THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, APPELLANT,
v.
ROBERT BELLAR, APPELLEE
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Prudential Insurance appeals a summary judgment granting coverage to a self-employed husband injured during employment under his wife's group health insurance policy. The court reverses, holding that the policy's exclusionary clause unambiguously bars coverage for injuries arising out of employment, regardless of workers' compensation coverage.
The exclusionary clause clearly and unambiguously excludes coverage for injuries arising out of or in the course of employment regardless of whether the injured person is covered by workers' compensation. The clause's plain language, with subsections (a) and (b) separated by the disjunctive 'or,' excludes occupational injuries on two separate grounds, not just when workers' compensation coverage exists.
[1] An insurance policy's exclusionary clause for occupational injuries is interpreted according to its plain language and grammatical structure, without rewriting its terms.
[2] An exclusionary clause separating occupational injury and disease with "or" and using sub-designations (a) and (b) excludes injuries arising out of or in the course of em…
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Join FLexlaw to unlock all legal intelligence“We simply cannot permit such a substitution or turn a blind eye to the plain intent of the (a) and (b) separation in the sentence quoted above.”
Establishes that the court will not rewrite contract language to favor the insured party.
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Join FLexlaw to unlock all legal intelligenceA self-employed husband was injured in the course of his employment. His wife held a group health insurance policy issued by her separate employer thr…
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LETTS, Chief Judge.
The trial court entered summary judgment in favor of a self-employed husband, injured while in the course of, and within the scope of, his employment. The ruling as a matter of law, granted coverage to the husband under his wife’s group insurance policy issued by her separate employer. We reverse.
The wife’s group insurance policy contained the following exclusionary clause:
(1) Occupational Injury or Disease Charges — charges incurred in connection with (a) injury arising out of, or in the course of, any employment for wage or profit or (b) disease covered, with respect to such employment, by any workmen’s compensation law, occupational disease law or similar legislation.
Basically, the Husband argues that this clause should be interpreted to exclude injury only if the injured is otherwise covered by workmen’s compensation which the Husband here was not. To reach this result one must ignore the (a) and (b) separation of the quoted exclusionary clause and substitute “and,” for the disjunctive “or.” We simply cannot permit such a substitution or turn a blind eye to the plain intent of the (a) and (b) separation in the sentence quoted above.
In reaching our conclusion we are not unmindful that exclusionary language is to be construed most strongly against the insurer. Stuyvesant Insurance Company v. Butler, 314 So. 2d 567 (Fla.1975) and that ambiguity should be resolved against the insurance company which drafts the contract. Daleo v. Bert and Bette Bayfront 66 Marine, 273 So. 2d 113 (Fla. 3d DCA 1972). To this end it is persuasive for the husband to argue that there is ambiguity here because the courts have reached contrary results on similar clauses. See United Benefit Life Insurance Company of Omaha v. Glisson, 105 Ga.App. 122, 123 S.E. 2d 350 (1961) and Rankin v. New York Life Insurance Co., 240 So. 2d 758 (La.App.1970). As the Husband argues, in a well written brief, “If the Georgia and Louisiana Courts of Appeal construed virtually identical language differently from the Courts in Oklahoma and the U.S. Court of Appeals Tenth Circuit then there must be ambiguity in the exclusionary clause”; ergo this Fourth District Court has no business reversing the trial judge. However, the clauses in the Georgia and Louisiana cases cited were not identical to the clause here under consideration, whereas the clause in the Oklahoma and Tenth Circuit cases involve the very same Insurance Company and is identical to the one now before us. See Wilson v. Prudential Insurance Company of America, 528 P. 2d 1135 (Okl.Ct.App.1974) and Roskell v. Prudential Insurance Company of America, 529 F. 2d 1 (10th Cir. 1976).
Much as we would like to find coverage for this injured Husband we agree with the Oklahoma case cited and find its logic reiterated below irrefutable:
Such an interpretation would require a rearrangement of the clauses or a change of the disjunctive “or” to the conjunction “and” and a deletion of the clause separating devices (a) and (b). Such a restructuring of the sentence would do violence to the contract language and would be in violation of established grammatical rules of construction.
Clauses (a) and (b) are connected by the disjunctive word “or” and are separated by the separating device of using (a) and (b). Charges in connection with injuries arising in the course of employment are excluded regardless of coverage or lack of coverage by any workmen’s compensation laws. The qualifying words of limitation relating to workmen’s compensation laws are properly restricted to the last antecedent “diseases” and do not limit or restrict the more remote antecedent “injury.” Wilson v. Prudential Insurance Company of America, supra, at 1137.
Accordingly, we hold that the exclusionary clause first above cited clearly excludes the self-employed Husband injured in the course of, and within the scope of his employ.
REVERSED WITH DIRECTIONS TO THE TRIAL COURT TO ENTER SUMMARY FINAL JUDGMENT IN ACCORDANCE HEREWITH.
ANSTEAD and HERSEY, JJ., concur.
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Sec. Ins. Co. OF Hartford v. Invs. Diversified Ltd., Inc., 407 So. 2d 314 (Fla. 4th DCA 1981)…lusions from a study of essentially the same language.3 It is well settled that ambiguity in an insurance contract is construed in favor of the insured and exclusionary language against the insurer. Prudential Insurance Company of America v. Bellar, 391 So. 2d 737 (Fla. 4th DCA 1980). Finally, we are of the view that the result is controlled by Collins v. Royal Globe Insurance Company, 368 So. 2d 941 (Fla. 4th DCA 1979). In Royal Globe the thief tricked the owner of a motor home into parting with his possess…
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Crown Life Ins. Co. v. Faustino Garcia and Ela Garcia, 424 So. 2d 893 (Fla. 3d DCA 1982)…, the conclusion that the policy terms provide coverage can be achieved only by changing the disjunc-five word, “or,” between the two separate exclusionary definitions of “disabled” to the conjunctive “and.” Prudential Ins. Co. of America v. Bellar, 391 So. 2d 737 (Fla. 4th DCA 1980). Courts are forbidden, however, from engaging in any such rewriting process, even in the guise of “interpreting” an insurance policy against the company. Griffin v. Speidel, 179 So. 2d 569 (Fla.1965). . Sec. 627.644, Fla.Stat. (…
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Fernandez v. The Prudential Ins. Co. OF Am., 395 So. 2d 281 (Fla. 3d DCA 1981)…PER CURIAM. Affirmed. Prudential Insurance Co. of America v. Bellar, 391 So. 2d 737 (Fla. 4th DCA 1980); see Roskell v. Prudential Insurance Co. of America, 529 F. 2d 1 (10th Cir. 1976); Wilson v. Prudential Insurance Co. of America, 528 P. 2d 1135 (Okl.Ct.App.1974).…
Previewing 3 of 6 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Stuyvesant Ins. Co. v. Alphonso Butler, 314 So. 2d 567 (Fla. 1975)
- Daleo v. Bert & Bette Bayfront 66 Marine, 273 So. 2d 113 (Fla. 3d DCA 1972)
- Roskell v. The Prudential Ins. Co. OF Am., 529 F.2d 1 (10th Cir. 1976)