Opinions of the Florida District Courts of Appeal
In Eckols v. 21st Century Centennial Insurance Company, 2018 WL 6422088 (Fla. 5th DCA Dec. 7, 2018), the Fifth District Court of Appeal reversed summary judgment in favor of an insurer, holding that specifically defined terms in the insurance policy (“owned” in a UM context) were ambiguous. This case is but one example of the increasingly common trend across Florida where judges will strain to find coverage.
In Safepoint Insurance Company v. Gomez, 2019 WL 208834 (Fla. 3d DCA Jan. 16, 2019), after initiating its right to appraisal and the selection of an umpire, Safepoint attempted to require the insureds to comply with certain post-loss obligations. The Third District Court of Appeal affirmed the trial court’s order requiring the parties to complete the appraisal process. This case stands for the proposition that appraisals are only a mechanism to determine the value of a loss, and are not a means for determining coverage.
Eckols v. 21st Century Centennial Insurance Company, 2018 WL 6422088 (Fla. 5th DCA Dec. 7, 2018): Facts and Procedural History
In September 2012, 21st Century issued a renewal automobile insurance policy for Maria Eckols, her husband, Rene Eckols, and their son, Cody Eckols. Notably absent from this policy was the Eckols’ oldest son, Jesse.
Although Jesse was not a named insured, the Eckols’ insurance policy expressly provided UM coverage for a “family member” of the named insured. The policy defined “family member” as “a person related to [named insured] by blood, marriage or adoption and who is a resident of the [named insured’s] household.” Thereafter, and during the policy period, Jesse, was injured when he was struck by an uninsured/underinsured motorist.
At the time of the collision, Jesse was operating a motorcycle that he owned. 21st Century argued that Jesse’s claim was excluded because he was injured while operating an owned vehicle that was not covered under the policy. The exclusion provision relied upon by 21st Century read:
A. We do not provide Uninsured Motorist Coverage for bodily injury sustained:
1. By an insured while occupying any motor vehicle owned by that insured which is not insured for this coverage under this policy. This includes a trailer of any type used with that vehicle.
(emphasis in original).
Jesse posited that the policy required the definition of boldfaced, italicized words to be given the meanings supplied in the policy, and that the policy had defined “owned” to mean having legal title to or legal possession of an “auto” or “trailer.” “Auto” was defined by the policy to mean a “four wheel private passenger car, van, pickup, or jeep type automobile designed for operation principally upon public roads . . . .” (emphasis added). Resultantly, Jesse argued that application of the policy’s definitions section itself rendered the exclusion provision relied ambiguous because Jesse’s motorcycle was not a “four wheel vehicle.”
The trial court, however, did not agree. It granted a final summary judgment in favor of 21st Century, determining that Mr. Eckols was not entitled to coverage under the uninsured/underinsured motorist provisions in the policy.
Appellate Court Decision
On appeal, the Fifth DCA recited the standard case law regarding construction and interpretation of insurance policy provisions and ambiguity, i.e. courts will generally construe an insurance policy in accordance with its plain language; if the relevant policy language is susceptible to more than one reasonable interpretation, one providing coverage and the other limiting coverage, the insurance policy is considered ambiguous; and ambiguous policy provisions are to be construed strictly against the insurer and liberally in favor of the insured.
The Fifth DCA then reversed summary judgment in favor of 21st Century, holding that the exclusion provision was ambiguous as to whether it applies to motorcycles. The court reasoned that the application of the policy’s own definition of the terms “owned” and “auto” could reasonably be construed to narrow the undefined term “motor vehicle” to certain specified four-wheeled motor vehicles, thereby rendering the exclusion inapplicable to motorcycles.
Safepoint Insurance Company v. Gomez, 2019 WL 208834 (Fla. 3d DCA Jan. 16, 2019): Facts and Procedural History
Eduardo and Mayra Gomez filed an insurance claim with Safpoint for a loss caused to the home by a toilet overflowing. Safepoint investigated the claim, acknowledged coverage, and sent payment to the Gomezes for the covered loss. The Gomezes, however, disputed the amount of the covered loss and demanded additional payment.
Thereafter, Safepoint invoked its right to appraisal under the policy, to which the Gomezes agreed. Predictably, the parties could not agree on the amount of loss and an umpire was selected by the appraisers. While the umpire was set to inspect the Gomezes home, Safepoint sent correspondence to Gomez: (1) requesting Gomez produce sworn proofs of loss; (2) purporting to schedule examinations under oath of Gomez and other individuals regarding 25 areas of inquiry; and (3) requesting Gomez to produce 24 different categories of documentation. Safepoint maintained that the Gomezes were required to comply as a part of their post-loss obligations under the policy.
The Gomezes refused to fulfill Safepoint’s requests. As a result, Safepoint terminated the appraisal process and denied the claim upon an assertion that the Gomezes failed to comply with their post-loss obligations. The Gomezes then filed a breach of contract action and moved to compel Safepoint to complete the appraisal process. The trial court agreed with the Gomezes and entered an order compelling the parties to complete the appraisal process.
Appellate Court Decision
The Third District Court of Appeal affirmed the trial court’s order. The Third DCA explained that the sole purpose of the appraisal process is to determine the amount of a loss. Here, the appraisal process had already commenced and was nearing completion when Safepoint demanded that the Gomezes comply with certain post-loss obligations. Further, there was nothing in the record to indicate that the appraisers or the umpire lacked the necessary information or documentation to appraise the amount of the loss. By invoking its right to appraisal pursuant to the terms of the insurance policy, Safepoint waived the requirement of compliance with post-loss obligations as a condition precedent to that appraisal.