Griswold v. Union Labor Life Ins. Co.
Decision Date | 23 March 1982 |
Citation | 442 A.2d 920,186 Conn. 507 |
Court | Connecticut Supreme Court |
Parties | Sally GRISWOLD et al. v. UNION LABOR LIFE INSURANCE CO. |
David M. Reilly, New Haven, for appellants (plaintiffs).
Wiggin & Dana, New Haven, for appellee (defendant).
Before SPEZIALE, C. J., and PETERS, HEALEY, PARSKEY and SHEA, JJ.
The plaintiffs have sued on a group health insurance policy issued by the defendant, Union Labor Life Insurance Co., to the Trustees of Local 443 Transportation Health Services and Insurance Plan. The plaintiffs are husband and wife with Sally Griswold an insured dependant under her husband's policy.
On March 5, 1977, Sally Griswold was injured in a one-car accident and, as a result, incurred certain medical and hospital expenses totaling under $5000. At the time of the accident, the plaintiffs maintained no insurance policy or acceptable substitute 1 on their automobile which would provide basic reparations benefits as required by the Connecticut No-Fault Motor Vehicle Insurance statutes. General Statutes §§ 38-319 through 38-351. 2 The plaintiffs sought reimbursement for their expenses, which would have qualified for basic reparations benefits under the no-fault statutes, by presenting a claim to the defendant. The defendant denied the claim on the basis that the policy excluded coverage for basic reparations benefits as required by the statutes referred to above. The plaintiffs then brought this action claiming that they were entitled to benefits under the policy and that the defendant had not paid any benefits under the policy despite their demands for payment.
By way of special defense to the plaintiffs' complaint, the defendant claimed that the plaintiffs were required, by statute, to provide security for basic reparations benefits and that, by virtue of their failure to provide such security, they became personally liable for the payment of these expenses. Therefore, pursuant to a policy exclusion (known as a "co-ordination of benefits" or "anti-duplication" clause), the defendant alleged that it was not liable to the plaintiffs for any expenses which would have been otherwise covered by the security for basic reparations benefits as required by statute. After a motion to strike this special defense was denied, 3 the plaintiffs answered the special defense and also alleged that the defendant was bound, under the principles of res judicata and collateral estoppel, by a Superior Court decision rendered in Conroy v. Union Labor Life Ins. Co., 37 Conn.Sup. 117, 442 A.2d 470 (1978). That case held that the same exclusionary language of the same insurance policy as is involved here precluded the defendant from denying benefits to another claimant in the same position as the plaintiff.
The defendant moved for summary judgment on January 24, 1979 and the court, Celotto, J., granted this motion on October 9, 1979. From this judgment, the plaintiffs have appealed.
The defendant's anti-duplication clause, which the court relied upon in granting summary judgment, provides as follows: The court found that the "defendant's policy clearly states that benefits are to be reduced by coverage required or provided by any statute and any no-fault insurance policy." In support of this, the court relied upon Neagle v. Connecticut Blue Cross, Inc., 36 Conn.Sup. 561, 420 A.2d 1169 (1980). In that case, the Appellate Session of the Superior Court held that coverage for any benefits required to be provided under General Statutes § 38-320(a) was excluded, without regard to whether any benefits were actually provided, by "an exclusion clause which denied benefits for expenses which were 'paid, payable or required to be provided as Basic Reparations Benefits under Section 38-320(a) of Connecticut General Statutes or similar benefits under any other no-fault automobile insurance law.' " (Footnote omitted.) Id., 562.
The trial court also stated that the defendant was not bound, under the doctrine of collateral estoppel, by Conroy, supra, because to do so would allow the plaintiffs, who were not parties to the Conroy case, to use that judgment offensively and in derogation of that doctrine's requirement of mutuality.
We conclude that the trial court erred in its interpretation of the anti-duplication clause and reverse the decision granting summary judgment.
General Statutes § 38-373(c)(1)(B) states that a health care insurance plan, otherwise providing minimum standard benefits, need not provide benefits for "(a)ny charge for any care for any injury or disease ... to the extent benefits are payable without regard to fault under a coverage statutorily required to be contained in any motor vehicle or other liability insurance policy or equivalent self-insurance." The major dispute in this matter is whether the language contained in the defendant's anti-duplication clause operates to exclude such benefits.
The plaintiffs claim that the purpose of the anti-duplication clause is to prevent a claimant from multiple recoveries if his expenses are covered by more than one policy. The plaintiffs point to the lower court's interpretation of the same clause in Conroy, supra, where Judge O'Sullivan stated that the clause Conroy, supra.
The defendant, on the other hand, argues that the "policy states in clear and unambiguous language that its coverage is secondary to 'any coverage required or provided by any statute.' " The defendant buttresses its argument with the fact that, under General Statutes § 38-327(e), an owner of a private passenger motor vehicle who does not maintain the required insurance or acceptable substitute shall be personally liable for the payment of basic reparations benefits and shall also have all of the rights and obligations of an insurer. Under § 38-320(a), the owner's insurer is liable for the payment of basic reparations benefits, without regard to fault, up to $5000 per person per accident.
"Under our law, the terms of an insurance policy are to be construed according to the general rules of contract construction. See, e.g., Weingarten v. Allstate Ins. Co., 169 Conn. 502, 509-10, 363 A.2d 1055 (1975); A. M. Larson Co. v. Lawlor Ins., Agency, Inc., 153 Conn. 618, 622, 220 A.2d 32 (1966). 'The determinative question is the intent of the parties, that is, what coverage the ... (plaintiff) expected to receive and what the defendant was to provide, as disclosed by the provisions of the policy.' Marcolini v. Allstate Ins. Co., 160 Conn. 280, 283, 278 A.2d 796 (1971). If the terms of the policy are clear and unambiguous, then the ' "language, from which the intention of the parties is to be deduced, must be accorded its natural and ordinary meaning." ' Weingarten v. Allstate Ins. Co., supra, 169 Conn. at 509, 363 A.2d 1055. However, '(w)hen the words of an insurance contract are, without violence, susceptible of two interpretations, that which will sustain the claim and cover the loss must, in preference, be adopted.' Raffel v. Travelers Indemnity Co., 141 Conn. 389, 392, 106 A.2d 716 (1954); see also 4 Williston, Contracts (3d Ed.) § 621.
Simses v. North American Co. for Life & Health Ins., 175 Conn. 77, 84-85, 394 A.2d 710 (1978). Griffith v. Security Ins. Co., 167 Conn. 450, 460-61, 356 A.2d 94 (1975) (Bogdanski, J., dissenting).
We cannot say that the clause...
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