twice per month, depending on where the twenty-eight-day cycle falls. Colonial has reimbursed the Seawells $400 each time Kathryn fills her prescription since her claim was first approved in 2016.



The Seawells contend that Colonial breached the terms of the policy by only reimbursing them $400 or $800 a month. They

interpret the "cost of the prescription for the day you have the prescription filled” to mean that the policy covers the cost of each daily dose of a "multi-day prescription.”



Based on this interpretation, the Seawells sued Colonial for breach of contract, maintaining that they are "entitled to the entire USCA11 Case: 24-142324 Opinion of the Court 24-14232 $1,200 monthly benefit” because Colonial must reimburse them for "the per-day cost of a multi-day prescription” up to the $1,200 maximum.

The district court granted Colonial’s motion for summary

judgment, finding the policy’s language unambiguously covers

only the cost of the prescription on the day the prescription is filled.



Affirmed