SIMON W. FELDMAN, APPELLANT,
v.
THE CENTRAL NATIONAL INSURANCE COMPANY OF OMAHA, A FOREIGN INSURANCE COMPANY, APPELLEE
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An insured sought recovery for hospital confinement costs incurred in December 1971 arising from injuries sustained in May 1971 while his policy was active, though the policy had expired by the December hospitalization. The court held that insurance coverage extends to hospitalizations resulting from injuries sustained while the policy was in force, even if the hospitalization occurs after policy expiration.
The policy provides coverage for hospitalization expenses incurred as a result of an injury sustained while the contract of insurance was in full force and effect, regardless of when the hospitalization occurs. The ambiguity in the policy language is resolved in favor of the insured-appellant.
[1] An insurance policy must be construed in its entirety to determine the intentions of the parties.
[2] Insurance policies are liberally construed in favor of the insured to secure the indemnity they were intended to provide.
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Join FLexlaw to unlock all legal intelligence“The policy must be liberally construed in favor of the insured so as not to defeat without a plain necessity his claim to the indemnity which in making the insurance it was his object to secure.”
Establishes the fundamental rule of insurance policy interpretation favoring the insured
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Join FLexlaw to unlock all legal intelligenceFeldman obtained a hospital insurance policy in July 1969 providing $100 per week in benefits. On May 12, 1971, he suffered injuries in an automobile …
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The appellee, on July 18, 1969, issued an insurance policy to the appellant providing for the payment of hospital costs up to $100.00 per week incurred as a result of injury or sickness.
On May 12, 1971, the appellant suffered accidental bodily injuries as a result of an automobile incident and was hospitalized. The policy was in full force and effect on that date, and continued to be during this first period of appellant’s confinement in the hospital. On August 18, 1971, however, the policy expired because of the appellant’s failure to pay the premiums due.
Appellant was hospitalized again, from December 10, 1971 to December 20, 1971. His confinement during this period arose as a direct result of the injuries sustained on May 12, 1971, while the policy was in full force and effect.
In accordance with the provisions of the policy, the appellant filed written proof of loss seeking to recover $142.84 as a result of the hospitalization in December. The appellee failed to pay and the appellant filed the instant suit to recover.
Both parties moved for summary judgment and the trial court ruled for the ap-pellee. On appeal, the primary issue before us centers on the proper interpretation of the following pertinent provisions of the insurance policy:
“DOES HEREBY INSURE the person named in the Schedule (herein called the Insured) and promises to pay benefits for loss because of hospital confinement of a covered person caused by injury or sickness, to the extent herein provided. *898“HOSPITAL CONFINEMENT BENEFIT PAYABLE FOR LIFE: If injury or sickness confines the covered person within a hospital for 24 hours or more while this policy is in force, the Company periodically will pay benefits at the rate of the applicable Weekly Benefit specified in the Schedule for the period of such confinement and for as long as such person shall live.
“DEFINITIONS: ‘Injury’ wherever used in this policy means bodily injury caused by an accident occurring while this policy is in force and resulting directly and independently of all other causes in hospital confinement covered by this policy.”
The appellant essentially argues that these provisions provide coverage for hospitalization expenses incurred as a result of injuries which are sustained while the policy is in full force and effect irrespective of the last date of hospitalization. The appellee, on the other hand, argues that hospitalization expenses are covered only for hospitalization while the policy is in full force and effect, irregardless of the fact that the injury occurred while the policy was in full force and effect.
In construing this policy, we are mindful that it must be considered in its entirety to determine the intentions of the parties. New Amsterdam Casualty Co. v. Addison, 169 So.2d 877 (Fla.App.2d, 1964). Certainly, in construing the provisions of an insurance policy to determine the intention of the parties, the proper rule of interpretation is:1
“ ‘The policy must be liberally construed in favor of the insured so as not to defeat without a plain necessity his claim to the indemnity which in making the insurance it was his object to secure.’ ”
Then, after construing an insurance policy, if ambiguity exists because of the existence of more than one possible interpretation,2
“such ambiguity must be resolved against the insurance company that drafted the particular language in question, and in favor of the insured.”
The policy under review is ambiguous on the issue to be decided. Therefore, in applying the rules for interpretation and construction as set out above, we resolve this ambiguity in favor of the insured-appellant, to-wit: the policy provides coverage for hospitalization expenses which are incurred as a result of an injtiry which was sustained while the contract of insurance was in fall force and effect.
Accordingly, we reverse and remand to the trial court for proceedings not inconsistent herewith.
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Ellenwood v. S. United Life Ins. Co., 373 So. 2d 392 (Fla. 1st DCA 1979)…age clause of the policy was ambiguous? First, we are enjoined both by statute, Section 627.419(1), Florida Statutes (1977), and by case law, e. g., Price v. Southern Home Ins. Co., 100 Fla. 338, 129 So. 748 (1930); Feldman v. Central Nat. Ins. Co., 279 So. 2d 897 (Fla. 3d DCA 1973); James v. Gulf Life Ins. Co., 66 So. 2d 62 (Fla.1953), from considering an isolated sentence in a policy as determinative on the question of coverage. Rather the entire contract must be construed according to its terms and conditi…
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Auto-Owners Ins. Co. v. Eddinger, 366 So. 2d 123 (Fla. 2d DCA 1979)…tion to the contrary. The above policy language is capable of more than one possible interpretation. In such case the interpretation should be given which provides coverage to the insured. See, Feldman v. Central National Insurance Company of Omaha, 279 So. 2d 897 (Fla.3d DCA 1973). There is no Florida case law directly on point. However, we are persuaded by those cases from other jurisdictions to the effect that the fraud of a co-insured does not void the coverage of the innocent co-insured. In Howell v. Oh…
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Shelby Mut. Ins. Co. of Shelby v. Manchester, 376 So. 2d 266 (Fla. 3d DCA 1979)…ms of an insurance policy are capable of two or more constructions, the construction permitting recovery is to be given effect. Queen Insurance Company v. Patterson Drug, 73 Fla. 665, 74 So. 807 (1917); Feldman v. Central National Insurance Company, 279 So. 2d 897 (Fla. 3d DCA 1973); Rowland v. National States Insurance Company, 295 So. 2d 335 (Fla. 1st DCA 1974). In its deliberations, as cited in its order, the trial court based its decision in favor of appellee on the rationale espoused in a similar case d…
Previewing 3 of 9 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- The Aetna Cas. & Sur. Co. v. Prank Cartmel, 87 Fla. 495 (Fla. 1924)
- NEW Amsterdam Cas. Co. v. Addison, 169 So. 2d 877 (Fla. 2d DCA 1964)
- Peerless Ins. Co. v. SUN Line Helicopters, Inc., 180 So. 2d 364 (Fla. 3d DCA 1965)
- AETNA Ins. Co. v. Webb, 251 So. 2d 321 (Fla. 1st DCA 1971)