Moorman v. Prudential Ins. Co. of America

Decision Date09 March 1983
Docket NumberNo. 82-281,82-281
Citation4 Ohio St.3d 20,4 O.B.R. 17,445 N.E.2d 1122
CourtOhio Supreme Court

Cross & Turner, Gerald L. Turner, Emerson R. Keck and Kevin Swick, Dayton, for appellee.

Pickrel, Schaeffer & Ebeling, Andrew C. Storar and Paul J. Winterhalter, Dayton, for appellant.


The sole issue presented is whether the charges for the crowning of teeth as part of the treatment for temporomandibular joint syndrome are excluded from coverage under the exclusionary provision dealing with "Mouth Conditions" in the insurance contract. For the reasons that follow, this court holds that such charges may be recovered under the terms of the policy.

At the outset, it is apposite to bear in mind that "[a] contract of insurance prepared and phrased by the insurer is to be construed liberally in favor of the insured and strictly against the insurer, where the meaning of the language used is doubtful, uncertain, or ambiguous." Munchick v. Fidelity & Casualty Co. (1965), 2 Ohio St.2d 303, 209 N.E.2d 167 , paragraph one of the syllabus. (Emphasis added.)

The exclusionary provision in this policy excludes costs of services for "Mouth Conditions" which includes "any treatment of the teeth." Appellant contends that since the crowning of the teeth is treatment of the teeth, the costs resulting therefrom are not covered.

Appellee, while conceding that the services in question affected Mrs. Moorman's teeth, nonetheless asserts that the costs for crowning of the teeth are covered because such service constituted treatment of a mispositioned jaw joint, a medical condition covered under the policy. Treatment of the jaw, appellee contends, is clearly distinct from treatment of the teeth.

As these arguments so demonstrate, the relevant exclusionary provision is susceptible of a number of constructions. The ordinary meaning of "treatment," as found in Black's Law Dictionary (5 Ed.1979), lends support to appellant's interpretation: "A broad term covering all the steps taken to effect a cure of an injury or disease; including examination and diagnosis as well as application of remedies." The record, in contrast, supports appellee's position, for it clearly indicates that crowning of the teeth was one of the specific procedures used toward the cure of Mrs. Moorman's TMJ. Charges for treatment of the teeth are excluded under appellant's policy while charges for the treatment of TMJ are not excluded. Of course, the charges in both instances are for the same service--crowning of the teeth. Clearly, then, there is uncertainty as to whether costs for teeth crowning are ever covered under the policy, and applying the principles set forth in Munchick, supra, this court must adopt the construction most favorable to the insured which would allow recovery for teeth crowning where it is done in the course of the...

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1 books & journal articles
    • United States
    • Full Court Press Zalma on Property and Casualty Insurance
    • Invalid date
    ...not clearly excluded from the operation of such contract is included in the operation thereof.’” Moorman v. Prudential Ins. Co. of Am., 445 N.E.2d 1122, 1124 (Ohio 1983) (quoting Home Indem. Co. v. Plymouth, 64 N.E.2d 248, 250 (Ohio 1945). The exclusion “must be stated clearly in explicit w......

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