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

Decision Date30 June 2009
Docket NumberNo. 1D08-0190.,1D08-0190.
Citation15 So.3d 701
PartiesSTATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. Joyce MASHBURN, Appellee.
CourtFlorida District Court of Appeals

Charles F. Beall, Jr., of Moore, Hill & Westmoreland, P.A., Pensacola, for Appellant.

Woodburn S. Wesley, Jr., of Wesley, McGrail & Wesley, Ft. Walton Beach, for Appellee.

BROWNING, J.

The trial court erred in entering summary judgment and we accordingly reverse. We remand for further proceedings for the reasons in this opinion.

In this insurance coverage case, Appellee Joyce Mashburn sought, and received, summary judgment by arguing she "is" eligible for medical expenses coverage under the terms of the policy issued by Appellant State Farm Mutual Automobile Insurance. Here on appeal, State Farm vigorously disputed that she is so eligible, and while Mashburn gamely defended the trial court's decision, she basically argued to this court that she "should" have been covered because of alleged conversations with Appellant's agent. We hold on this record that Mashburn is not entitled to a summary judgment for medical expenses under the policy, but express no judgment on whether she might be entitled to coverage under other theories of liability alleged in her complaint, or that might be alleged by an amended complaint, and remand to the trial court for further consistent proceedings.

Mashburn has lived with Luis Palacios since 1997, but they never married. Palacios bought Mashburn a car in 1997. Palacios insured the car with State Farm through its agent. Palacios was the only person listed on the policy's declarations page as a named insured. Mashburn was never listed as a named insured. Mashburn was not a named insured because the title to the car was in Palacios' name, so Mashburn did not have an insurable interest in the car.

Originally, the policy extended coverage for medical expenses to "the first person named in the declarations," "his or her spouse," "their relatives," and "any other person while occupying a vehicle covered under the liability coverage...." Thus Mashburn, who was not a named insured, a spouse, or a relative, was nevertheless eligible for such coverage so long as she occupied a covered vehicle.

In 2002, Palacios bought another car to replace the one he had given to Mashburn in 1997. State Farm issued a new policy effective May 14, 2002, to cover the new car. On this new policy's declarations page is a notice of "Exceptions and Endorsements." Among the endorsements listed is Endorsement 6910. This endorsement changed eligibility for medical expense coverage to "you" or "any relative" alone, removing "any other person" from eligibility. The policy defines "you" as the "named insured or named insureds shown on the declarations page."

The new policy, effective on May 14, 2002, included a copy of Endorsement 6910. Palacios acknowledged receiving a premium notice prepared on July 30, 2002, which states "Endorsement 6910 effective SEP 19, 2002." This premium notice, like others, identified Palacios and Mashburn as licensed drivers.

On May 18, 2003, Mashburn was injured in an accident while driving the 2002 car. There is no dispute that she incurred medical expenses as a result of her injuries.

"We review de novo the trial court's interpretation of the insurance policy contract, the determination of whether the law requires the insurer to provide coverage, and the ruling on the motion for partial summary judgment." First Professionals Ins. Co., Inc. v. McKinney, 973 So.2d 510, 513-14 (Fla. 1st DCA 2007). "Like other contracts, contracts of insurance should receive a construction that is reasonable, practical, sensible, and just." Gen. Star Indem. Co. v. W. Fla. Village Inn, Inc., 874 So.2d 26, 29 (Fla. 2d DCA 2004). "[I]n 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); see Riveroll v. Winterthur Int'l Ltd., 787 So.2d 891, 892 (Fla. 3d DCA 2001). In other words, a single policy provision should not be read in isolation and out of context, for the contract is to be construed according to its entire terms, as set forth in the policy and amplified by the policy application, endorsements, or riders. See Swire Pac. Holdings, Inc. v. Zurich Ins. Co., 845 So.2d 161, 166 (Fla.2003); St. Paul Guardian Ins. Co. v. Canterbury Sch. of Fla., 548 So.2d 1159, 1160 (Fla. 2d DCA 1989) (finding no ambiguity in insurance contract titled "Trustee and Personnel Liability Policy," where declaration page of policy listed "insured's name and address" as the school's name and address, whereas definitional portion of policy clarified that "insured" meant elected or appointed trustees or school directors and employees, and school paid premiums for a trustee and personnel liability policy). The mere fact that an insurance contract is complex and requires some analysis to interpret it does not, by itself, render the agreement ambiguous. See Swire Pac. Holdings, 845 So.2d at 165. Absent ambiguity or inconsistency, "insurance contracts are construed in accordance with the plain language of the policies as bargained for by the parties." Anderson, 756 So.2d at 34.

Mashburn is not eligible for medical expenses coverage under the policy terms as modified by Endorsement 6910. The policy provides "We will pay medical expenses for bodily injury sustained by you or any relative [.]" (emphasis in original). In its "Defined Words" section, the policy provides that "You or Your — means the named insured or named insureds shown on the declarations page." (emphasis in original). Thus, to claim coverage for medical expenses, Mashburn must be either a "named insured" (that is, "you") or any relative.

The policy document entitled "Declarations Page" shows the term "NAMED INSURED" (emphasis in original). Only one name is under this heading — Luis Palacios. Because Mashburn is neither a named insured nor a relative of a named insured, she is not entitled to payment of medical expenses under the policy.

Mashburn argues alternatively that the policy is ambiguous as to whether she is entitled to medical payment coverage, and that therefore the policy should be read in favor of coverage. There is no doubt that, in the case of a legitimate ambiguity, the policy is read in the insured's favor. "However, 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." Gen. Star Indem., 874 So.2d at 30. Mashburn does not make a cogent case for ambiguity here.

She argues first that the standard policy form states that it will pay medical expenses for injuries sustained by the "first person named in the declarations," and that the standard policy form defines "person" as "a human being." This is true but does not create ambiguity. First, the only person named in the declarations is Palacios. Second, to the extent Mashburn argues there is conflict between the standard form and the endorsement, "[e]very insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy and as amplified, extended, or modified by any application therefor or any rider or endorsement thereto." McKinney, 973 So.2d at 514 (quoting § 627.419(1), Fla. Stat.). Endorsement 6910 expressly changes the standard policy provision on eligibility for medical expenses coverage. Mashburn does not argue otherwise.

Next, Mashburn argues that neither "declarations page" nor "named insured" is defined in the policy. This is true, but...

To continue reading

Request your trial
23 cases
  • Gee v. U.S. Bank Nat'l Ass'n
    • United States
    • Florida District Court of Appeals
    • 30 septembre 2011
    ...as motion merely stated that no material issues existed and movant was entitled to judgment); see also State Farm Mut. Auto. Ins. Co. v. Mashburn, 15 So.3d 701, 706 (Fla. 1st DCA 2009) (reversing summary judgment entered against insurer based on notice issue, which was not raised with parti......
  • Southern-Owners Ins. Co. v. Easdon Rhodes & Assocs. LLC
    • United States
    • U.S. Court of Appeals — Eleventh Circuit
    • 29 septembre 2017
    ...surrounding the phrase "similar coverage" to select between these two possible meanings. See, e.g. , State Farm Mut. Auto Ins. Co. v. Mashburn , 15 So.3d 701, 704 (Fla. Dist. Ct. App. 2009) (explaining a "single policy provision should not be read in isolation and out of context, for the co......
  • Property v. Johnson
    • United States
    • Florida District Court of Appeals
    • 21 juin 2013
    ...terms, as set forth in the policy and amplified by the policy application, endorsements, or riders.” State Farm Mut. Auto. Ins. Co. v. Mashburn, 15 So.3d 701, 704 (Fla. 1st DCA 2009). We do not read the language in section 2 of the policy here as creating a contractual right to void the pol......
  • Yanes v. Nat'l Specialty Ins. Co.
    • United States
    • U.S. District Court — Southern District of Florida
    • 29 avril 2021
    ...as set forth in the policy and amplified by the policy application, endorsements, or riders." State Farm Mut. Auto. Ins. Co. v. Mashburn , 15 So. 3d 701, 704 (Fla. Dist. Ct. App. 2009). Additionally, "in construing insurance policies, courts should read each policy as a whole, endeavoring t......
  • Request a trial to view additional results

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT