No. 13102
I N THE SUPREME COURT OF THE STATE OF M N A A
OTN
1976
MELVIN FASSIO and MARITA J U N E FASSIO,
husband and w i f e ,
P l a i n t i f f s and Respondents,
-vs -
M N A A PHYSICIANS' SERVICE,
OTN
Defendant and A p p e l l a n t .
Appeal from: D i s t r i c t Court o f t h e F o u r t h J u d i c i a l D i s t r i c t ,
Honorable E. Gardner Brownlee, Judge p r e s i d i n g .
Counsel o f Record:
For Appellant :
Hughes, B e n n e t t , C a i n and S t u a r t K e l l n e r , Helena,
Montana
Alan Cain a r g u e d , Helena, Montana
F o r Respondents:
Garnaas, H a l l , R i l e y and P i n s o n e a u l t , M i s s o u l a ,
Montana
H. J . P i n s o n e a u l t a r g u e d , and R o b e r t J. R i l e y ,
a p p e a r e d , M i s s o u l a , Montana
- --
Submitted: March 3 , 1976
Decided : > . I 1 1 1976
Filed : yfiy 11 1976
Hon. W. W. L e s s l e y , D i s t r i c t J u d g e , s i t t i n g i n p l a c e of M r .
Chief J u s t i c e James T . H a r r i s o n .
The F a s s i o s a r e t h e p a r e n t s of a d a u g h t e r Marita, who
i s a f f l i c t e d by a c y t o g e n e t i c d i s o r d e r known a s Mongolism;
t h e y w e r e members o f t h e Montana P h y s i c i a n s ' S e r v i c e ; t h e i r
membership s e c u r e d t o them and t o M a r i t a c o v e r a g e f o r enumerated
h o s p i t a l , m e d i c a l and s u r g i c a l s e r v i c e s .
W e a r e concerned s p e c i f i c a l l y w i t h t h r e e h e a l t h c o v e r a g e
a g r e e m e n t s r u n n i n g from A p r i l t o A p r i l f o r t h e y e a r s 1971, 1972
and 1973. The t r e a t m e n t s a d m i n i s t e r e d t o M a r i t a by t h e p h y s i c i a n
Dr. T u r k e l were on J u n e 1 8 , 1971, J a n u a r y 7 , 1972, November 1 7 ,
1972 and f i n a l l y o n J u l y 23, 1973. On August 4 , 1971 t h e re-
s p o n d e n t s were informed t h a t t h e a p p e l l a n t would deny payment of
t h e c l a i m f o r t h e above s e r v i c e s .
The case w a s t r i e d t o t h e d i s t r i c t c o u r t w i t h o u t a j u r y .
B e f o r e s u b m i s s i o n o f t h e proposed f a c t s , t h e judge i s s u e d what
he termed "Opinions" t h a t s t a t e d h i s p o s i t i o n and d e c i s i o n ; a f t e r
s u b m i s s i o n of f i n d i n g s by t h e a t t o r n e y s , t h e judge a d o p t e d h i s
"Opinions" a s t h e c o u r t ' s f i n d i n g s o f f a c t and c o n c l u s i o n s of
law. The judge concluded t h a t t h e r e s p o n d e n t F a s s i o s s h o u l d be
r e i m b u r s e d i n f u l l f o r a l l t h e m e d i c a l s e r v i c e s performed f o r
t h e i r i n f a n t d a u g h t e r by D r . Henry T u r k e l , M.D. of D e t r o i t ,
Michigan.
Montana P h y s i c i a n s ' S e r v i c e a p p e a l s . Its appeal i s
premised on t h e p r o p o s i t i o n t h a t t h e s e r v i c e s s o performed by
Dr. T u r k e l f o r M a r i t a w e r e w o r t h l e s s and u n n e c e s s a r y and t h e r e f o r e
n o t c o v e r e d by t h e h e a l t h agreements.
The d i s t r i c t c o u r t ' s "Opinions" d e s c r i b e p o i g n a n t l y t h e
F a s s i o s ' odyssey i n t r e a t m e n t of t h e i r d a u g h t e r i n t h e s e words:
" I n J a n u a r y , 1970, t h e P l a i n t i f f s herein suffered
one of l i f e ' s most u n f o r t u n a t e t r a g e d i e s when
t h e i r daughter w a s born w i t h a chromosome d e f i c -
iency r e s u l t i n g i n a c o n d i t i o n commonly known as
Mongolism. They were immediately advised to
commit the girl to the Montana School for the
Retarded at Boulder, Montana; within a week
they were at that institution talking with Dr.
Philip Pallister, one of the country's leading
medical experts on Mongolism. Dr. Pallister
gave them a prescription which was based on his
experience and knowledge, and which would bring
about a one hundred per cent improvement in the
baby's future. That prescription was: 'Take the
baby home and give her lots of love and attention.'
The Plaintiffs have followed his advice and their
daughter's present physical, emotional and mental
state is witness to its effectiveness. After the
first year passed the Plaintiffs began more
earnestly to search for more help from the medical
profession. This search lead them to Dr. Henry
Turkel of Detroit, Michigan. * * * "
The record shows that the plaintiffs were referred to Dr.
Turkel by Dr. J. M. Law, M.D. of Missoula, Montana; that they
made their first visit to Dr. Turkel on June 28, 1971; his charge
was $750; and that this claim and his subsequent claims of $3,000
for reimbursement were denied by Montana Physicians' Service.
The appellant told the Fassios its denial was justified because
the services as performed by Dr. Turkel were at best "experimental"
and "unacceptable medical practice".
Chronologically and timewise, Dr. Turkel's treatments
of June 28, 1971 and January 7, 1972 are clearly within the ambit
of the April, 1971 contract; the treatment of November 17, 1972
is covered by the 1972 agreement and the final treatment of July
23, 1973 is under the time limit of the 1973 agreement.
We will discuss the three contracts separately. Consider-
ing the 1971 contract we cut through the verbiage and go directly
to the portion entitled "Group Major Medical Endowment." We find
the controlling definition of the covered medical expenses in
Subsection 1 of Section A in the following language:
* * * usual, customary, and reasonable charges
incurred by a Member for necessary services per-
formed or prescribed by a licensed Doctor of
Medicine for an illness * * *."
Section C of the endorsement called Exclusions and
L i m i t a t i o n s s p e l l s o u t t h e l i m i t i n g o r n u l l i f y i n g l a n g u a g e on
t h e coverage s t a t e d . The p e r t i n e n t l a n g u a g e of t h e e x c l u s i o n
s t a t e s no b e n e f i t s s h a l l be p r o v i d e d f o r " s e r v i c e s and s u p p l i e s
n o t i n c i d e n t a l t o o r n e c e s s a r y f o r t r e a t m e n t of i l l n e s s . "
The p r o v i s i o n s of t h e 1972 c o n t r a c t a r e i d e n t i c a l w i t h
t h e 1971 agreement.
The b a s i c p r o v i s i o n s and e x c l u s i o n s l i m i t a t i o n o f b o t h
t h e 1971 and 1972 agreements l i m i t reimbursement by t h e c a r r i e r ,
Montana P h y s i c i a n s ' S e r v i c e , t o n e c e s s a r y s e r v i c e s performed
o r p r e s c r i b e d by a l i c e n s e d Doctor o f Medicine. Dr. Turkel i s
a Doctor o f Medicine and he, a s a Medical D o c t o r , performed
t h e s e r v i c e s f o r M a r i t a ; a more c o m p e l l i n g f a c t i s t h a t t h e
F a s s i o s were s e n t t o D r . Henry T u r k e l by r e f e r r a l o f D r . J . M .
Law, M.D. of M i s s o u l a , Montana.
W e l o o k a t t h e problem of c h a r a c t e r i z a t i o n of t h e a c t u a l
s e r v i c e s performed by D r . T u r k e l f o r M a r i t a . The a p p e l l a n t de-
s c r i b g t h o s e s e r v i c e s a s " w o r t h l e s s and u n n e c e s s a r y " and f u r t h e r
of no r e a l v a l u e i n t r e a t i n g t h e c o n d i t i o n s f o r which t h e y w e r e
prescribed. I t i s admitted t h a t t h e d i s t r i c t c o u r t ' s "Opinions"
a r e n o t complimentary a s t o D r . T u r k e l l s s e r v i c e s and h i s f e e s
shocked t h e c o u r t , b u t it d o e s s t a t e :
" * * * This i l l n e s s , t h i s b i r t h d e f e c t c a l l s f o r
a t t e n t i o n from a m e d i c a l d o c t o r j u s t a s much a s
any o t h e r t e r m i n a l i l l n e s s . I t may even be t h a t
t h e m e d i c a l a t t e n t i o n c a n d o n o t h i n g more t h a n
t o a s s u r e t h e parents t h a t everything i s being
done t h a t c a n be done, b u t even t h i s i s i m p o r t a n t
f o r t h e p r o p e r a d m i n i s t r a t i o n by t h e p a r e n t s o f
D r . P a l l i s t e r ' s original prescription."
The n o t i c e o f d i s a l l o w a n c e from Montana P h y s i c i a n s 1 S e r -
v i c e s i g n e d by D r . James J . McCabe d i d n o t c a l l D r . T u r k e l ' s
s e r v i c e s " w o r t h l e s s and u n n e c e s s a r y " and o f no r e a l v a l u e i n
t r e a t i n g t h e c o n d i t i o n s f o r which p r e s c r i b e d , r a t h e r t h e s e r v i c e s
performed under t h e 1971 and 1972 c o n t r a c t s were d e s c r i b e d a s
"unacceptable medical p r a c t i c e " o r "experimental."
W e c o n s i d e r t h e word n e c e s s a r y . I t i s an a d j e c t i v e
and t h e r e f o r e i s a t e r m of d e g r e e . Implicit i n the use of t h e
word n e c e s s a r y i n t h e a r e a o f m e d i c a l s e r v i c e s , a s p r e s c r i b e d
by a m e d i c a l d o c t o r , i s t h e c o n c l u s i o n t h a t s u c h s e r v i c e s a r e
n e c e s s a r y and more p a r t i c u l a r l y a n e c e s s a r y e x p e n s e when s o p r e -
s c r i b e d o r performed. An e x h a u s t i v e s e a r c h o f c a s e s and l a w
r e v i e w a r t i c l e s f a i l s t o g i v e u s a n e x a c t d e f i n i t i o n o f t h e word
necessary. I n t h i s c o n t e x t w e m i g h t s a y t h e word n e c e s s a r y i s
ambiguous, b u t w e d o n o t s o h o l d a s it i s u s e d i n t h e s e c o n t r a c t s
i n t h e c o n t e x t o f m e d i c a l s e r v i c e s performed o r p r e s c r i b e d by a
physician. I n any e v e n t w e must l i b e r a l l y c o n s t r u e it f o r t h e
b e n e f i t of t h e p a r t y i n s u r e d under t h e s e agreements. Travelers
I n s . Co. v . American C a s u a l t y Co., 1 5 1 Mont. 1 9 8 , 441 P.2d 1 7 7 ;
W i l l i a m s v . I n s . Co. o f N o r t h America, 150 Mont. 292, 434 P.2d
395; S t . P a u l F i r e & Marine I n s . Co. v . Thompson, 150 Mont. 1 8 2 ,
433 P.2d 795, 2 7 ALR 3d 1048; J o n e s v . V i r g i n i a S u r e t y Co., 145
Mont. 440, 401 P.2d 570; A l e k s i c h v . Mutual A c c . A s s ' n . , 118
Mont. 223, 164 P.2d 372, 162 A.L.R. 263.
The l a n g u a g e o f t h e s e i n s u r a n c e c o n t r a c t s w a s c a r e f u l l y
chosen. T h i s was done i n t h e a b s e n c e o f t h e F a s s i o s and u s e d t o
c a r e f u l l y l i m i t and p r o t e c t t h e c a r r i e r , Montana P h y s i c i a n s '
S e r v i c e , a g a i n s t extended l i a b i l i t y . I f Montana P h y s i c i a n s '
Service wishes t o exclude o r l i m i t t h e r i s k c o n t r a c t e d f o r , then
l e t them d o s o i n words t h a t l e a v e no d o u b t . The l a w i s c l e a r
i n t h i s j u r i s d i c t i o n t h a t exclusion c l a u s e s a r e construed narrowly
against the insurer. Atcheson v . S a f e c o I n s u r a n c e Company, 165
Mont. 239, 527 P.2d 549; S t a t e Farm Mutual Automobile Co. v .
P a r t r i d g e , 109 C a l . R p t r . 811, 514 P.2d 1 2 3 .
W e a r e d e a l i n g w i t h group h e a l t h i n s u r a n c e c o n t r a c t s .
The c o v e r a g e a g r e e m e n t s f o r t h e y e a r s 1 9 7 1 and 1972 p r o v i d e r e i m -
bursable coverage t o t h e F a s s i o s f o r necessary medical s e r v i c e s .
A s i n t h e i n s t a n t c a s e t h o s e s e r v i c e s a r e p r e s c r i b e d and p e r -
formed by a l i c e n s e d Doctor o f Medicine. T h a t s h o u l d b e and
i s s u f f i c i e n t t o m e e t t h e demands o f t h e l a n g u a g e o f t h e 1 9 7 1
and 1972 c o n t r a c t s .
The 1973 h e a l t h c o v e r a g e a g r e e m e n t c o n c e r n s i t s e l f w i t h
t h e s e r v i c e s r e n d e r e d o n J u l y 23, 1973. The l a n g u a g e i n t h i s
agreement i s i n t h e main t h e same a s t h e l a n g u a g e c o n t a i n e d i n
t h e a g r e e m e n t s o f 1 9 7 1 and 1972; t h e r e i s however a n i n t e r e s t i n g
change o r a d d i t i o n . W e f i n d t h i s change o r a d d i t i o n i n Sub-
s e c t i o n (J) of t h e exclusion a r t i c l e :
" * * * and s u r g e r y o r m e d i c a l t r e a t m e n t which
i s e x p e r i m e n t a l i n n a t u r e o r which d o e s n o t
c o n s t i t u t e accepted medical p r a c t i c e . " (Emphasis
supplied.)
The a p p e l l a n t , Montana P h y s i c i a n s 1 S e r v i c e , s u p p l i e d t h i s l a n g u a g e
i n t h e 1973 c o v e r a g e a g r e e m e n t ; t h e s e l f - s a m e l a n g u a g e u s e d i n t h e
l e t t e r s o f James J . McCabe, S e c r e t a r y o f Montana P h y s i c i a n s 1 S e r -
vice. T h i s s p e c i f i c change u s i n g t h e word " e x p e r i m e n t a l " and t h e
phrase "unacceptable medical p r a c t i c e " s p e c i f i c a l l y excludes t h e
s e r v i c e s b a r g a i n e d f o r and p a i d f o r by t h e F a s s i o s from D r . T u r k e l
on J u l y 23, 1973. It follows then t h a t t h e r u l e s of c o n s t r u c t i o n
a s w e have a p p l i e d them on t h e a g r e e m e n t s o f 1 9 7 1 and 1972 a r e n o t
applicable.
C o n s i d e r i n g t h e 1973 agreement it i s s t a t e d i n 55 A.L.R.
"The g r o u p i n s u r a n c e c o n t r a c t i s p e c u l i a r i n t h a t
it i s made by t h e i n s u r e r and t h e employer, i n -
s t e a d o f between t h e i n s u r e r and t h e i n s u r e d , a s
i n o t h e r c o n t r a c t s of insurance, thus a f f e c t i n g
f o u r p a r t i e s , - - t h e i n s u r e r , t h e employer, t h e
i n s u r e d , and t h e b e n e f i c i a r y . * * *"
The f a c t s o f t h e i n s t a n t c a s e c l e a r l y emphasize t h e pecu-
l i a r i t y of s u c h a n i n s u r a n c e p o l i c y . The f i r s t o n e i n t h i s series
o f h e a l t h a g r e e m e n t s u n d e r which t h e F a s s i o s w e r e t h e b e n e f i c i a r i e s
and M i s s o u l a County C o u r t h o u s e , MissoulatMontana was t h e group-
employer c o n t i n u e d i t s c o v e r a g e from A p r i l 1 5 , 1971 t o A p r i l 1 5 ,
1972; t h e c o v e r a g e was c o n t i n u e d w i t h a n i d e n t i c a l p o l i c y from
A p r i l 1 5 , 1972 t o A ~ i 1 5 , 1973; t h e n s u d d e n l y and a d m i t t e d l y
l
w i t h o u t n o t i c e t o t h e b e n e f i c i a r i e s , F a s s i o s , t h e e x c l u d i n g word
and p h r a s e " e x p e r i m e n t a l " and " u n a c c e p t a b l e m e d i c a l p r a c t i c e "
were i n s e r t e d .
premium of
I t i s e l e m e n t a l t h a t no/group insurance is v a l i d unless
it s a t i s f i e s t h e a p p l i c a b l e s t a t u t o r y r e q u i r e m e n t s . Whitney v.
C o n t i n e n t a l L i f e and A c c i d e n t Company, 8 9 I d a . 96, 403 P.2d 573.
The c o n c e r n and s u p e r v i s i o n o f t h e l e g i s l a t u r e i s found i n t h i s
p e r t i n e n t p o r t i o n o f s e c t i o n 40-4102(2), R.C.M. 1947:
" ( 2 ) A provision t h a t t h e insurer w i l l furnish
t o t h e p o l i c y h o l d e r f o r d e l i v e r y t o e a c h employee
o r member o f t h e i n s u r e d group, a s t a t e m e n t i n
summary form o f t h e e s s e n t i a l f e a t u r e s of t h e
i n s u r a n c e c o v e r a g e * * *."
The mandate of t h i s s e c t i o n i s t h e p r o t e c t i o n of t h e b e n e f i c i a r y
r i g h t s under a group i n s u r a n c e p o l i c y . I t requires information
and knowledge s o t h e i n d i v i d u a l member o f t h e c o v e r e d g r o u p w i l l
know. True i t r e l a t e s t o t h e agreement a t i t s i n i t i a l s t a g e ; b u t
t h i s b a s i c and e q u i t a b l e " r u l e of n o t i c e " a p p l i e s w i t h e q u a l
f o r c e t o t h e f a c t s o f t h e 1973 agreement. The even t e n o r o f t h e
1971 and 1972 c o n t r a c t s was broken u n i l a t e r a l l y a s t o t h e F a s s i o s
and t h e i r d a u g h t e r Marita. I t had a p e r s o n a l impact a s t h e words
o f e x c l u s i o n used w e r e t h e v e r y words used by Montana P h y s i c i a n s t
S e r v i c e i n i t s n o t i c e o f d i s a l l o w a n c e under t h e 1971 and 1972
contracts. Group l i f e i n s u r a n c e c a s e law d o e s n o t a l l o w s u c h
change w i t h o u t n o t i c e on t h e t h e o r y t h a t a v e s t e d i n t e r e s t i s
involved. Fagan v . John Hancock Mutual L i f e I n s . Co., 200 F.Supp.
1 4 2 , 1 4 4 ; Hayes v . E q u i t a b l e L i f e A s s u r . Soc., 235 Mo.App. 1261,
150 S.W.2d 1113; ( i n f r a ) Lindgren v . M e t r o p o l i t a n L i f e I n s . Co.,
57 I l l . A p p . 2 d 315, 206 N.E.2d 734. The r u l e of group l i f e i n -
s u r a n c e a s t o v e s t i n g , of c o u r s e , w i l l n o t a p p l y h e r e , b u t it
d o e s i n d i c a t e t h e c o n c e r n o f c o u r t s on g r o u p i n s u r a n c e .
I n a group i n s u r a n c e s i t u a t i o n a s h e r e s u r e l y t h e r e
must be a n o t i c e t o a l l o w t h e b e n e f i c i a r y o f s u c h g r o u p i n -
surance t h e opportunity t o secure o t h e r coverage elsewhere;
p a r t i c u l a r l y where t h e r i s k i s s o s p e c i f i c a l l y and a b r u p t l y
excluded. Poch v . E q u i t a b l e L i f e A s s u r . Soc. o f U n i t e d S t a t e s ,
343 Pa. 119, 22 A.2d 590, 142 A.L.R. 1279.
Hayes v . E q u i t a b l e L i f e A s s u r . S o c . , 235 Mo.App. 1261,
150 S . W . 2d 1113, i s p e r s u a s i v e on t h i s p o i n t . The f a c t s i n
t h a t c a s e w e r e t h a t t h e g r o u p p o l i c y was renewed a n n u a l l y f o r
t h e y e a r s 1927 - 1931 i n c l u s i v e w i t h o u t change. In the year
1932 t h e c o n t r a c t was m o d i f i e d t o e x c l u d e a d i s a b i l i t y c l a u s e .
The company i n v o l v e d i n t h e g r o u p i n s u r a n c e p o l i c y s e n t o u t
b o o k l e t s and l e t t e r s and p o s t e d n o t i c e s on t h e b u l l e t i n b o a r d
t h a t n o t i f i e d employees o f t h e change. The b e n e f i c i a r y d e n i e d
a c t u a l n o t i c e , a s no l e t t e r had been s e n t t o him p e r s o n a l l y ;
e v e n u n d e r t h o s e f a c t s t h e c o u r t h e l d t h a t t h e i n s u r e d w a s en-
t i t l e d t o c o v e r a g e under t h e o l d p o l i c y ; t h e c o u r t i n e f f e c t
h e l d t h a t t h e o l d p o l i c y remained i n f o r c e a s t o t h a t p a r t i c u l a r
beneficiary.
I t i s n o t p l a c i n g t o o l a r g e a b u r d e n upon t h e i n s u r e r
Montana P h y s i c i a n s ' S e r v i c e t o s a y t h a t t h e y , by t h e a b r u p t
change i n t h e 1973 c o n t r a c t w i t h o u t n o t i c e o f a n y k i n d t o t h e
F a s s i o s , i n e f f e c t r e v i v e d t h e t e r m s o f t h e 1972 c o n t r a c t by
s u c h f a i l u r e t o comply w i t h t h e s t a t e l a w and w i t h s i m p l e f a i r -
n e s s and e q u i t y t o t h e b e n e f i c i a r i e s . The t i m e s p a n from A p r i l
1 5 , 1973 ( t h e b e g i n n i n g d a t e o f t h e 1973 a g r e e m e n t ) t o J u l y 23,
1973 ( t h e t i m e t h e s e r v i c e s w e r e c o n t r a c t e d w i t h D r . T u r k e l )
was a m e r e 69 d a y s . The F a s s i o s u n d e r t h i s g r o u p i n s u r a n c e
p o l i c y had been p a y i n g monthly payments s t a r t i n g September 1 5 ,
1 9 7 1 and c o n t i n u i n g t o and p a s t J u l y 23, 1973.
W do n o t h o l d by t h i s d e c i s i o n a s t o t h e 1973 a g r e e -
e
ment t h a t i n group i n s u r a n c e c o v e r a g e t h e i n d i v i d u a l g r o u p bene-
f i c i a r i e s must have w r i t t e n p e r s o n a l n o t i c e w i t h e a c h change,
b u t w e do h o l d t h a t i n k e e p i n g w i t h t h e t h r u s t of s e c t i o n 40-
4102, a summary form of t h e e s s e n t i a l f e a t u r e s of t h e change
s h o u l d be b r o u g h t t o t h e a t t e n t i o n of t h e b e n e f i c i a r i e s under
t h e group i n s u r a n c e . Obviously a s p e c i f i c e x c l u s i o n of c o v e r a g e
i s such a change; e q u a l l y o b v i o u s i s t h a t e q u i t y and f a i r n e s s
demand s u c h knowledge be made a v a i l a b l e t o t h e b e n e f i c i a r i e s .
W affirm.
e
s i t t i n g i n p l a c e of
t i c e ~ a m e sT . ~arr$n:
Chief JUS-
I
W e concur:
Justices /
Mr. J u s t i c e John C. H a r r i s o n c o n c u r r i n g and d i s s e n t i n g .
I concur and d i s s e n t . Clearly t h e p l a i n t i f f s are
e n t i t l e d t o c o v e r a g e f o r t h e f i r s t v i s i t made t o D r . T u r k e l .
The r e f e r e n c e was made by a l i c e n s e d p r a c t i t i o n e r o f t h i s s t a t e
and t h e r e was no way t h a t t h e y c o u l d d e t e r m i n e t h a t t h e t r e a t m e n t
performed would be found t o be " e x p e r i m e n t a l " and " u n a c c e p t a b l e
medical p r a c t i c e " a f t e r t h e f a c t .
However, t h e v i s i t s t h e r e a f t e r f o l l o w e d n o t i c e by t h e
a p p e l l a n t t h a t s u c h t r e a t m e n t would n o t be p a i d f o r , and t h e
r e a s o n s why t h e s e r v i c e s would be d e n i e d . Respondents, i n s p i t e
of t h i s n o t i c e c o n t i n u e d t r e a t m e n t a t t h e i r own r i s k . I would
n o t a u t h o r i z e any r e c o v e r y f o r t h e v i s i t s f o l l o w i n g t h e n o t i c e
from a p p e l l a n t .