NATIONWIDE MUTUAL INSURANCE COMPANY, APPELLANTS,
v.
ED SOULES CONSTRUCTION COMPANY, INC., APPELLEE

Fla. 1st DCA | 1981-05-05
No. VV-397
SHIVERS and JOANOS, JJ., concur.
397 So. 2d 775 Florida District Court of Appeal, First District (1981) Positive Treatment
Cited by 2 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

Nationwide Insurance appealed a summary judgment ruling that it could not collect additional workers' compensation premiums for job classifications not listed in the original policy. The court reversed, holding that the policy's explicit terms allowing for audit-based premium adjustments entitled Nationwide to collect earned premiums for all exposures, even those not originally stated in the classification section.


Holding

Nationwide is entitled to collect the additional earned premium. The policy's explicit terms—stating the initial premium was estimated only and that earned premiums would be computed based on actual records revealed by audits—override any prior case law limiting liability to stated classifications, entitling Nationwide to premiums for all actual exposures covered under the policy.


Headnotes

[1] A workers' compensation insurance policy's stated premium is an estimate, and the earned premium is subject to computation based on audits of the insured's records.

[2] An insurance policy provision allowing for post-termination audits to determine earned premiums supersedes prior case law that limited liability to classifications explic…

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Key Quotes

“The premium stated in the Declarations is an estimated premium only. Upon termination of this policy, the earned premium shall be computed in accordance with the rules, rates, rating plans, premiums and minimum premiums applicable to this insurance in accordance with the manuals in use by the Company.”

This contractual provision establishes that the initial premium was only an estimate and that actual earned premiums would be computed later based on company manuals and records, forming the basis for Nationwide's entitlement to additional premiums.

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Facts & Procedural History

In October 1975, Nationwide issued a workers' compensation policy to Ed Soules Construction Company estimating premiums based on a 'carpentry' classif…

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Opinion of the Court
McCORD, Judge.

McCORD, Judge.

Appellant, Nationwide Mutual Insurance Company (Nationwide), appeals from the trial court’s summary judgment entered in favor of appellee, ruling that appellee is not liable to appellant Nationwide for earned premiums attributable to classifications of operations not stated in the classification of operation section of a workers’ compensation policy, which is the subject matter of this action. We reverse.

In October 1975, Nationwide and appellee entered into an insurance contract, whereby Nationwide would provide workers’ compensation insurance coverage for the em ployees of appellee for one year. Nationwide wrote the policy of insurance and estimated the premium on a rate applicable to a classification of operations entitled “carpentry” based on its initial understanding of the exposure involved in issuing a workers’ compensation policy for appellee’s business. In August 1976, Nationwide canceled the policy. Subsequently, Nationwide became aware and confirmed through an audit of the records of appellee’s business that it had had exposure far greater than that originally compensated due to the fact that numerous operations of appellee’s business and its subcontractors had not been included in the original computation of the premium, even though Nationwide, under Florida law, was bound to provide workers’ compensation coverage for all employees of appel-lee and its various nonexempt uninsured subcontractors. The audit disclosed that appellee’s subcontractors were engaged not only in the classification “carpentry,” but also various separate classifications. Nationwide determined that the additional exposure called for an additional earned premium of $5,254. Appellee denied liability for that premium, and Nationwide brought this suit. The facts are undisputed and both sides moved for summary judgment.

The trial court, in granting summary judgment for appellee, relied upon Maryland Casualty Company v. Jinks, 144 Fla. 373, 198 So. 17 (1940). In that case, the court ruled that the insured was not liable for payment of premhims attributable to classifications of operations not specifically designated in the policy of workers’ compensation insurance.

The insurance policy in question sub judi-ce contains the following condition:

The premium stated in the Declarations is an estimated premium only. Upon termination of this policy, the earned premium shall be computed in accordance with the rules, rates, rating plans, premiums and minimum premiums applicable to this insurance in accordance with the manuals in use by the Company. If the earned premium thus computed exceeds the premium previously paid, the insured shall pay the excess to the company, if less, the company shall return to the insured the unearned portion paid by the insured. (Emphasis supplied.)

The policy further provided:

The Company and any rating authority having jurisdiction by law shall each be permitted to examine and audit the Insured’s payroll records, general ledger, disbursements, vouchers, contracts, tax reports and all other books, documents and records of any and every kind at any reasonable time during the policy period and any extension thereof and within three years after termination of this policy as far as they show or tend to show or verify the amount of remuneration or other premium basis, or relate to the subject matter of this insurance.

Thus, the policy clearly provided that the stated premium was an estimated premium only and that, subject to audits and examinations of appellee’s records, the true earned premium could be computed at a later date and appellee would be liable for any additional premium found to be due as a result of computations made in that manner. The holding in the Jinks case does not override the specific terms of the policy in the case sub judice. The Jinks opinion does not relate the specific facts of that case nor does it relate the provisions of the policy involved there. Under the facts of this case and under the terms of the policy in question, Nationwide is entitled to the earned premium due. Compare Tropical Roofing Company v. Charnow, 134 So. 2d 32 (Fla.2d DCA 1961).

Reversed.

SHIVERS and JOANOS, JJ., concur.


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Citator

Cited By

  • Nat'l Fire Ins. Co. v. Hous. Dev. Co., 827 F.2d 1475 (11th Cir. 1987)
    …yroll of mistakenly classified employees and retrospectively adjust the employer’s premium. See e.g. University Medical-Surgical Clinic, 435 F.Supp. at 281; Taliaferro, 298 P. 2d at 917; Nationwide Mutual Insurance Co. v. Ed Soules Construction Co., 397 So. 2d 775, 776 (Fla. 1st DCA 1981); Great American Insurance Co. v. Nova-Frost, Inc., 362 N.W. 2d 358, 360 (Minn.Ct.App.1985); Silver Threads, 530 S.W. 2d at 876. Nevertheless, “the interpretation of state law by a federal district judge sitting in that state…

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