Entzminger v. Provident Life & Acc. Ins. Co., 01-82-0446-CV

• Decision Date: 05 May 1983
• Docket Number: No. 01-82-0446-CV,01-82-0446-CV
• Citation: 652 S.W.2d 533
• Parties: Jennifer Holly ENTZMINGER, et al., Appellants, v. PROVIDENT LIFE & ACCIDENT INSURANCE CO., Appellee. (1st Dist.)
• Court: Texas Court of Appeals

Page 533

652 S.W.2d 533

Jennifer Holly ENTZMINGER, et al., Appellants, v. PROVIDENT LIFE & ACCIDENT INSURANCE CO., Appellee.

No. 01-82-0446-CV.

Court of Appeals of Texas,

Houston (1st Dist.).

May 5, 1983.

B. Lee Ware, Houston, for appellants.

Jeffrey S. Wolff, Houston, for appellee.

Before SMITH, DUGGAN and LEVY, JJ.

OPINION

DUGGAN, Justice.

Appellants are beneficiaries under a life and accidental death insurance policy issued by the appellee insurance company. They appeal the district court judgment, based on jury answers to special issues, which denied them the accidental death portion of the policy's benefits following the insured's death in an Air National Guard airplane crash.

Six of their seven points of error center on the construction and application of an aviation exclusion clause in the accidental death portion of the policy. Appellee, Provident Life and Accident Insurance Company, paid $25,000 in life insurance proceeds to the beneficiary appellants, the insured deceased's minor children, Jennifer Holly Entzminger, and Heather Lin Entzminger, represented by their mother and next friend, Nanette Entzminger. However, appellee declined to pay the $25,000 accidental death indemnity on the grounds that the insured's fatal air crash was expressly excluded under the terms and conditions of the policy. The appellants brought suit to recover the accidental death benefit, statutory penalties, interest, and attorneys' fees.

Dr. Lindell B. Entzminger, Jr., was a participant in a group life and accidental death policy issued by the appellee and sponsored and approved by the American Medical Association. The policy provided for payment of $25,000 in life insurance coverage in the event of Dr. Entzminger's death and included as accidental death benefits the additional amount of $25,000 if he were to die of accidental causes.

In addition to practicing medicine in his civilian life, Dr. Entzminger was a major in the Texas Air National Guard and served as a flight medical officer, or flight surgeon, attached to the 111th Fighter Intercept Squadron stationed at Ellington Air Force Base. Part of the doctor's duties included logging a minimum number of "sorties" or missions in military aircraft each month.

On February 18, 1976, Dr. Entzminger died in the crash at Ellington of a T-33 aircraft in which he was one of two occupants. The pilot, Major Otis L. Finkelman, had sixteen to seventeen years' experience as a fighter pilot and some 3,000 hours of military flight time. Major Finkelman presumably intended to fly the airplane to a predetermined coordinate to serve as a simulated enemy aircraft for medium altitude radar tracking by an F-101 fighter interceptor aircraft. The aircraft crashed immediately after takeoff.

In their first three points of error, the appellants argue that the exclusionary provision in question is ambiguous and does not give fair notice of what is excluded from coverage, and that the court erred in overruling their motions for instructed verdict and for judgment non obstante verdicto, and in rendering judgment for the appellee insurance company.

The appellee insists, by a reply point, that the appellants waived their right to raise the issue of ambiguity at trial by failing to plead it. It is generally true that one seeking to establish ambiguity under a written contract must specifically plead such ambiguity. Crozier v. Horne Children Maintenance and Educational Trust, 597 S.W.2d 418 (Tex.Civ.App.--San Antonio 1980, writ ref'd n.r.e.). An exception to this pleading requirement applies when the plaintiff challenges the applicability of an exclusion of coverage under an insurance policy. Rule 94 of the Texas Rules of Civil Procedure provides, in relevant part:

Where the suit is on an insurance contract which insures against certain general hazards, but contains other provisions limiting such general liability, the party suing on such contract shall never be required to allege that the loss was not due to a risk or cause coming within any of the exceptions specified in the contract ....

(Vernon 1979). An insured is not obliged to plead that the loss resulted from a cause not excluded by the policy since Rule 94 places the duty upon the insurance carrier to plead the exclusion it relies upon. National Union Fire Insurance Co. v. Cox, 393 S.W.2d 939, 941 (Tex.Civ.App.--Houston 1965, no writ). The party seeking to recover benefits under the policy then has the burden to prove that the loss did not come within the exception from liability raised by the insurer. Id., Golden State Mutual Life Insurance Co. v. White, 374 S.W.2d 901, 906 (Tex.Civ.App.--Austin 1964, writ ref'd n.r.e.); Merryman v. Employers National Life Insurance Co., 416 S.W.2d 609 (Tex.Civ.App.--Beaumont 1967, writ ref'd n.r.e.). Thus, the appellants were not required to reply to the appellee's first amended answer, which alleged the aviation exclusion as an affirmative defense, in order to move for judgment on the ground of ambiguity of the exclusion. National Life and Accident Insurance Co. v. Green, 477 S.W.2d 689 (Tex.Civ.App.--Waco 1972, no writ).

The appellants take the position that the language of the exclusion is capable of several inconsistent interpretations, some of which would exclude recovery and at least one of which would allow recovery. Therefore, they argue, the exclusion is ambiguous as a matter of law, and that interpretation affording recovery should prevail.

It is undisputed that language in an insurance provision is ambiguous if it is uncertain which of two or more meanings was intended. Universal C.I.T. Credit Corp. v. Daniel, 150 Tex. 513, 243 S.W.2d 154, 157 (1951); Standard Fire Insurance v. Griggs, 567 S.W.2d 60, 63 (Tex.Civ.App.--Amarillo 1978, writ ref'd n.r.e.). More specifically, ambiguity in the terms of an insurance contract occurs when there are two or more inconsistent interpretations, both of which are fair and reasonable. Cabell v. World Service Life Insurance Co., 599 S.W.2d 652, 654 (Tex.Civ.App.--Texarkana 1980, writ ref'd n.r.e.). When ambiguity is determined to exist, ambiguous language is then construed in favor of the insured. Glover v. National Insurance Underwriters, 545 S.W.2d 755, 761 (Tex.1977); General American Indemnity v. Pepper, 161 Tex. 263, 339 S.W.2d 660, 661 (1960); Southwestern Life Insurance Co. v. Rowsey, 514 S.W.2d 802, 805 (Tex.Civ.App.--Austin 1974, writ ref'd n.r.e.) (aviation exclusion). But the court must first determine as a matter of law whether there is an ambiguity, Melton v. Ranger Insurance Co., 515 S.W.2d 371, 373 (Tex.Civ.App.--Fort Worth 1974, writ ref'd n.r.e.), and plain, clear and unambiguous language of a policy must be given such meaning as will carry out and effectuate the intention of the parties; only where there is uncertainty as to the meaning of the contract, or a portion thereof, will rules of construction be applied. Paul Revere Life Insurance Co. v. First National Bank in Dallas, 359 F.2d 641 (5th Cir.1966); Glover, supra.

The exclusion in question reads:

No Accidental Death and Dismemberment Insurance will be payable for any loss caused directly or indirectly, wholly or partly by:

....

2. flight in an aircraft operated for any training or testing or experimental purpose ....

The appellants agree that this exclusion was intended to limit risks associated with aviation or flight. It does not relate to the status of the insured, e.g., whether he was a passenger or crew member, or to any qualification required of the pilot, e.g., that he be licensed or experienced, or to the type of aircraft involved, e.g., civilian or military. Instead, coverage is denied when the loss is caused by "flight in an aircraft operated for any training ... purpose."

First, the appellants suggest that ambiguity exists in the language of the exclusion because the phrase "any training ... purpose" could conceivably mean the unintended exclusion of coverage for an insured group traveling by chartered airplane for the purpose of study or "training" in some discipline unrelated to aviation. This theory contradicts the appellants' earlier recognition of the irrelevance of the insured's purpose on board. Conceding that the exclusion is intended to be read as applying to "flight in an aircraft operated for any [aviation] training ... purpose," the appellants next insist the term "[aviation] training" is ambiguous because it can refer to student flight as well as proficiency flying by an experienced pilot to prevent loss of skills. They propose that the former definition should apply; this, then, would take the death of the insured outside the scope of the exclusion.

To accept this theory...