Filed: Feb. 17, 2012
Latest Update: Mar. 02, 2020
Summary: [PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ FILED No. 10-14714 U.S. COURT OF APPEALS _ ELEVENTH CIRCUIT FEB 17, 2012 JOHN LEY D. C. Docket No. 1:08-cv-23401-JIC CLERK SYDELLE RUDERMAN, by and through her Attorney-in-fact, Bonnie Schwartz, SYLVIA POWERS, by and through her Attorney- in-fact, Les Powers, individually and on behalf of all others similarly situated, et al. Plaintiffs-Appellees, versus WASHINGTON NATIONAL INSURANCE CORPORATION, Successor in Interest to
Summary: [PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ FILED No. 10-14714 U.S. COURT OF APPEALS _ ELEVENTH CIRCUIT FEB 17, 2012 JOHN LEY D. C. Docket No. 1:08-cv-23401-JIC CLERK SYDELLE RUDERMAN, by and through her Attorney-in-fact, Bonnie Schwartz, SYLVIA POWERS, by and through her Attorney- in-fact, Les Powers, individually and on behalf of all others similarly situated, et al. Plaintiffs-Appellees, versus WASHINGTON NATIONAL INSURANCE CORPORATION, Successor in Interest to P..
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[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
_____________________________
FILED
No. 10-14714 U.S. COURT OF APPEALS
_____________________________ ELEVENTH CIRCUIT
FEB 17, 2012
JOHN LEY
D. C. Docket No. 1:08-cv-23401-JIC
CLERK
SYDELLE RUDERMAN, by and through her
Attorney-in-fact, Bonnie Schwartz,
SYLVIA POWERS, by and through her Attorney-
in-fact, Les Powers, individually and on behalf of
all others similarly situated, et al.
Plaintiffs-Appellees,
versus
WASHINGTON NATIONAL INSURANCE
CORPORATION, Successor in Interest to Pioneer
Life Insurance Company,
Defendant-Appellant.
_________________________________________
Appeal from the United States District Court
for the Southern District of Florida
_________________________________________
(February 17, 2012)
Before EDMONDSON, MARTIN and SUHRHEINRICH,* Circuit Judges.
PER CURIAM:
This case involves a dispute between Plaintiff-Appellees Sydelle
Ruderman, Sylvia Powers, and other class members (“the insureds”) and Pioneer
Life Insurance Company, which is succeeded in this action by Defendant-
Appellant Washington National Insurance Corporation (“Washington National”).
The controversy is over the proper interpretation of certain similar insurance
contracts under Florida law. Washington National appeals the District Court’s
grant of summary judgment for the insureds.
The District Court concluded that the policies in question were ambiguous
and that, under Florida law, they were then to be construed against Washington
National. We agree that the policies are ambiguous, but we conclude that Florida
law is unsettled on the proper way to resolve the ambiguity. To establish the
proper approach to take under Florida law in interpreting the ambiguity, we need
some help; so we certify a question to the Supreme Court of Florida.
*
Honorable Richard F. Suhrheinrich, United States Circuit Judge for the Sixth Circuit,
sitting by designation.
2
Background
The insureds each purchased a Limited Benefit Home Health Care Coverage
Policy (“Policy”) from Pioneer Life Insurance Company providing reimbursement
for certain Home Health Care expenses.1 For purposes of this appeal, the body of
each Policy contains identical language but attached to each Policy is a Certificate
Schedule (“Certificate”) that sets forth the exact coverage amounts specific to each
of the insureds and provides a level of differentiation between each Policy. The
Policy provides for reimbursement through a maximum daily benefit called the
“Home Health Care Daily Benefit” (“Daily Benefit”). The provision of the Daily
Benefit is limited by a “Per Occurrence Maximum Benefit” (“Per Occurrence
Cap”) for each illness, and a “Lifetime Maximum Benefit” (“Lifetime Cap”) for all
injuries and sicknesses over the life of the Policy.
1
Washington National Insurance Corporation is the successor to Pioneer Life Insurance Company
for the purposes of this case.
3
In addition to the Daily Benefit, the Per Occurrence Cap, and the Lifetime
Cap, the Policy also provides for an “Automatic Daily Benefit Increase” which is
defined this way: “AUTOMATIC DAILY BENEFIT INCREASE: On each policy
anniversary, we will increase the Home Health Care Daily Benefit payable under
the policy by the Automatic Benefit Increase Percentage shown on the schedule
page.” On the Certificate, the words “Home Health Care Daily Benefit,” “Lifetime
Maximum Benefit Amount,” and “Per Occurrence Maximum Benefit” are each
listed on a separate line -- in chart form -- next to a corresponding monetary value.
Directly below these lines is an identically formatted line with the words
“Automatic Benefit Increase Percentage” and -- where the other lines have a
monetary value -- the words “Benefits increase by 8% each year.” 2
This controversy focuses on the application of the Policy’s “Automatic
Benefit Increase Percentage” (“Automatic Increase”) provision. The language
2
The pertinent portion of the Certificate appears this way (dollar amounts provided are illustrative
only):
CERTIFICATE SCHEDULE
HOME HEALTH CARE DAILY BENEFIT $ 180 / Day
LIFETIME MAXIMUM BENEFIT AMOUNT $ 250,000
PER OCCURRENCE MAXIMUM BENEFIT $ 150,000 / Illness
AUTOMATIC BENEFIT INCREASE PERCENTAGE Benefits increase by 8% each year
4
from the body of the Policy and the language from the Certificate create a
potential ambiguity in the Policy about whether the Automatic Increase applies
only to the Daily Benefit or whether it also applies to the Lifetime Cap and Per
Occurrence Cap in addition to the Daily Benefit. The Plaintiffs represent a class
of insureds who have not yet been denied any coverage, but who are seeking to
establish the correct amount of their Lifetime Cap and Per Occurrence Cap under
the Policy. The District Court concluded that an ambiguity exists in the Policy
and granted Summary Judgment for the insureds based on the court’s
understanding that policy ambiguities should be construed against Washington
National as drafter of the Policy.
Discussion
Under the Florida law of insurance contracts “[i]f the relevant policy
language is susceptible to more than one reasonable interpretation, one providing
coverage and the [sic] another limiting coverage, the insurance policy is
considered ambiguous.” Auto-Owners Ins. Co. v. Anderson, 756 So. 2d 29, 34
(Fla. 2000). In searching for meaning in an insurance contract under Florida law
5
“courts should read each policy as a whole, endeavoring to give every provision its
full meaning and operative effect.” Id.
We agree with the District Court’s conclusion that the Policy is ambiguous
about whether the Lifetime Cap and Per Occurrence Cap increase each year or
whether only the Daily Benefit increases each year. The way the “Benefits”
section of the Policy and the Certificate are drafted, it is reasonable to read the
Certificate language “Benefits increase by 8% each year” as applying solely to the
Daily Benefit; but it is also reasonable to read the Certificate language to mean
that all the amounts listed within the Policy’s “Benefits” section -- including the
“Per Occurrence Maximum Benefit” and the “Lifetime Maximum Benefit” --
increase annually. Under Florida law, because “the relevant policy language is
susceptible to more than one reasonable interpretation, one providing coverage
and the [sic] another limiting coverage, the insurance policy is considered
ambiguous.”
Id.
For us, the correct approach under Florida law in resolving the ambiguity in
the Policy is unclear. The chief case out of the Florida Supreme Court on the
interpretation of an ambiguity in insurance contracts seems to be Auto-Owners
Ins. Co. v. Anderson,
756 So. 2d 29 (Fla. 2000). Anderson was a response to a
question certified from this Court and has been repeatedly cited by state and
6
federal courts for the principle that “[a]mbiguous policy provisions are interpreted
liberally in favor of the insured and strictly against the drafter who prepared the
policy.” Id. at 34.
While Anderson seems to support the District Court’s entry of Summary
Judgment against Washington National, another principle of Florida law supports
looking to extrinsic evidence to resolve the ambiguity before construing any
remaining ambiguity against the drafter of the policy. In Excelsior Ins. Co. v.
Pomona Park Bar & Package Store, 369 So. 2d 938 (Fla. 1979), the Florida
Supreme Court -- many years before Anderson -- qualified the longstanding rule
of construing an ambiguity against the drafter, stating that “[o]nly when a genuine
inconsistency, uncertainty, or ambiguity in meaning remains after resort to the
ordinary rules of construction is the rule apposite.”
Id. at 942. This position has
been the basis for many Florida state trial and appeals courts looking to extrinsic
evidence to resolve policy ambiguities. See, e.g., Reinman, Inc. v. Preferred Mut.
Ins. Co.,
513 So. 2d 788 (Fla. 3rd Dist. Ct. App. 1987).
With the Excelsior line of cases in mind, Washington National offered in
District Court extensive extrinsic evidence to explain the marketing of the Policy
and to show the understanding of various of the insureds -- both when the Policy
was purchased and during the life of the Policy -- about what benefits in the Policy
7
increased annually. There is at least a colorable position that Washington
National’s proffered extrinsic evidence would resolve any ambiguity in the Policy
about what benefits increase annually and would support Washington National’s
position that only the Daily Benefit increases annually.
While a line of cases exists in Florida supporting the use of extrinsic
evidence -- such as that provided by Washington National -- to attempt to resolve
ambiguity in insurance contracts before construing any ambiguity against the
drafter, the recent Anderson opinion -- while citing Excelsior -- says nothing about
this attempt-to-resolve position in reaching its determination that “[a]mbiguous
policy provisions are interpreted liberally in favor of the insured and strictly
against the drafter who prepared the policy.” See Anderson, 756 So. 2d at 34.
Given the state precedents, the proper approach to take in resolving an ambiguity
in an insurance contract seems to us to be an unsettled question of Florida law.
While certification of questions has immense value, it has been our practice
to show restraint in certifying questions to state courts. But for truly debatable
questions “a federal court should certify the question to the state supreme court to
avoid making unnecessary Erie3 ‘guesses’ and to offer the state court the
opportunity to interpret or change existing law.” Mosher v. Speedstar Div. of
3
Erie R.R. Co. v. Tompkins, 304 U.S. 64,
58 S. Ct. 817,
82 L. Ed. 1188 (1938).
8
AMCA Int’l, Inc., 52 F.3d 913, 916-17 (11th Cir. 1995). So, instead of attempting
to Erie “guess” how the Florida Supreme Court would resolve the ambiguity in an
insurance contract like the one in this Policy, we certify the following question to
the Florida Supreme Court, pursuant to Fla. Const. art. V, § 3(b)(6). See
Pendergast v. Sprint Nextel Corp.,
592 F.3d 1119, 1143 (11th Cir. 2010).
Question Certified
I. In this case, does the Policy’s “Automatic Benefit Increase Percentage”
apply to the dollar values of the “Lifetime Maximum Benefit Amount” and
the “Per Occurrence Maximum Benefit”?
We understand answering this question might include answering the three
following sub-questions:
A. Does an ambiguity exist about whether the Policy’s “Automatic
Benefit Increase Percentage” applies only to the “Home Health Care
Daily Benefit” or whether it also applies to the “Lifetime Maximum
Benefit Amount” and the “Per Occurrence Maximum Benefit”?
9
B. If an ambiguity exists in this insurance policy -- as we understand that
it does -- should courts first attempt to resolve the ambiguity by
examining available extrinsic evidence?
C. Applying the Florida law principles of policy construction, does the
Policy’s “Automatic Benefit Increase Percentage” apply to the
“Lifetime Maximum Benefit Amount” and to the “Per Occurrence
Maximum Benefit” or does it apply only to the “Home Health Care
Daily Benefit”?
Our statement of the question is not intended to limit the inquiry of the
Florida Supreme Court in addressing the issues as it perceives them in considering
the record in this case. See Pendergast, 592 F.3d at 1144. To assist the Florida
Supreme Court, we hereby order that the entire record in this case, together with
the briefs of the parties, be transmitted to that high court.
QUESTION CERTIFIED.
10
