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TOTEDO v. BANKERS LIFE & CAS. CO.

September 23, 1987

Dennis J. Totedo, an incompetent, by the Union National Bank Of Pittsburgh and Gloria A. Totedo, Co-Guardians, Plaintiffs,
v.
Bankers Life And Casualty Company, Defendant



The opinion of the court was delivered by: MENCER

 GLEN E. MENCER, United States District Judge

 On November 5, 1986, the plaintiff, Totedo, filed a complaint against the defendant, Bankers Life and Casualty Company (Bankers Life), demanding reinstatement under an insurance policy. In April, 1987, the parties filed stipulations to all the material facts. In July, 1987, the parties filed cross-motions for summary judgment which are now pending before this court.

 Stipulated Facts

 As a result of his two years of continuous disability, Totedo met the general eligibility requirements for Medicare under the provisions of Subchapter II of the Social Security Act, 42 U.S.C. § 426(b)(2)(A). However, Totedo's medical expenses were also covered by an automobile no-fault insurance policy. Under 42 U.S.C. § 1395y(b)(1), the no-fault benefits precluded Totedo from collecting Medicare benefits.

 The two pertinent parts of the Catastrophic Health Expense Policy read as follows:

 
"RENEWAL CONDITIONS -- RENEWABLE AT OUR OPTION
 
. . . Renewal is also subject to the following:
 
(A) For adults, subject to the Conversion Privilege, we won't renew coverage beyond: . . .
 
2. The date they become eligible or qualified for benefits under Medicare."
 
"CONVERSION PRIVILEGE
 
A. If this coverage ends because a Family member becomes eligible for Medicare we will issue a new policy to that person. We won't ask that person to prove good health or meet other qualifications. You must apply for it and pay the initial premium. The new policy will be on a form we are then issuing which provides ...

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