Summary
In Edmonson, certain critical terms were defined in one section of the insurance policy but not in another part of the policy and, thus, the court found that this left the policy open to differing reasonable interpretations.
Summary of this case from City of Eastlake v. St. Paul Fire Marine Ins. Co.Opinion
No. 76-229
Decided November 10, 1976.
Insurance — Motor vehicles — Accidental death benefit — "First named insured," construed.
APPEAL from the Court of Appeals for Hamilton County.
Appellant Edward G. Edmondson is the named insured in an automobile policy issued by the appellee, Motorists Mutual Insurance Company. While the policy was in effect, on March 31, 1973, Edward G. Edmondson, Jr., the son of the named insured, was struck by a motor vehicle and sustained fatal injuries. He was a member of the named insured's household.
The sole issue before the trial court was whether a first party supplementary accidental death benefit of the policy was applicable to the deceased. The trial court granted appellants' motion for summary judgment.
An appeal was taken to the Court of Appeals, and the judgment of the trial court was reversed.
The cause is now before this court pursuant to the allowance of a motion to certify the record.
Mr. William I. Bubenzer and Mr. Arthur F. Freedman, for appellants.
Messrs. Rendigs, Fry, Kiely Dennis and Mr. J. Kenneth Meagher, for appellee.
This controversy involves the demand of appellants for payment of a first party supplementary accidental death benefit. The legal issue upon which this dispute hinges relates to interpretation of the Insuring Agreement I provision of the insurance contract issued by appellee, captioned "Supplementary Payment — (Coverage C)." That provision declares that the company will pay $1,000 upon the death of the "named insured"; such "named insured" is defined in this provision as "a first named insured if an individual." This latter phrase ("first named insured") is defined in the Insuring Agreement III provision of the insurance contract as the individual first named in the declarations of the policy and, while a resident of such individual's household, the spouse of such individual and any relative of either.
The Supplementary Payment provision, declaring that "the named insured" means "a first named insured," is not self-explanatory. Although it is true that Insuring Agreement III refers to the unqualified word "insured," the phrase "first-named insured" is defined nowhere else in the policy. If appellee intended to exclude relatives of the named insured living in the same household from accidental death benefit coverage, appellee attempted to do so by declining to define terms in one section of the policy which require definition in a different section. This device leaves the policy open to differing reasonable interpretations.
Appellee contends that when an agreement contains both a general and a specific provision, the latter controls if the two may not otherwise be reconciled. That contention may generally be correct, but it is inappropriate in an instance when two contractual provisions cannot be reconciled due to an insurer's device as indicated above. This outcome is consistent with the holding in Butche v. Ohio Cas. Ins. Co. (1962), 174 Ohio St. 144, 187 N.E.2d 20. That case held that when an insurance policy prepared by the insurer provides generally for a certain coverage, exclusions must be expressed or must arise by necessary implication from the policy language, and held further that insurance policies in language selected by the insurer and reasonably open to different interpretations are to be construed most favorably for the insured.
The instant insurance policy is in language selected by the insurer which is reasonably open to different interpretations; it is to be construed most favorably for the insured.
The judgment of the Court of Appeals is reversed.
Judgment reversed.
O'NEILL, C.J., HERBERT, CORRIGAN, STERN, CELEBREZZE, W. BROWN and P. BROWN, JJ., concur.