An ambiguously-worded insurance policy was cited by Florida’s First District Court of Appeal in its reversal of an earlier summary judgment in favor of the insurer. Instead, the court ruled, the plaintiff’s request for coverage of all reasonable medical expenses related to the crash – without limit of liability – should be honored.
The case of Spaid v. Integon Indemnity Corp. is just one of many examples in personal injury cases where the exact language of the insurance policy requires careful analysis by an experienced Fort Lauderdale car accident lawyer.
According to the background facts provided in the court records, the crash in question occurred in February 2011 in Pensacola. The plaintiff/policy holder was injured and incurred more than $10,000 in medical bills as a result.
She requested coverage from her auto insurer of all medical expenses, per the terms of the extended personal injury protection provision of the policy. However, the insurer said the most it would pay was $10,000 because that was the liability limit for PIP and Extended PIP coverage.
The plaintiff filed a lawsuit against her insurer, seeking a declaratory judgment requiring the insurer to pay all reasonable medical expenses relating to the crash. She argued the policy contained no reference to liability limits for medical expenses in either the Declarations or PIP Endorsement pages. She asserted that for the insurer to deny her claims would be a contradiction of the plain terms of the policy. Further, she argued that to whatever extent the policy was ambiguous, this had to be construed against the insurer, which had drafted the policy.
The trial court, after a short hearing, sided in favor of the insurer, finding the extended PIP provision didn’t modify the $10,000 liability limit contained in the basic PIP provision.
The plaintiff appealed.
The First District Court of Appeal first noted the 1997 ruling in Berkshire Life Ins. Co. v. Adelberg, in which justices held the insurer, as the writer of the policy, is bound by the language and that interpretation of the policy is to be construed liberally in favor of the insured and against the insurer.
While the declarations page of the policy clearly states the most the insurer will pay for any one person in any one crash is $10,000, the extended PIP coverage page indicates, “the percentage of medical expenses covered are increased to 100 percent.”
The court ruled that this extended coverage portion of the policy creates an ambiguity regarding how much can be recovered for medical expenses. The insurer argued 100 percent of medical expenses would be covered – but only up to $10,000. The trial court agreed, but the appellate court opinion differed. While conceding that may have been the intent of the insurer, the fact is, the insurer was required to express its intention clearly and without ambiguity.
The insurer failed in this obligation. As such, the case was remanded with a directive for the trial court to grant the summary judgment motion of the plaintiff.
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Spaid v. Integon Indemnity Corp., June 18, 2014, Florida’s First District Court of Appeal
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