Opinion ID: 538592
Heading Depth: 2
Heading Rank: 1

Heading: Scope of Aetna's Duty Under the Policy

Text: 15 Under Florida law, the construction of an insurance policy is a question of law for the court. Jones v. Utica Mut. Ins. Co., 463 So.2d 1153, 1157 (Fla.1985); Ellenwood v. Southern United Life Ins. Co., 373 So.2d 392, 394 (Fla.App.1979) (if the facts are undisputed and there is an ambiguity in the policy, the case should be decided by the judge). It is for the jury, however, to determine whether the facts of the case fall within the scope of the coverage as defined by the court. Jones, 463 So.2d at 1157. Aetna argues that the material facts of this case were undisputed and that the district court therefore erred in refusing Aetna's motion for a directed verdict. We agree. It is undisputed that Aetna refused to pay for counsel in the tax matter. Thus, the central question in the trial was whether the scope of Aetna's duty to defend was broad enough to encompass the suit against the IRS. This was a question of contractual interpretation, which the judge should have decided. 16 Under Florida law, an insurer's duty to defend is determined by asking whether the allegations in the complaint fall within the coverage provided by the policy. Trizec Properties, Inc. v. Biltmore Constr. Co., 767 F.2d 810, 811 (11th Cir.1985); Reliance Ins. Co. v. Royal Motorcar Corp., 534 So.2d 922, 923 (Fla.App.1988); Logozzo v. Kent Ins. Co., 464 So.2d 605, 606-07 (Fla.App.1985). If the complaint alleges facts partially within and partially outside the scope of coverage, the insurer is obligated to defend the entire suit. Trizec, 767 F.2d at 811-12. All doubts as to whether a duty to defend exists are resolved in favor of the insured. Id. at 812. 17 Aetna argues that under the contract it had no duty to bring suit against the IRS. The language of the contract defines Aetna's duty to defend as follows: 18 [Aetna] will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as damages on account of any claim made against the Insured for any Wrongful Act, and [Aetna] shall have the right and duty to defend such claim against the Insured seeking such damages.... 19 This language refers only to claims brought against the insured and does not refer to claims brought by the insured. The policy does not provide that Aetna will bring actions on behalf of the plan or the trustees; it merely provides that Aetna will defend actions brought by third parties against the plan and the trustees. 7 The damages, moreover, that Aetna must cover under the policy do not include taxes, fines, or penalties. Aetna, therefore, had no duty to prosecute an action in the tax court defending the plan's tax exempt status and is not liable under the policy for the fees of plaintiff's tax attorneys.