THE AETNA CASUALTY & SURETY COMPANY, A CONNECTICUT CORPORATION AUTHORIZED TO DO BUSINESS IN THE STATE OF FLORIDA AS AN INSURER, APPELLANT,
v.
SHERMAN V. MILLS, APPELLEE

Fla. 3d DCA | 1966-11-22
No. 66-385
Before HENDRY, C. J., and CARROLL and BARKDULL, JJ.
192 So. 2d 59 Florida District Court of Appeal, Third District (1966) Caution
Cited by 13 cases

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Synopsis

Aetna appealed an interlocutory declaratory judgment finding that Sherman Mills was covered under a non-ownership auto liability policy despite giving an initial sworn statement that his brother lived in his household, which would have excluded coverage. The court affirmed, holding that the insured's false statement did not materially prejudice the insurer's investigation because most investigation was completed before the statement.


Holding

The insured's initial false statement did not constitute a materially prejudicial breach of the cooperation clause. While the statement was material and initially justified the insurer's reliance, the insurer failed to show that its investigation was seriously impaired because most investigative steps had already been completed before the statement was obtained.


Key Quotes

“the insurer must show that the lack of cooperation was material and that the insurer was substantially prejudiced in the particular case by such lack of cooperation”

Establishes the Florida legal standard for denying coverage based on breach of cooperation clause, requiring both materiality and actual prejudice to the insurer.

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Facts & Procedural History

Aetna issued Mills a non-ownership auto liability policy excluding coverage for vehicles owned by relatives residing in the same household. Mills was …

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Opinion of the Court
HENDRY, Chief Judge.

HENDRY, Chief Judge.

Plaintiff, Aetna Casualty & Surety Company, appeals from an interlocutory decree in a declaratory decree action wherein it was held that the defendant, Sherman V. Mills, was covered under a policy issued by plaintiff. Plaintiff also appeals from an interlocutory decree taxing attorney’s fees. Jurisdiction was retained by the chancellor to determine the amount of damages.

*60Plaintiff issued to the defendant its policy of non-ownership automobile liability insurance. The policy covers only vehicles which are not owned by the insured or any relative resident in the same household. The policy contains a standard assistance and cooperation clause and an uninsured motorist endorsement.

On April 26, 1964, the defendant was involved in a motor vehicle collision while driving a vehicle owned by his brother Theodore Roosevelt Mills, Jr. Written notice of intention to proceed under the uninsured motorist provision was given to the plaintiff on June 16, 1964.

On June 30, 1964, the investigation of the claim was begun by William McDermott, a claim representative employed by the plaintiff. Mr. McDermott testified that he obtained a copy of the official police accident report and attempted to contact all of the witnesses within two weeks from the time he was assigned the claim; He was unable to contact either the driver or the three passengers' of the other vehicle involved in the collision. He did contact the passenger in defendant’s car and one other witness. He was able to verify the fact that the other driver was an uninsured motorist. On September 24, 1964, Mr. McDermott interviewed the defendant in the presence of defendant’s attorney and obtained a sworn statement in which the following questions and answers concerning defendant’s brother appear;

“Q. Where. did he live at the time of the accident ?
“A. I don’t know the address right off.
“Q. Did he live at the same place you did?
“A. Well, I guess that address, but it was at the rooming house. He lived with me. I-Ie and his wife were separated. ■ They are together now.
“Q. Just to. clarify a point. Was he residing with you at your home at the time of the accident?
“A. Yes.”

The defendant had been undergoing-medical treatment and medical reports were-furnished to the plaintiff. On November-10, 1964, a letter was sent to the defendant, indicating that the plaintiff had arranged, an appointment for him to see a doctor.

Mr. McDermott testified that on or about' November 20, 1964, he talked with defendant’s attorney by telephone and denied coverage under the policy. By letter dated January 18, 1965, the plaintiff confirmed the-denial of coverage on the ground that the policy endorsement excluded coverage to-the insured occupying an automobile owned by any relative resident in the same household.

By letter dated August 9, 1965, defend-ant’s attorney notified, plaintiff that his investigation determined that defendant’s-brother was not in fact a member of the-household in which defendant resided at the time of the accident although he listed', that address for convenience.

On January 3, 1966, following a demand for arbitration, plaintiff filed this action for declaratory relief and .to-stay arbitration. On February 9, 1966, defendant gave a. deposition in which he stated that his brother-was not residing with him at the time of the accident. This testimony was repeated' at trial with the explanation that he- misunderstood or ,made a mistake when giving the sworn statement to the contrary.

Plaintiff contends that the chancellor erred- '-when finding that there was no-prejudicial breach of the cooperation clause.. It is also contended that it was error to tax attorney’s fees against the plaintiff.

The chancellor found that the defendant’s-brother was not. residing in the same household as defendant at the time of the-accident. The plaintiff argues that therefore, it follows, that defendant’s sworn statement was false and constituted a material breach of the cooperation clause which was prejudicial as a matter of law. In this *61regard plaintiff cites the case of Glens Falls Indemnity Co. v. Lingle, Fla.App. 1961, 133 So.2d 78 wherein the second district held as a matter of law that the insurer should have been granted a summary judgment. In the Lingle case, the insured gave a written statement one month after an accident which contained the' information that the injured persons were his employees thereby excluding coverage. The insurer did not investigate any further. By deposition taken over two years later,while common law suits filed by the injured persons were pending, the insured stated they were not his employees, thus making the insurer liable.

In a later case, American Fire & Casualty Company v. Collura, Fla.App.1964, 163 So.2d 784, 790, the second district rejected an insurance company’s effort to use the Lingle decision as precedent requiring it to hold that an insurer may avoid liability under its, policy by merely showing a violation of one of the condition precedent clauses without a further showing of how such violation prejudiced the insurer. The court, at page 794, held that the rule in Florida is- that the insurer must show that the lack of cooperation was material and that the insurer was substantially prejudiced in the particular case by such lack of cooperation.1

The Lingle case is similar to the one before us in that the first statement made by the insured indicated to the insurer that it - would not be liable. Under the cooperation provision the insurer is entitled to truthful statements by the insured of the cause of the accident and other facts in connection therewith. Thus, the initial statement made by the insured indicating non-liability was material and in reliance thereon insurer was justified in not investigating further. At this point the similarity between the cases disappears. In the Lingle case, the insurer’s statement was given within a short time after the accident. It appears that the insurer completed no other investigation before the statement and as previously stated it was justified in not investigating further. The second statement repudiating the first was not given until over two years later at a time when suits filed -by the injured persons were pending. It “went without saying” that the insurance company was prejudiced by the insured’s breach of the cooperation clause. It was evident that the insured’s breach did seriously impair the insurer’s investigation.

It is just as evident that in the case before us the insured’s breach did not seriously impair the insurer’s investigation. The evidence reveals ’that much of the investigation- was completed prior to the' time of the insured’s first statement. The insurer alleges that it was prejudiced because it ceased its investigation, but it does not indicate what investigative steps remain to be completed.

Under the circumstances of this case, the finding of the chancellor that there was no prejudicial breach of the cooperation clause should not be disturbed.

Under .§ 627.0127 Fla.Stat., F.S.A., the chancellor was correct in taxing attorney’s fees against the insurer in favor of the insured.2

Accordingly the interlocutory decrees, appealed from are affirmed.

Affirmed.


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Citator

Cited By

  • Roberts v. Carter, 350 So. 2d 78 (Fla. 1977)
    …3 So. 2d 340 (Fla. 3d DCA 1964), cert. denied, 188 So. 2d 314 (Fla. 1966), which applied James Furniture to sustain a fees award for an injured tort claimant on the theory that the claimant was a policy “beneficiary”. Aetna Cas. & Sur. Co. v. Mills, 192 So. 2d 59 (Fla. 3d DCA 1966), illustrates a situation where the current statute would authorize attorney’s fees, despite the reliance there on the James Furniture and Johnson decisions. See also Dawson v. Aetna Cas. & Sur. Co., 233 So. 2d 860 (Fla. 3d DCA 197…
  • Bassette v. Standard Fire Ins. Co., 803 So. 2d 744 (Fla. 2d DCA 2001)
    …r is required to pay attorney’s fees to the insured or beneficiary. Bell v. U.S.B. Acquisition Co., 734 So. 2d 403 (Fla.1999). This applies when an insured prevails in a declaratory judgment action regarding coverage. Aetna Cas. & Sur. Co. v. Mills, 192 So. 2d 59 (Fla. 3d DCA 1966). As we observed in Sanchez v. American Ambassador Casualty Co., 559 So. 2d 344 (Fla. 2d DCA 1990), the purpose of section 627.428 is to penalize an insurance company for wrongfully causing its insured to resort to litigation in or…
  • Queen v. Travelers Ins. Co., 258 So. 2d 35 (Fla. 3d DCA 1972)
    …he statute to the policy holder Queen is apparent from the fact that the Florida courts have held that the statute is not limited to a direct action against an insurance company. In the case of Aetna Casualty & Surety Company v. Mills, Fla.App.1966, 192 So. 2d 59, this court held attorney’s fees proper under F.S. § 627.0127, F.S.A., in an action for declaratory relief and to stay arbitration by the insured. Fees were awarded also under F.S. § 627.0127, F.S.A., in the case of Carter v. State Farm Mutual Autom…

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