Florida Court of Appeal Allows Severely Injured Woman to Access Dependent Children Benefits in Parents’ Auto Insurance Plan

 

The Florida First District Court of Appeal recently issued an opinion regarding the coverage in an auto insurance policy for a woman severely injured in a motorcycle accident.  The woman’s mother had purchased “two-parent family” auto insurance coverage for herself, her spouse, and her children.  “Dependent children” were defined in the mother’s policy as natural children who are unmarried, under 25, and qualify as legal dependents for tax exemption purposes under the US Tax code. 

The injured woman filed suit and the matter eventually went to a jury trial.  Both witness and expert medical testimony were offered, providing conflicting accounts to the fact-finder.  The insurer claimed the injured woman was not in a coma long enough to qualify for coverage.  The appellate court found there was competent substantial evidence supporting the trial court’s findings of the injury.  The trial court agreed the type of injuries suffered were covered within the auto policy for the coma and third degree burns.  The court, however, did not agree the injured woman was a “dependent child” under the policy.  The court determined she was ultimately not covered and the insurer was not obligated to pay benefits for her injury.  The family appealed. 

Case law directs courts to favor the plain language of an insurance contract.  The appellate court found the policy language to be extremely clear about the definition of a dependent.  The parties agreed the IRS definition for a dependent was based on Internal Revenue Code (I.R.C.) section 152 which allows a qualifying child to be anyone who bears a relationship to the taxpayer, shares the same principal place of abode as the taxpayer, meets the age requirements (under 19 by the end of the calendar year, or under 24 and a student); and has not provided more than half of the individual’s own support.  The insurer argued the policy’s definition contradicted itself with the phrase “under age 25”, which differs from the age requirements in Internal Revenue Code (I.R.C.) section 152.  When she was injured, the plaintiff was over the age of 19 and not a student nor disabled. 

The court acknowledged the inconsistency within the provision.  Case law allows specific provisions of a contract to control over the general conditions and requires courts to read each policy as a whole to give every provision full effect.  Insurance contracts should not be interpreted in a way that renders it meaningless when a reasonable interpretation is available.  The appellate court determined  the phrase “Under age 25” in the insurance policy was meant to expand the class of individuals that are considered dependents under the policy.  The reference to the IRS was meant to help establish the relationship and residency requirements.  The appellate court reasoned that applying a more restrictive age provision after several explicit provisions granting coverage would be counterintuitive to the policy.

The Court of Appeal also looked to long established Florida case law about insurance policies.  If a provision is considered to be ambiguous, the court must read it in favor of the insured and against the insurer.  This is in line with general contract law where the drafter of the document is held accountable for the language since they had the opportunity to craft and revise the provisions within.  The trial court’s determination the injured woman was not covered as a dependent child was reversed and the case remanded for a judgment in favor of the woman and her parents. 

The Florida motorcycle injury attorneys of Donaldson & Weston understand the financial strain a family faces after a severe injury accident.  Our lawyers will aggressively pursue all avenues of legal relief to provide you the monetary damages you need. Call our office today at 772-266-5555 or 561-299-3999.

More Blog Posts:

Florida District Appellate Court Reviews Future Medical Expenses in Multi-Car Accident Case, Florida Injury Lawyer Blog, November 28, 2016

Federal Circuit Court of Appeal Declines to Find Equitable Tolling in Slip and Fall Case, Florida Injury Lawyer Blog, October 21, 2016

Florida Court of Appeal Allows Injured Motorist to Pursue Additional PIP Payments to Medical Providers, Florida Injury Lawyer Blog, May 18, 2017