Washington National Insurance Corp. v. Ruderman

Summary

The Florida Supreme Court answered certified questions from the Eleventh Circuit concerning whether an insurance policy’s automatic benefit increase applied only to the daily home health care benefit or also to the lifetime and per-occurrence maximum benefits. The court held that the policy was ambiguous and that, under Florida law, the ambiguity must be construed against the insurer and in favor of coverage without resort to extrinsic evidence. The court concluded that the automatic increase applied to all three benefit categories and conditionally granted appellate attorney’s fees to the insureds.

Holdings

1. The insurance policy is ambiguous because the certificate schedule's statement that benefits increase by 8 percent each year reasonably may be read either to apply only to the daily benefit or to apply to all benefits listed on the schedule, including the lifetime and per-occurrence maximum benefits.
2. Under Florida law, courts do not resort to extrinsic evidence to resolve the patent ambiguity in this insurance policy before construing it against the insurer.
3. The policy's automatic benefit increase applies to the Home Health Care Daily Benefit, the Lifetime Maximum Benefit, and the Per Occurrence Maximum Benefit.

Questions Presented

1. Whether the policy's Automatic Benefit Increase Percentage applies to the Lifetime Maximum Benefit Amount and the Per Occurrence Maximum Benefit.
2. Whether the policy is ambiguous regarding whether the automatic increase applies only to the Home Health Care Daily Benefit or also to the lifetime and per-occurrence maximum benefits.
3. Whether Florida law requires or permits courts to consider extrinsic evidence before construing an ambiguity in an insurance policy against the insurer.
4. Whether, under Florida insurance-policy construction principles, the automatic increase applies to the daily benefit, lifetime maximum benefit, and per-occurrence maximum benefit.

Disposition

other