State Farm Mut. Auto. Ins. Co. v. Fischer

• Decision Date: 09 September 2009
• Docket Number: No. 2D08-589.,2D08-589.
• Citation: 16 So.3d 1028
• Parties: STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. Steven FISCHER, Appellee.
• Court: Florida District Court of Appeals

16 So.3d 1028

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. Steven FISCHER, Appellee.

No. 2D08-589.

District Court of Appeal of Florida, Second District.

September 9, 2009.

Robert H. Oxendine and Edwin Valen of Oxendine & Oxendine, P.A., Tampa, for Appellant.

Kevin B. Weiss of Weiss Legal Group, P.A., Maitland, for Appellee.

SILBERMAN, Judge.

State Farm Mutual Automobile Insurance Company appeals a summary judgment and a final declaratory judgment entered in favor of Steven Fischer. Because the trial court erred in determining that an ambiguity existed in the insurance policy at issue and that Mr. Fischer is entitled to medical expense coverage under his parents' insurance policy with State Farm as a matter of law, we reverse and remand for further proceedings.

On March 19, 2006, Mr. Fischer was a passenger in a car being driven by his friend. They were involved in an automobile accident, resulting in injuries to Mr. Fischer. Mr. Fischer's parents owned the car and insured it with State Farm. The insurance policy included $10,000 in personal injury protection ("PIP") coverage and $50,000 in medical expense coverage. As a result of Mr. Fischer's injuries, State Farm paid the $10,000 in PIP coverage to Mr. Fischer's health care providers, but it denied Mr. Fischer's demand for payment of medical expenses in excess of $10,000.

Mr. Fischer filed a declaratory judgment action against State Farm, seeking a determination that he was entitled to the medical expense coverage under his parents' policy. He also requested a determination that State Farm was obligated to pay pre-judgment interest on benefits not timely paid and his reasonable attorney's fees and costs. State Farm denied that Mr. Fischer was entitled to the medical expense coverage on the basis that he "was not a resident relative of the named insured at the time of the accident."

The insurance policy provides that it will pay medical expenses for bodily injury sustained by the first person named in the declarations, his or her spouse, and their relatives. Concerning medical expense coverage, the policy defines "relative" as "a relative of any degree by blood or by marriage who usually makes his home in the same family unit, whether or not temporarily living elsewhere." (Emphasis added.)

Mr. Fischer filed a motion for final summary judgment, arguing that there were no genuine issues of material fact and that his entitlement to medical expense coverage could be decided as a matter of law. He argued that the applicable definition of "relative" in the policy was ambiguous and must be construed to extend coverage to him. In support of his motion, he filed his deposition and the depositions of his parents.

The deposition testimony established that at the time of the accident, Mr. Fischer lived in a mobile home some three to four miles away from his parents' home. He purchased the mobile home in 1998. The mortgage for the mobile home and the lot lease were in his name, as were the electric and water bills. Mr. Fischer received mail at his home, including the mortgage, electric, and water bills. However, he received some mail at his parents' home address. At various times during the eight years that he lived in his mobile home, he rented a room in the mobile home to others.

Mr. Fischer has a learning disability, and he worked sporadically in the construction industry. He had financial difficulties, and his parents paid many of his debts. His mother testified that they paid 95% of his bills, and his father stated that Mr. Fischer paid part of his bills some of the time. If Mr. Fischer could not pay his bills, his parents would pay them. Mr. Fischer's parents purchased a truck for him and paid for significant repairs to the truck. They also paid for the furniture that Mr. Fischer had purchased on credit.

Mr. Fischer's mother took him to the grocery store and purchased groceries for him about once a month. Mr. Fischer visited his parents' home two to four times a month and sometimes ate meals there. During the eight years that he lived in his mobile home, he spent the night at his parents' home a total of three or four times.

After a hearing on Mr. Fischer's motion for summary judgment, the trial court concluded, without explanation, that the applicable definition of "relative" in the insurance policy was ambiguous and that "the undisputed facts of this case require an interpretation in favor of coverage under the medical payment provisions." On that basis, the trial court granted summary judgment and then entered a final judgment in Mr. Fischer's favor.

State Farm argues that the trial court erred in concluding that the policy language is ambiguous. It contends that there is no ambiguity in the definition of the term "relative" and that the pertinent policy language is readily understood. It notes that the definition of "relative" applicable to the policy's no-fault coverage and medical expense coverage, quoted above, is in all material respects identical to the definition of "relative residing in the same household" found in section 627.732(6), Florida Statutes (2005), which is part of the Florida Motor Vehicle No-Fault Law.¹ See § 627.730. However, State Farm concedes that a factual dispute exists as to whether Mr. Fischer was a relative within the meaning of the policy.

Mr. Fischer responds that State Farm's definition of "relative" is ambiguous because State Farm did not define the term "family unit" or the phrases "usually made his home in the same family unit" or "whether or not temporarily living elsewhere." Alternatively, he contends that even if the policy is not ambiguous, the judgment should be affirmed based on the evidence that he presented in support of his motion for summary judgment.

Our standard of review is de novo. State Farm Mut. Auto. Ins. Co. v. Colon, 880 So.2d 782, 783 (Fla. 2d DCA 2004). Insurance contracts, like other contracts, "should receive a construction that is reasonable, practical, sensible, and just." Gen. Star Indem. Co. v. W. Fla. Vill. Inn, Inc., 874 So.2d 26, 29 (Fla. 2d DCA 2004); see also The Doctors Co. v. Health Mgmt. Assocs., Inc., 943 So.2d 807, 809 (Fla. 2d DCA 2006) (quoting Gen. Star for same). "Terms used in a policy should be read in light of the skill and experience of ordinary people." Gen. Star, 874 So.2d at 29; see also Auto-Owners Ins. Co. v. Above All Roofing, LLC, 924 So.2d 842, 847 (Fla. 2d DCA 2006) (citing Gen. Star for same). In addition, "in construing insurance policies, courts should read each policy as a whole, endeavoring to give every provision its full meaning and operative effect." Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29, 34 (Fla.2000).

"If the relevant policy language is susceptible to more than one reasonable interpretation, one providing coverage and [] another limiting coverage, the insurance policy is considered ambiguous. Ambiguous policy provisions are interpreted liberally in favor of the insured and strictly against the drafter who prepared the policy." Id. (citations omitted). But, "the rule of liberal construction in favor of the insured applies only when a genuine inconsistency, uncertainty, or ambiguity in meaning remains after resort to the ordinary rules of construction," and the fact that a policy fails to define an operative term does not, by itself, create an ambiguity. Gen. Star, 874 So.2d at 30. "When the insurer has not defined a term, the common definition of the term should prevail." Above All Roofing, 924 So.2d at 847.

We cannot agree with the trial court's conclusion that the definition of "relative" contained in the policy is ambiguous. The policy language, including the definition of "relative," is readily understood as providing medical...