Spaid v. Integon Indemnity Corp. – Ambiguous Auto Insurance Policies
One tactic is deployed before the crash even happens. Insurers draft policies with a host of loopholes and verbose exceptions that allow them to deny coverage on a variety of different grounds. However, as the recent ruling by Florida’s First District Court of Appeal in Spaid v. Integon Indemnity Corp. reveals, this can backfire. This is particularly true when the language of the policy is ambiguous, and could be interpreted in a number of different ways.
The 1997 Florida Supreme Court foundation is Berkshire Life Insurance Co. v. Adelberg That was a case in which the insured held a private disability insurance policy with the defendant. When the plaintiff suffered a work-related knee injury, he sought benefits from the insurer. He was terminated from his post, as he could no longer do the job. He found other, lesser-paying work, but continued to collect benefits because he could no longer work in his previous position. The insurer sought to deny benefits on the grounds that he was not totally disabled.
At issue before the state high court in that case was the language of the policy was ambiguous with regard to occupational terminology. The court held it is a tenant of Florida insurance law that and insurer, as the party drafting the policy, be bound by it. Further, where the language is ambiguous, it is to be “construed liberally in favor of the insured and strictly against the insurer.”
This brings us back to the Spaid case. Here, the plaintiff was involved in a car accident, a result of which she incurred more than $10,000 in medical bills. Per the policy she held with her insurer, there was an extended personal injury protection clause indicating that “all medical expenses” would be covered. However, the base personal injury protection clause indicated the limit of liability for medical coverage was $10,000 per accident.
It was on this basis the insurer denied the injured woman coverage of anything over $10,000. The trial court sided with the insurer in affirming denial of judgment.
However, the disparity in the policy language was the center of the dispute.
The insurer argued that the intent of the policy language was that all medical expenses would be covered – until that $10,000 limit was reached.
The injured woman argued that per the extended PIP endorsement, the insurer made no reference to a limit on medical coverage liability. To the extent that this specific clause might be seen as ambiguous, she argued, the court had a duty to construe that ambiguity in her favor and against the insurer.
The appellate court agreed. It noted the insurer may well have intended for the coverage to cut off at the $10,000 mark. However, because the policy was not clear on this point, the court had no choice but to reverse the grant of summary judgment and remand the case for further proceedings.
How We Can Help
If you, a friend or a family member find themselves in a situation such as this, please call the Law Office of Scott A. Ferris, P.A. at 305 670-3330 right away. Scott A. Ferris, Esq. is a licensed civil law attorney who has been practicing law since 1987. He is available whenever you need him to pursue your rights. Please learn about our firm at www.FerrisLawFirm.com.