Winter v. State Farm – Insurance Firms Must Write Clear Policies

Case law in Florida has well-established that insurance companies must write policies that are clear and without ambiguity. Any dual interpretations or omissions are to be considered in a light most favorable to the insured.
Cape Coral car accident lawyers note this principle was highlighted most recently in Florida in the case of Spaid v. Integon Indemnity Corp., wherein the First District Court of Appeals held a discrepancy in the policy with regard to medical coverage fell in favor of the plaintiff.

While court opinions have varied somewhat from state-to-state in this regard, many courts have reached similar conclusions, strengthening the basis for future claims. One of the more recent cases is that of Winter v. State Farm Mutual Automobile Insurance Company, weighed by the Montana Supreme Court.

Here again, the court ruled discrepancies in the policy must be interpreted in favor of the insured, because it is the duty of the insurer, as the writer of the policy, to avoid such issues.

According to court records, the plaintiff was performing maintenance on his own truck when he injured his knee while stepping into the vehicle. The result of that injury caused him to require surgery and ultimately cost him nearly $8,000 in medical expenses.

At the time of the accident, the plaintiff held an auto insurance policy in which the truck involved was specifically named as the insured vehicle for that policy. Per the terms of the contract, the insurer agreed to pay medical coverage of up to $15,000 per incident.

Additionally, the plaintiff had health insurance coverage under a policy that was separately held. The premium for his insurance was $8,000 annually.

The bills were submitted to the plaintiff’s health insurance policy, which covered almost all of the expenses save for $25. The auto insurer thereafter refused to pay any further benefits, arguing that no additional benefits were owed.

The plaintiff then filed a lawsuit against the auto insurer, citing breach of contract for refusal to pay the entirety of his medical bills.

The policy at issue indicates the firm will cover medical expenses incurred due to bodily injury sustained by the insured as a result of a motor vehicle accident. Additionally, there were provisions in the policy that excluded from coverage bills that were paid by other forms of insurance- specifically, workers’ compensation and similar vehicle insurance. Health insurance coverage was not specifically stated as a form of insurance that would be considered under the provision.

The district court granted summary judgment to the insurer, indicating that the insurer wasn’t presented with any evidence of a medical cost incurred, and that the firm couldn’t be expected to cover non-existing debt.

However, the state supreme court reversed on the grounds that the plain language of the policy placed no limitation on the insured receiving duplicate coverage for medical expenses under a separate, uncoordinated health insurance policy.

If you’ve been injured, call Associates and Bruce L. Scheiner, Attorneys for the Injured, at 1-800-646-1210.

Additional Resources:
Winter v. State Farm Mutual Automobile Insurance Company, July 1, 2014, Montana Supreme Court
More Blog Entries:
Millea v. Erickson – Caretaker Liability for Child Injuries, June 30, 2014, Cape Coral Injury Lawyer Blog

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