Opinion ID: 429836
Heading Depth: 1
Heading Rank: 4

Heading: iii. limits of liability

Text: 10 Regardless of the number of insureds under this insurance the company's liability is limited as follows: 11 The limit of liability stated in the schedule as applicable to each claim is the limit of the company's liability for all damages because of each claim or suit covered hereby. The limit of liability stated in the schedule as aggregate is, subject to the above provision respecting each claim, the total limit of the company's liability hereunder for all damages. 12 The key issue in interpreting this provision is the meaning of claim. Nowhere in the policy is claim defined. The word claim does not lend itself to easy definition, nor does it mean the same thing to all people. See, e.g., Smith v. Benedict, 279 F.2d 211, 213 (7th Cir.1960) (equating claim as used in Fed.R.Civ.P. 54(b) with cause of action); Downey v. Dairymen's League Co-op Ass'n, 149 F.Supp. 615, 618 (D.N.J.1957) (claim is a legal right, the invasion of which by defendant has caused damage to the plaintiff); Steele v. State, 159 Ala. 9, 48 So. 673, 674 (Ala.1909) (the word 'claim' signifies a right to claim, a just title to something in the possession or at the disposal of another). Despite the difficulty in defining claim, Bellefonte implies that the word, as used in its insurance policy, means a single lawsuit, or perhaps a single lawsuit by a single plaintiff. In the provision in question, however, claim is used in the disjunctive with suit, indicating that they do not mean the same thing. Cf. St. Paul Fire & Marine Ins. Co. v. Hawaiian Ins. & Guar. Co., 2 Haw.App. 595, 637 P.2d 1146, 1147 (1981). Therefore, we cannot accept the argument that just because Martin filed only one suit against the Hospital, she presented only one claim. 13 Having rejected the insurance company's proposed definition of claim, we find it unnecessary to adopt a particular definition. Under the peculiar facts of this case, we believe that the Hospital must prevail under most reasonable interpretations of claim. Clearly, Martin could have filed a suit for only one or two of the three operations she underwent at the Hospital. Or, she could have filed three separate suits for the three operations. Of course, the preferred practice in federal court is to consolidate as many claims as possible against a particular party into a single suit. See Fed.R.Civ.P. 18(a). Martin's complaint against the Hospital, introduced into evidence at trial, supports the Hospital's assertion that Martin had three separate and distinct claims in her lawsuit. Under each theory of recovery advanced by Martin she alleges in separate paragraphs the facts of each of her three admissions to the Hospital, claiming separate injuries from each admission. Thus, the Hospital could have been found liable at trial for only one or two of Martin's admissions, rather than all three. 1 14 Our approach in this case is consistent with the only authority on point that the parties found. In St. Paul Fire & Marine Ins. Co. v. Hawaiian Ins. & Guaranty Co., 2 Haw.App. 595, 637 P.2d 1146 (1981), the Hawaii Intermediate Court of Appeals construed an insurance policy provision similar to that at issue here. 2 The St. Paul court had to determine whether one claim or three claims were asserted by a patient's estate, which filed two lawsuits (consolidated for trial) alleging that on three separate occasions the patient was negligently administered Halothane anesthesia, and that each administration of the anesthesia contributed to his death. Two of the administrations were performed by one doctor, and the other by a second doctor. The two doctors practiced with a third doctor as Medical Anesthesia, and the three were insured together by the same insurance company. The appellant, St. Paul Fire and Marine Insurance Co., argued that only one claim was presented, but the court disagreed and held that three claims, which resulted in two suits, were terminated in one settlement. 2 Haw.App. at 596, 637 P.2d at 1147. Bellefonte attempts to distinguish St. Paul on the ground that two different physicians treated the patient, whereas here the same doctor performed surgery on Martin each time. But Bellefonte's distinction fails to explain why treatment by two doctors in St. Paul resulted in the court finding three claims. Obviously, in St. Paul two claims were presented against the doctor who administered anesthesia twice, just as here three claims were presented against the doctor who operated thrice. 15 Bellefonte also cites a number of cases to show that St. Paul goes against the great weight of authority in the country and is bad law. Those cases, however, simply draw a distinction between claim and occurrence, and show that a single occurrence often gives rise to several claims. For example, in Combined Communications Corp. v. Seaboard Surety Co., 641 F.2d 743 (9th Cir.1981), Combined Communications Corp. (CCC) broadcast allegedly libelous matter on one occasion resulting in multiple claims by multiple plaintiffs. Thus, one occurrence caused many suits. The issue in Combined Communications was whether the $5,000 deductible for each claim provided for in the insurance policy covering CCC applied to each claim filed by a plaintiff as a result of the one broadcast, or whether the deductible applied only once. The court of appeals ruled that the deductible applied to each claim. Bellefonte attempts to argue from Combined Communications and other similar cases that the three occurrences of surgery upon Martin presented only one claim. The argument is a non-sequitur. Certainly it is possible for several occurrences to result in a single claim, but we fail to see how that is the case here. Even if the three operations had been performed on Martin on the same day, without a break, she could present three claims based on three separate and distinct acts during the series of operations if each act would, by itself, suffice to place liability on the Hospital. 16 Even if we found that Bellefonte's insurance provision did not clearly compel the conclusion that three claims were presented against the Hospital by Martin, we would conclude that the provision was, at best, ambiguous. Under Alabama law, if an insurance contract provision is subject to more than one interpretation, it should be construed in favor of coverage, and against the insurer. See Miles v. St. Paul Fire & Marine Ins. Co., 381 So.2d 13, 14 (Ala.1980); see also St. Paul, 2 Haw.App. at 596, 637 P.2d at 1147 (insurance contract is contract of adhesion, to be construed liberally in favor of insured and against insurer). Moreover, if doubt arises as to the limitation of liability, or to matters subsequent to the attaching of the liability, the policy provisions are to be construed most favorably toward the insured. Miller v. Liberty National Life Ins. Co., 243 Ala. 250, 9 So.2d 132, 134 (1942). Thus, we would still rule in favor of the Hospital. 17 The judgment is REVERSED and REMANDED for entry of judgment in favor of appellants.