Blue Cross and Blue Shield of Florida, Inc. v. Cassady

• Decision Date: 15 October 1986
• Docket Number: No. 85-1238,85-1238
• Citation: 496 So.2d 875,11 Fla. L. Weekly 2192
• Parties: 11 Fla. L. Weekly 2192 BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC., Appellant, v. Lucy E. CASSADY and Martin T. Cassady, Appellees.
• Court: Florida District Court of Appeals

Page 875

496 So.2d 875

11 Fla. L. Weekly 2192

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC., Appellant, v. Lucy E. CASSADY and Martin T. Cassady, Appellees.

No. 85-1238.

District Court of Appeal of Florida Fourth District.

Oct. 15, 1986.

Rehearing and Clarification Denied Nov. 20, 1986.

Emory C. Teel, III of Fee, Bryan, Kobelgard, Teel & Kenney, P.A., Fort Pierce, for appellant.

William E. Raikes, III of Brennan and Muschott, Fort Pierce, for appellees.

HERSEY, Chief Judge.

Appellant, medical insurance carrier, appeals a determination adverse to it that appellee claimant is entitled to coverage under his mother's policy because of his status as a full-time student under the age of twenty-four years.

The policy provision in issue provides as follows:

"Subscriber" means and includes the contract holder and any of his or her dependents covered under this contract but only if and while any such person is so covered. Coverage of a newborn child of a contract holder under an existing family contract shall commence with the date of birth. Under a family contract a subscriber child is entitled to the same benefits as the subscriber-parent. A child shall cease to be a subscriber under a family contract when such child becomes nineteen (19) years of age, except if such child is in full time attendance at an accredited college or university and is dependent upon the contract holder for support, coverage will continue until such child becomes twenty-four (24) years of age, or upon marriage of such child.

(Emphasis added).

Following are the operative facts:

Claimant was born on December 4, 1964. He was, at all times relevant to the coverage issue presented here, less than twenty-four years of age.

At the age of seventeen, claimant dropped out of high school, left his mother's residence and moved in with a friend. Five months later he returned to his mother's household and decided to take the General Educational Development (GED) test as a necessary prerequisite to attending college. He paid for the test on November 28, 1983, and began studying to take the test. On December 4, 1983, he reached his nineteenth birthday. At that time he was unemployed and lived with his mother.

On January 31, 1984, claimant received his GED high school diploma, too late to enter Indian River Junior College for the winter term; however, he planned to enroll for the summer term.

On March 23, 1984, the injuries for which compensation is sought in these proceedings occurred as a result of a collision between claimant's motorcycle and an automobile.

On April 6, 1984, claimant paid an application fee of $10 to Indian River Junior College. Because classes in the subject he wished to pursue were not available during the summer term, however, he did not commence his formal studies until August of 1984.

Because we think it is reasonably clear that claimant was "dependent" on his mother for support within the meaning of the policy provision in question, we have omitted recital of evidence on that issue. It is also undisputed that claimant is within the age brackets to qualify for coverage. Remaining for our consideration on the issue of coverage is whether claimant, at the time of the injury, was "in full time attendance at an accredited college or university." In simpler terms, the question is whether claimant was a full-time student.

The trial court took testimony on this issue to the effect that one enrolled to attend college would be covered even during summer break. Apparently assuming that the term "full-time" did not in ordinary usage encompass a student during a summer break, the court found the policy language ambiguous in this respect and therefore entitled to be expanded and explained by parol evidence. Based upon the policy language, enlightened by trial testimony the trial court construed the coverage provision as broad enough to include claimant.

If "full-time attendance" is ambiguous, then claimant was entitled to have the policy construed in his favor and the final judgment affirmed. If that term is not ambiguous, then its plain, ordinary meaning must be applied to the facts of this case, perhaps with a different result. The applicable rules are succinctly stated by the Court of Appeals in Ideal Mutual Insurance Co. v. C.D.I. Construction, Inc., 640 F.2d 654, 657-658 (5th Cir.1981), as follows:

Under Florida law, which applies to issues of policy construction, the basic rule is: where there is an ambiguity such that two (or more) reasonable interpretations can fairly be made, the court will choose that interpretation favoring the insured. Shelby Mutual Ins. Co. v. Manchester, 376 So.2d 266 (Fla. 3rd DCA 1979); Travelers Ins....