Case Name: The EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Appellant, v. Catherine R. Best WAGONER, Appellee
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1972-11-22
Citations: 269 So. 2d 747
Docket Number: No. 71-356
Parties: The EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Appellant, v. Catherine R. Best WAGONER, Appellee.
Judges: CROSS, J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 269
Pages: 747–750

Head Matter:
The EQUITABLE LIFE ASSURANCE SOCIETY OF the UNITED STATES, Appellant, v. Catherine R. Best WAGONER, Appellee.
No. 71-356.
District Court of Appeal of Florida, Fourth District.
Nov. 22, 1972.
Rehearing Denied Dec. 27, 1972.
Joe B. Weeks, of Gurney, Gurney & Handley, Orlando, for appellant.
John W. Williams, Jr., of Howell, Kirby, Montgomery, D’Aiuto, Dean & Hallowes, Rockledge, for appellee.

Opinion:
OWEN, Judge.
The beneficiary brought suit on a group life insurance policy, resulting in a judgment adverse to the insurer following a jury trial. The principal question on appeal is whether the effective date of coverage for a deceased employee is determined by the language of the policy of group insurance issued to the employer, or by the contradictory provisions of the certificate of insurance issued to the deceased employee.
Appellant issued a group life insurance policy covering the employees of Federal Electric Corporation. William Best com menced his duties as an employee of Federal Electric on July 18, 1968. On that date the employer delivered to Mr. Best an individual certificate of insurance which referred to the master policy and which, among other things, contained a statement as to the insurance protection to which he was entitled. This certificate stated that the effective date of coverage under the policy was July 18, 1968, the date of his employment. The certificate also contained the following clause:
"This individual certificate is furnished in accordance with and subject to the terms of the Group policy (ies). Each policy, and the respective application of the Employer therefor, constitute each entire contract. This certificate is merely evidence of insurance provided under the policy (ies), which insurance is effective only if the Employee is eligible for insurance and becomes and remains insured in accordance with the provisions, terms and conditions of each respective policy."
The conflict between the effective date as shown on the certificate, and the effective date as provided in the policy was due to a clause in the policy which stated that the effective date of coverage was the day following the date of the insured's completion of a probationary period of one-month's service. The conflict becomes material because Mr. Best sustained injuries in the course of his employment on July 30, 1968 resulting in his death on August 7, 1968, which was after the effective date as shown by the certificate, but prior to the effective date as established by the policy.
The beneficiary's claim for payment under the policy was denied on the grounds that coverage had not become effective for Mr. Best. This suit resulted. The insurer sought, by both motion for summary judgment and motion for directed verdict, to have the court rule as a matter of law that where the certificate of insurance provides that it is subject to the terms and conditions of the group policy the latter necessarily controls as to any conflicts or inconsistencies between it and the certificate. The lower court denied both of these motions and the appellant now presents the same point to this court.
By statute, F.S. Section 627.0414, F.S.A., the group life insurer is required to issue to the policy holder (in this case the employer), for delivery to each person insured, an individual certificate containing a statement as to the insurance protection to which the insured is entitled, to whom the insurance benefits are payable and the rights and conditions set forth in F.S. Sections 627.0415, 627.0416, and 627.0417, F.S. A. In compliance with the statute, the insurer furnished to the employer a supply of the certificates, and in turn the employer delivered the certificates to the individuals insured. The certificate was 20 pages of fine print, the first page of which stated on its face the effective date. Except for the provision that the certificate was subject to the terms of the group policy, nothing in the certificate otherwise indicated that the effective date was not that which was shown on the face of the certificate.
As a practical matter, the certificate is the only document which the insured under a group life insurance policy ever sees. When the terms of the Certificate are in conflict with the provisions of the master policy a problem arises as to which should prevail. While the authorities are divided on the question, we believe the better view to be the one which holds that under group life insurance policies there is a contract between the insurer and the individual insured, that the contract consists of both the master policy and the certificate of insurance construed together, and that ambiguities or conflicts between the two must be resolved so as to provide the broadest coverage. See, Prudential Insurance Company of America v. Roberts, 5 Cir. 1966, 358 F.2d 394; DaCosta v. General Guaranty Insurance Company of Florida, Fla.1969, 226 So.2d 104; Moore v. Peninsular Life Insurance Company, Fla. App.1968, 213 So.2d 721; and 1 Appleman, Insurance Law & Practice, § 46. Under this view the coverage for William Best became effective on the date set forth in the certificate, and the court did not err in denying both the appellant's motion for summary judgment and its motion for a directed verdict.
At trial appellant sought to show that the effective date set forth in the certificate was a clerical error and that the insured could not have been misled by such because he had been told expressly that the insurance coverage would not be effective until after he had been employed for 30 days. The problem is that appellant had no direct proof of this fact but sought to establish it indirectly by proof of the employer's custom and habit of giving a detailed explanation of the insurance program to each new employee at the time of commencing his employment. The court properly excluded this testimony. It was inadmissible for the purpose of showing that the employer gave Mr. Best such an explanation of the insurance coverage at the time of commencing employment, in the absence of proof that the custom and habit was actually followed on that occasion. See Jarrard v. Associates Discount Corp., Fla.1957, 99 So.2d 272; General Motors Acceptance Corp. v. American Liberty Insurance Co., Fla.App.1970, 238 So.2d 450; and 29 Am.Jur.2d Evidence, § 303.
The judgment is affirmed.
CROSS, J., concurs.
DRIVER, B. J., Associate Judge, dissents with opinion.