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LESSARD v. METROPOLITAN LIFE INS. CO.12/28/1989
sed above, the policy at issue in Bush contained a recoupment provision. That provision read as follows:
If it is determined that any benefits paid to an Employee under
the Group Policy should not have been paid or should have been
paid in a lesser amount, the Insurance Company shall be
entitled to a refund of the amount of the overpayment. If the
Employee fails to repay such amount . . ., the Insurance
Company may recover the amount of the overpayment by making an
appropriate deduction or deductions from any future benefit
payment or payments payable to the Employee under the Group
Policy.
Id. at 232. (emphasis in original). The plaintiff argued that " t the time of payment the benefits were not benefits that `should not have been paid,'" but were absolutely due her at the time she received them. Id. at 233. Metropolitan argued that the language should be read to include "situations in which later developments render the earlier payments incorrect;" according to Metropolitan, such a situation was one "in which benefits `should have been paid in a lesser amount[.]'" Id. at 232-3. The court held that the above provision, when read with the integration of benefits provisions, was ambiguous and thus resolved the ambiguity in favor of the plaintiff.
We find the analysis in Bush persuasive. Further, plaintiffs' construction in this case is strengthened by the absence of any future benefits. Accordingly, we vacate that portion of the Superior Court's order granting Metropolitan's motion for summary judgment on count VI and order that plaintiffs' motion for summary judgment be granted on the issue of liability subject only to a determination of the statute of limitation defenses set forth in defendant's answer.
The entry is:
Order affirmed in part and vacated in part.
Remanded for further proceedings consistent with the opinion herein.
All concurring.
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