ROBERT M. SKINNER, APPELLANT,

v.

CONTINENTAL CASUALTY COMPANY, APPELLEE

Fla. 2d DCA | 1972-11-08

No. 72-85

LILES, A. C. J., and McNULTY, J., concur.

268 So. 2d 576 Florida District Court of Appeal, Second District (1972) 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.

Holding

The court held that the prior determination of non-disability for a specific period does not preclude a later claim, but it does establish that the insured was able to work during that prior period, thus breaking continuity for accident-based claims.

Headnotes

[1] A prior judgment determining an insured was not disabled under a policy's broader definition does not preclude a later claim for disability if the injury's effects are no…

[2] Disability resulting from an accident requires a showing of continuity under an insurance policy, unlike disability from sickness which may be treated as a continuation u…

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Facts & Procedural History

Skinner was injured and received disability benefits for two years. The insurer then denied further benefits, citing a policy provision requiring cont…

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Topics

Disability Insurance Policy Interpretation Disability Benefits Claim Ambiguity In Insurance Contracts Res Judicata

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Opinion of the Court

MANN, Judge.

Skinner was seriously injured in an accident. His employer had a policy providing to employees certain benefits upon a showing of disability resulting from accident or illness. The language is fairly common, and is set out in the margin.1 The insurer paid Skinner for the two years that he was disabled from performance of his regular *578job, and thereafter claimed that, while he may not have been able to perform his regular job, he was not “prevented by reason of said injury from engaging in each and every occupation or employment for wage or profit for which he is reasonably qualified by training, education or experience.” In a prior action in Duval County, the insurer won a verdict on this question. This second action was terminated upon a showing that the Duval County action had determined that Skinner was not disabled under this broader definition for the period involved in the earlier claim.

If the question were whether the Duval County action is res judicata of the question of present disability, we would agree that it is not. Eminent Household of Columbian Woodmen v. Bunch, 1917, 115 Miss. 512, 76 So. 540, on which Skinner mainly relies, would be persuasive. Because' one may be presently disabled from the later effects of an injury that was not previously disabling, res judicata would not apply.

But the question before us is whether the disability is continuous. Therefore, the determination that there was a period during which Skinner was not disabled within the meaning of the policy is determinative not that he is presently able to work but that he was able to work during the period involved in the prior action. If Skinner were disabled by sickness, the recurrence would be treated as a continuation by the policy’s terms, but where disability results from accident, continuity must be shown. This is the uniform interpretation of- this language in the decided cases.2 If the language were ambiguous, it would be interpreted in the insured’s favor, but it is not ambiguous language.

Affirmed.

LILES, A. C. J., and McNULTY, J., concur.

. “Paragraph A. When, as the result of injury and commencing within thirty days after the date of the accident, or as the result of sickness and commencing while the policy is in force as to the Insured Employee, the Insured Employee is wholly and continuously disabled and prevented from performing each and every duty pertaining to his occupation and is under the regular care and attendance of a legally qualified physician or surgeon, other than himself, the Company will pay, commencing immediately following the applicable elimination .period written in the Schedule of Benefits, the applicable monthly indemnity written in the Schedule of Benefits, not to exceed twenty-four consecutive months or the applicable maximum period payable written in the Schedule of Benefits, whichever is lesser. Paragraph B. If the applicable maximum period payable as to the Insured Employee is a period in excess of twenty-four months, after the payment of such monthly indemnity for twenty-four months under Paragraph A, the Company will continue to pay such monthly indemnity for the period the Insured Employee is wholly and continuously disabled and under the regular care and attendance of a legally qualified physician or surgeon, other than himself, and prevented by reason of said injury or sickness from engaging in each and every occupation or employment for wage or profit for which he is reasonably qualified by training, education or experience for a period not to exceed in the aggregate under Paragraphs A and B hereof, the applicable maximum period payable written in the Schedule of Benefits.

“If monthly sickness indemnity is payable hereunder and if the' Insured Employee, while the policy is in force, suffers a recurrence of total disability from the same or related cause or causes, the subsequent period of total disability will be deemed a continuation of the prior period, unless between such periods the Insured Etnployee has performed the duties of his occupation on a full-time basis for at least six consecutive months, in which event, such total disability shall be deemed the result of a new sickness and subject to a new elimination period.”

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Stuyvesant Ins. Co. v. Alphonso Butler, 314 So. 2d 567 (Fla. 1975)

…peidel, 179 So. 2d 569 (Fla.1965); Aetna Casualty and Surety Co. v. Cartmel, 87 Fla. 495, 100 So. 802 [*571] (1924). See also: Pennsylvania Nat. Mut. Casualty Insurance Co. v. Ritz, 284 So. 2d 474 (Fla.App.1973); Skinner v. Continental Casualty Co., 268 So. 2d 576 (Fla.App. 1972); Eagle Star Insurance v. Ross, 247 So. 2d 514 (Fla.App.1971); Quick v. National Indemnity Co., 231 So. 2d 22 (Fla.App.1970); Peerless Insurance Co. v. Sun Line Helicopters, Inc., 180 So. 2d 364 (Fla.App.1965). In view of the nature…
Jennings v. Louie L. Wainwright, 486 F.2d 1041 (5th Cir. 1973)

…cord for Dade County, Florida, the appellant, William Jennings, Jr., was convicted of armed robbery, State disposition of Jennings’ original appeal and subsequent motions to vacate are reported, Jennings v. State, 228 So. 2d 117; 248 So. 2d 247; and 268 So. 2d 576 (D.C.A., Fla., 1969, 1971, and 1972). Jennings has filed four previous petitions for habeas corpus in the United States District Court for the Southern District of Florida. In the instant proceedings Jennings contends that he is [*1042] entitled to…

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ROBERT M. SKINNER, APPELLANT, v. CONTINENTAL CASUALTY COMPANY, APPELLEE

Cases With Similar Vibessemantic neighbors from the corpus

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ROBERT M. SKINNER, APPELLANT,

v.

CONTINENTAL CASUALTY COMPANY, APPELLEE