NEW AMSTERDAM CASUALTY COMPANY, A MARYLAND CORPORATION, APPELLANT,
v.
JULIUS N. KNOWLES AND LAURA D. KNOWLES, HIS WIFE, APPELLEES
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An insurer is obligated to defend its insured in a lawsuit arising from an injury at a convalescent home, even if the policy contains an exclusion for professional services, unless the facts clearly demonstrate the injury resulted from such services.
The insured, operating a convalescent home, sought a declaratory judgment to compel their liability insurer to defend a lawsuit. The lawsuit alleged a…
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THOMAS, Justice.
New Amsterdam Casualty Company of Maryland issued to Laura and J. N. Knowles, doing business as Oak Grove Convalescent Home, a liability insurance policy obligating the company to pay on behalf of the insured certain sums for which the policy holder might become liable. In the insurance contract was a provision that no responsibility was assumed by the insurer for claims “resulting from the rendering of any professional services or omission thereof.”
We are principally concerned with the construction of the quoted exclusion clause in the light of the facts appearing in the record, but other pertinent conditions of the policy will be stated as we discuss the point of law to be resolved.
The appellees sought a declaratory decree establishing their right to have the appellant provide a defense in an action brought against them by the wife and next friend of William Grimmig, Jr., a mental and physical incompetent, a paralytic, who had been placed in appellees’ convalescent home for nursing and care. According to the complaint in that case William Grim-mig, Jr. suffered serious injuries by reason of the negligence of an incompetent attendant in the service of the appellees while the attendant was engaged in the performance of his duties.
In the complaint filed in the present suit it was alleged that appellees had no direct knowledge of any defect in the bed occupied by the invalid and knew of no reason why he had fallen from it. From their investigation of the incident they learned that the attendant while “making his early morning rounds” found the bed bars down and the invalid on the floor. The appellees averred that the injury resulted from an accident and that under the policy the insurer was bound to defend them in the suit brought on behalf of William Grimmig, Jr. By the denial of any responsibility for the defense of the appellees, the clear-cut question whether or not the services being furnished to Grimmig by the appellees were from their nature “professional” is presented.
The chancellor concluded that the appellant was obligated to defend the appel-lees in the action brought against them and this appeal followed.
When the policy was issued to Oak Grove Nursing Home the insurer should have become aware of the nature of the enterprise in which the appellees were engaged. Under the contract for which, •of course, the insurance company was compensated, an obligation arose to defend suits against the policy holder for •damages resulting from “bodily injury, sickness, or disease * * *.”
It is true that the appellant was privileged by the contract to make investigations in connection with any liability that might be claimed against it, but we •do not find provisions in the contract or .allegations in the pleading that justify the position, presumably taken after investigation, that what happened to Grim-mig in the nursing home resulted from the rendition of professional services, therefore, that the appellant could wash its hands of the whole affair. It seems to us it would be more logical to expect that in the action against the appellees it might be shown that the injury was one that could happen in a nursing home without any connection with professional services. And if the insurer can under such a policy decide for itself that such an injury as described in the complaint filed against appellees sprang from professional services, we cannot resist the rhetorical questions: “What did the appellant intend to insure when it issued the policy to a nursing home” and “What sort of protection were the appel-lees to receive for the premium paid?” In other words, if the appellant considered a nursing home a place in which professional services only were furnished, what did it propose to insure? The only person shown by the record to have had any connection with the injury was an attendant.
The language of the declarations in the policy under the title “Premises — Operations” does not strengthen the appellant’s position for it simply reads “Sanitariums or Health Institutions Not hospitals or mental-Psychopatic [sic], Institutions.”
Furthermore, the appellees were insured against loss from “hazards hereinafter defined.” Next, under the heading “Definition of Hazards” appears this language : “Premises — Operations. The ownership, maintenance or use, for the purposes stated in the declarations, of the premises, and all operations which are necessary or incidental to such purposes.”
To our mind, the title “convalescent home” does not connote an institution where “professional services” only are rendered, and the word “attend ant” does not describe a person who renders them. City of Miami v. Oates, 152 Fla. 21, 10 So. 2d 721.
When we undertake to reason that an insurance company may issue a policy to the operator of a “convalescent home,” stipulated to be a sanitarium or health institution and not a hospital, and insure for a price, against the loss from hazards incident to the operation, and then arrogate to itself the right of deciding that, after all, an injury with which no one except an attendant seems to have had any connection, resulted from professional services, hence responsibility to defend did not arise, we come full cycle in our thinking. And when we compare the allegations of the complaint filed against the appellees with the terms of the insurance policy, we discover no basis for the presumption that injury arose only from services of professional character. Moreover, the policy must be construed favorably to the holder. Poole v. Travelers Ins. Co., 130 Fla. 806, 179 So. 138.
We have referred to the situation disclosed by the record so far made in the action against appellees for damage to the invalid. If there actually existed a set of facts so different as to relieve the appellant from liability, that would be developed only in an eventual trial. But the appellant could not meanwhile decline any participation in the action. On the contrary it was its duty to defend it. Virginia Surety Company v. Russ, Fla., 86 So. 2d 643.
We agree with the circuit judge that the appellant should be required to keep its bargain and defend the suit brought against the appellees.
Affirmed.
TERRELL, C. J., and ROBERTS and THORNAL, JJ., concur.
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Baron OIL Co. v. Nationwide Mut. Fire Ins. Co., 470 So. 2d 810 (Fla. 1st DCA 1985)…surer’s obligation to defend a claim made against its insured must be determined from the allegations in the complaint. E.g., National Union Fire Insurance Co. v. Lenox Liquors, Inc., 358 So. 2d 533 (Fla.1978); New Amsterdam Casualty Co. v. Knowles, 95 So. 2d 413 (Fla.1957); State Farm Mutual Automobile Insurance Co. v. Universal Atlas Cement Co., 406 So. 2d 1184 (Fla. 1st DCA 1982); Kings Point West, Inc. v. North River Insurance Co., 412 So. 2d 379 (Fla. 2d DCA 1982); Federal Insurance Co. v. Applestein, 3…1 / 4
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Bennett v. Fid. & Cas. Co. OF NEW York, 132 So. 2d 788 (Fla. 1st DCA 1961)…d in an action brought against him is to be determined from the allegations of the complaint, declaration, or other statement of the cause of action, filed in such action against the insured. See New Amsterdam Casualty Company v. Knowles, Fla. 1957, 95 So. 2d 413, and the annotation in 50 A.L.R.2d 465, page 504. In accordance with this rule, which is applicable in Florida, the sole question before us on this appeal is whether the Alexanders in their amended complaint in their action against Bennett alleged…
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Allstate Ins. Co. v. Conde, 595 So. 2d 1005 (Fla. 5th DCA 1992)…of the complaint fall within the exclusions of the policy, then ISLIC is not required to defend the Raeburn action. Any doubt as to whether the policy provides a duty to defend should be resolved against ISLIC. New Amsterdam Casualty Co. v. Knowles, 95 So. 2d 413 (Fla.1957). Id., at 253. Subsequently, the court in Markham cites State Farm Fire and Casualty v. Nail, 516 So. 2d 1022 (Fla. 5th DCA 1987), a case upon which the majority places unfounded reliance. Nail involved a situation where the trial court…
Previewing 3 of 14 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Poole v. The Travelers Ins. Co., 130 Fla. 806 (Fla. 1937)
- City OF Miami v. Oates, 152 Fla. 21 (Fla. 1942)
- Va. Sur. Co. v. Russ, 86 So. 2d 643 (Fla. 1956)