Berkshire Life Ins. Co. v. Adelberg, 89128

• Decision Date: 28 August 1997
• Docket Number: No. 89128,89128
• Citation: 698 So.2d 828
• Parties: 22 Fla. L. Weekly S513 BERKSHIRE LIFE INSURANCE COMPANY, Appellant, v. Bruce ADELBERG, Appellee.
• Court: Florida Supreme Court

Page 828

698 So.2d 828

22 Fla. L. Weekly S513

BERKSHIRE LIFE INSURANCE COMPANY, Appellant, v. Bruce ADELBERG, Appellee.

No. 89128.

Supreme Court of Florida.

Aug. 28, 1997.

Jay S. Blumenkopf and Kenneth Strick of Proskauer, Rose, Goetz & Mendelsohn, Boca Raton, for Appellant.

Andrew E. Grigsby of Hinshaw & Culbertson, Miami, for Appellee.

WELLS, Justice.

We have for review the following certified question from a federal circuit court ¹ that is determinative of a cause pending before that court and for which there appears to be no controlling precedent:

WHEN THE TERM "OCCUPATION" IS LEFT UNDEFINED IN AN OCCUPATIONAL DISABILITY INSURANCE POLICY, DOES THE TERM "OCCUPATION" REFER TO PRECISELY (AND ONLY) THE JOB HELD BY THE INSURED AT THE TIME OF THE INJURY, OR SHOULD IT BE INTERPRETED MORE GENERALLY TO INCLUDE ANY JOB REQUIRING SIMILAR SKILLS AND PRODUCING A COMPARABLE INCOME?

Adelberg v. Berkshire Life Ins. Co., 97 F.3d 470, 472 (11th Cir.1996). In order to answer the question on the basis of the instant case, we rephrase the question as:

WHEN THE TERM "OCCUPATION" IS LEFT UNDEFINED IN AN OCCUPATIONAL DISABILITY INSURANCE POLICY WHICH STATES THAT TOTAL DISABILITY MEANS "YOUR INABILITY TO ENGAGE IN YOUR OCCUPATION," DOES THE TERM "YOUR OCCUPATION" REFER TO PRECISELY (AND ONLY) THE WORK IN WHICH THE INSURED IS ENGAGED AT THE TIME OF THE INJURY, OR SHOULD THE TERM BE INTERPRETED MORE GENERALLY TO INCLUDE ANY WORK REQUIRING SIMILAR SKILLS AND PRODUCING A COMPARABLE INCOME?

We have jurisdiction under article V, section 3(b)(6) of the Florida Constitution, and we hold that the term "your occupation" refers to the work in which the insured is engaged at the time of the injury.

Berkshire Life Insurance Company (Berkshire) insured Adelberg under an occupational disability policy. During the life of the policy, Adelberg worked at various times as a jeweler, a food-commodities salesman, a yacht salesman, and a freight-space salesman. In February 1990, while he was working as a yacht salesman, Adelberg injured his knee and was found to be totally disabled as to his occupation. From July 17 to October 1, 1990, Berkshire paid disability benefits to Adelberg totaling $3300. Adelberg's duties included showing yachts to customers and acquiring in-depth knowledge of yacht interiors by walking and crawling through them. On October 1, 1990, Adelberg returned to work as a yacht salesman, and his benefits were terminated. Later that month, after climbing on yachts for several days, Adelberg's knee swelled so that he could no longer walk. On November 7, 1990, Adelberg notified Berkshire of the aggravation of his earlier injury, indicating that he was totally disabled. Three months later, Adelberg obtained employment as a freight-space salesman for a trucking company. Although Adelberg held a sales position with the trucking company, he maintained his disability claim with Berkshire because of his inability to perform the duties of a yacht salesman. Berkshire denied Adelberg's claim on the basis that he was not totally disabled from his occupation as a salesman, as evidenced by his new job. Berkshire has paid no benefits to Adelberg since October 1, 1990. The Berkshire policy states:

[T]otal disability means your inability to engage in your occupation, except: the terms of this policy may provide that the indemnity can be paid for more than 120 months. In such a case, for benefits that are paid for disability after the first 120 months, the term "total disability" will have this meaning: your inability to engage in any gainful occupation in which you might reasonably be expected to engage, with due regard for your education, training, experience, and prior economic status.

The policy does not define the term "your occupation."

Adelberg filed a complaint against Berkshire in the Dade County Circuit Court. Based on diversity, Berkshire removed the action to the United States District Court. Adelberg moved for partial summary judgment, arguing that his occupation was that of a "yacht salesman" and that he was totally disabled as to that occupation rather than as to the occupation generally defined as "salesman." The court denied this motion, and the case was set for a jury trial. Prior to trial, the case was transferred to another judge, who informed the parties that she disagreed with her predecessor's ruling on Adelberg's motion for summary judgment. The court ruled that Adelberg's occupation, for purposes of recovery, was yacht salesman. Using this definition of Adelberg's occupation, a jury awarded him $224,226.93. Berkshire appealed the district court's conclusion that Adelberg's occupation was, as a matter of law, that of yacht salesman. Berkshire contended that if occupation is undefined in a disability policy, the term should not be limited to the particular job held by the insured at the time of injury but should apply to any similar position of the same general character. On appeal, the Eleventh Circuit found that the case presented an issue of Florida law and certified the question for resolution by this Court.

On appeal to this Court, Berkshire contends that the district court should have held that Adelberg was a salesman rather than a yacht salesman under the terms of the insurance policy Berkshire sold to Adelberg. ² It has long been a tenet of Florida insurance law that an insurer, as the writer of an insurance policy, is bound by the language of the policy, which is to be construed liberally in favor of the insured and strictly against the insurer. Firemans Fund Ins. Co. v. Boyd, 45 So.2d 499, 501 (Fla.1950). Berkshire...