NELSON A. STINCHOMB, APPELLANT,
v.
MUTUAL LIFE INSURANCE COMPANY OF NEW YORK, APPELLEE

Fla. 2d DCA | 1974-12-04
No. 74-161
McNULTY, C. J., and OVERSTREET, MURRAY W., Associate Judge, concur.
305 So. 2d 84 Florida District Court of Appeal, Second District (1974) Positive Treatment
Cited by 6 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

Nelson Stinchomb appeals a summary judgment denying his claim for accidental dismemberment benefits under a group insurance policy issued by Mutual Life Insurance Company of New York. The court affirmed the denial, holding that the policy's requirement that loss occur within 90 days of the accident and its definition of loss as "actual severance" precluded coverage where amputation occurred 163 days after the initial injury.


Holding

The court held that the policy language clearly limited coverage to losses occurring within 90 days of the accident and defined loss as "actual severance" of the member, which requires the amputation to have actually occurred within that period. Since the amputation occurred 163 days after the accident, there was no coverage regardless of when the need for amputation became apparent.


Headnotes

[1] Accidental dismemberment benefits under an insurance policy are typically limited to losses occurring within a specified period following the accident.

[2] Loss of a hand or foot under an accidental dismemberment policy is defined as actual severance at or above the wrist or ankle joint.

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Key Quotes

“Loss of a hand or foot means actual severance at or above the wrist or ankle joint”

The policy's definition of covered loss, which the court interpreted to require actual physical amputation, not merely the necessity or inevitability of it

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Facts & Procedural History

Stinchomb suffered a compound fracture of his leg in an accident. Foreign material ground into the wound caused infection and prevented bone union des…

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Opinion of the Court
GRIMES, Judge.

GRIMES, Judge.

This is an appeal from a summary judgment denying appellant’s claim to accidental dismemberment benefits under a group insurance policy issued by appellee.

The pertinent portions of the policy are as follows:

“The insured losses are any of the following that may occur during the 90 days following the date of the accident causing the bodily injuries:
Loss of

* * * * * *

One Hand or One Foot **

Loss of a hand or foot means actual severance at or above the wrist or ankle joint, . . .”

Appellant accidentally suffered a compound fracture of the leg. By reason of foreign material which had been ground into the wound, the leg became infected. The bones were properly aligned, but no union of the bones occurred. It became evident that union could not be expected and that appellant would continue to have chronic infection. Finally, two separate amputations were performed on appellant’s leg, the first occurring 163 days after the accident. On these undisputed facts, the lower court concluded that appellant could not recover by reason of the above quoted provisions of the policy.

Provisions such as these are common in accident policies. While there is no controlling case in Florida, there have been a number of decisions throughout the United States construing similar policies. The weight of authority favors appellee. 39 A.L.R.3d 1311. It should be noted that no court has held this type of provision to be against public policy. See 39 A.L.R.3d 1311 at page 1313.

Appellant argues ambiguity in the policy language. Thus, he suggests that the word “may” appearing in the first paragraph should be contrasted with the word “shall,” so as to favor a construction which would include a situation where an amputation might have occurred within the ninety day period but which, for legitimate reasons, was postponed until a time beyond the period. To the contrary, we read the word “may” as referring to a contingency, the occurrence of which will bring the coverage into play. To adopt appellant’s reasoning would result in the conclusion that coverage would exist either where the loss “may” occur within ninety days or where it “may not” occur within ninety days.

Appellant further contends that the loss of the foot as defined in the policy actually occurred at the time it became apparent that the amputation would be necessary even though the operation took place after the ninety day period had run. Were it not for the fact that loss of a hand or foot is defined in the policy as “actual severance,” a reasonable argument could be made that the loss of a hand or foot could include a constructive or functional loss. However, we believe the words “actual severance” mean what they say; that is, where the member is actually severed from the rest of the body. If the language in an insurance policy is sufficiently plain and unambiguous, there is no occasion to apply the rule of construction which requires ambiguities to be construed against the insurer. Federal Insurance Company v. W. G. McNichols, Fla.1955, 77 So. 2d 454. The language of this policy clearly dictates the result obtained in the lower court.

We cannot blame appellant and his doctor for having delayed the amputation in the vain hope that the leg might be saved. Unfortunately, the policy did not provide for such a circumstance. Since the foot was not amputated within the ninety day period, there was no coverage.

The judgment is affirmed.

McNULTY, C. J., and OVERSTREET, MURRAY W., Associate Judge, concur.


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Citator

Cited By

  • Haines v. S. Life & Health Ins. Co., 363 So. 2d 175 (Fla. 4th DCA 1978)
    …and the policy terms required death within 90 days. We affirm. The appellant concedes that the present law in Florida, articulated by the Second District, would uphold such 90 day limitations. Stinchomb v. Mutual Life Insurance Company of New York, 305 So. 2d 84 (Fla.2d DCA 1974), cert. den., 318 So. 2d 402. In Stinchomb the facts involved a leg amputation which occurred some 73 days beyond the allowable 90 days. As that court said: We cannot blame appellant and his doctor for having delayed the amputation…
  • Vardit M. Sasloe v. Home Life Ins. Co., 416 So. 2d 867 (Fla. 3d DCA 1982)
    …partly contributed to his death. Therefore, there was no liability under this policy. See and compare: Haines v. Southern Life and Health Insurance Company, 363 So. 2d 175 (Fla. 4th DCA 1978); Stinchomb v. Mutual Life Insurance Company of New York, 305 So. 2d 84 (Fla. 2d DCA 1974). The cases relied upon by the appellant, [Harris v. Carolina Life Insurance Company, 233 So. 2d 833 (Fla.1970); Mason v. Life and Casualty Ins. Co. of Tennessee, 41 So. 2d 153 (Fla.1949); Mason v. Life and Casualty Insurance Comp…
  • Stinchomb v. Mut. Life Ins. Co. OF NEW York, 318 So. 2d 402 (Fla. 1975)
    …Certiorari denied. 305 So. 2d 84. ROBERTS, BOYD, OVERTON and ENGLAND, JJ., concur. ADKINS, C. J., dissents.…

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