RALPH K. ROBERSON, APPELLANT (PLAINTIFF),
v.
UNITED SERVICES AUTOMOBILE ASSOCIATION, APPELLEE (DEFENDANT)

Fla. 1st DCA | 1976-04-05
No. Y-195
RAWLS, Acting C. J., and SMITH, J., concur.
330 So. 2d 745 Florida District Court of Appeal, First District (1976) Caution
Cited by 19 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

Roberson appeals a summary judgment denying medical payment coverage for a cerebral vascular accident (sudden internal bleeding) he suffered while stooping near a gas stove in his insured travel trailer. The court holds that a cerebral vascular accident constitutes an 'accident' under the policy's medical payments clause despite the absence of external trauma.


Holding

A cerebral vascular accident constitutes an 'accident' under the medical payments clause because the insured experienced an unexpected result, the policy does not define or narrow the term 'accident,' and policies should be construed liberally in favor of the insured to provide the broadest coverage consistent with the language used.


Headnotes

[1] A cerebral vascular accident can be considered an "accident" under the medical payments coverage of an automobile liability insurance policy when the policy does not defi…

[2] Insurance policies are construed liberally in favor of the insured and strictly against the insurer.

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Key Quotes

“An accident is defined as an unexpected or unusual event; it is something which happens by chance and without design; it is an event from an unknown cause.”

Establishes the controlling definition of 'accident' that the court applies to the cerebral vascular incident.

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Facts & Procedural History

While stooping to examine a gas stove in his insured travel trailer, Roberson suffered a cerebral vascular accident in which something in his brain su…

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Opinion of the Court
MILLS, Judge.

MILLS, Judge.

Plaintiff appeals from a final summary judgment rendered in favor of the defendant in a suit seeking to recover benefits under the medical payments coverage of an automobile liability insurance policy.

The issue before us is whether the trial court erred in entering the final summary judgment. The specific point is whether a cerebral vascular accident is an accident under the terms of the medical payments clause of the policy.

The facts are not in dispute. While stooping to examine a gas stove in his travel trailer, which was insured by the defendant, the plaintiff suffered a cerebral vascular accident. Plaintiff’s physician stated that somewhere in his brain something suddenly bled. The cause was unknown.

The defendant denied coverage contending there was no accident, because there was no external trauma or force.

The pertinent provisions of the medical payments clause are:

“To pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical, x-ray, and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services.

“Division 1. To or for the named insured and each relative who sustains bodily injury, sickness, or disease, including death resulting therefrom, hereinafter called ‘bodily injury’, caused by accident, (a) while occupying the owned automobile, . . .”

Neither the term “accident” nor the term “caused by accident” is defined by the policy. In addition, there is an absence of qualifying or exclusionary language. In many policies, the terms are narrowed by limiting liability to injury or death caused by means described as external, violent, or accidental. But that is not done here.

Customarily, an accident is defined as an unexpected or unusual event; it is something which happens by chance and without design; it is an event from an unknown cause. Bennett v. Fidelity & Casualty Company of New York, 132 So. 2d 788 (Fla.App. 1st, 1961).

The medical payments clause of an automobile liability insurance policy‘is closely akin to a personal accident policy. Government Employees Insurance Company v. Sweet, 186 So. 2d 95 (Fla.App. 4th, 1966). An average person buying a personal accident policy assumes that he is covered for any fortuitous and undesigned injury. Gulf Life Insurance Company v. Nash, 97 So. 2d 4 (Fla.1957).

Insurance policies are construed liberally in favor of the insured and strictly against the insurer. An insurer will not be allowed, by the use of obscure terms, to defeat the purpose for which the policy was procured. Where two interpretations are available, the one allowing the greater indemnity will prevail. National Casualty Company v. General Motors Acceptance Corporation, 161 So. 2d 848 (Fla.App. 1st, 1964).

In 1952, the Florida Workmen’s Compensation Act defined accident as an unexpected or unusual event happening suddenly. In construing this provision, the Supreme Court of Florida stated that there was an accident if there was an unexpected result, although there was no unexpected cause. Gray v. Employers Mutual Lia bility Insurance Company, 64 So. 2d 650 (Fla.1952).

Because the purpose of medical payments coverage is to provide personal accident insurance for bodily injury, sickness or disease caused by accident while occupying an insured automobile; because the insurer chose not to define, qualify, or narrow the term “accident”; because insurance policies should he construed in favor of the insured so as to provide the broadest possible coverage consistent with the language used; because the insured experienced an unexpected result when he stooped over, the cerebral vascular accident suffered by him came within the terms of the medical payments coverage.

Accordingly, the judgment entered in favor of the defendant is reversed, and this case is remanded to the trial court with directions to enter judgment for the plaintiff on the issue of liability only.

RAWLS, Acting C. J., and SMITH, J., concur.

Other
MILLS, Judge.

MILLS, Judge.

The defendant brings to our attention that we did not state the specific point involved on this appeal as it was stated in defendant’s brief. The defendant is correct. We now adopt the point as stated by defendant: whether a cerebral vascular accident is caused by accident under the terms of the medical payments clause of the policy. Having adopted the question as stated by defendant, our opinion remains unchanged.

We reverse and remand with instructions to enter judgment for plaintiff on the issue of liability only.

RAWLS, Acting C. J., and SMITH, J., concur.


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Citator

Cited By

  • …rmine whether a given accident, under many easily imagined circumstances, would or would not be covered. In this sense, the terms are “ambiguous,” hence the need for construction or interpretation. Roberson v. United Services Automobile Association, 330 So. 2d 745 (Fla. 1st DCA 1975); Southside Motor Co. v. Transamerica Ins. Co., 380 So. 2d 470 (Fla. 1st DCA 1980); Ellenwood v. Southern United Life Ins. Co., 373 So. 2d 392 (Fla. 1st DCA 1979). The insurer cannot, by failing to define the terms “auto accident…
  • Grissom v. Commercial Union Ins. Co., 610 So. 2d 1299 (Fla. 1st DCA 1992)
    …favor of the insured and strictly against the insurer, and that whenever the language is susceptible of two or more constructions, the court must adopt that which is most favorable to the insured. E.g., Roberson v. United Services Automobile Ass’n, 330 So. 2d 745, 746 (Fla. 1st DCA), cert. denied, 342 So. 2d 1104 (Fla.1976). As used in various types of insurance policies, the term “accident,” when not otherwise explicitly defined or clarified by language in the policy itself, has been given varying meanings…
    1 / 2
  • Travelers Indem. Co. v. PCR Inc., 889 So. 2d 779 (Fla. 2004)
    …bounded meaning. In Workmen’s Compensation it has been applied to that which happens by chance or casually, that which proceeds from an unknown cause or the unusual which sometimes results from known causes.”); Roberson v. United Servs. Auto. Ass’n, 330 So. 2d 745, 746 (Fla. 1st DCA 1976) (“Customarily, an accident is defined as an unexpected or unusual event; it is something which happens by chance and without design; it is an event from an unknown cause.”); Braley v. American Home Assurance Co., 354 So. 2d…

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