Opinion ID: 218623
Heading Depth: 2
Heading Rank: 2

Heading: The District Court's Interpretation of Policy Language

Text: Although we have already determined that the District Court erred in applying an abuse-of-discretion standard, we consider nonetheless Plaintiff's second contention to provide guidance to the District Court on remand. Plaintiff argues that the District Court misinterpreted the Policy because the Medical Exclusion Provision was ambiguous at best. Specifically, she argues that LINA should not be able to apply the Exclusion to Viera's Coumadin treatment based on a canon of statutory construction, the last-antecedent rule, and the general maxim that ambiguous contract language should be construed against the drafter. [12] The District Court rejected this argument and held that although a strict application of the last-antecedent rule supports Plaintiff's interpretation, sufficient indicia of contrary meaning exist to overcome this maxim of interpretation. Viera, 2010 WL 1407312, at . We review the legal interpretation of contractual language de novo. Heasley, 2 F.3d at 1254. The last-antecedent rule is a canon of statutory interpretation, but we have extended application of the rule to a life insurance policy as well. See J.C. Penney Life Ins. Co. v. Pilosi, 393 F.3d 356, 365-66 (3d Cir.2004). The rule provides that qualifying words, phrases, and clauses are to be applied to the words or phrase immediately preceding and not to others more remote. Stepnowski v. C.I.R., 456 F.3d 320, 324 (3d Cir.2006) (quoting United States v. Hodge, 321 F.3d 429, 436 (3d Cir.2003)). In other words, if a sentence reads A or B with respect to C, it should be interpreted as containing two items: (1) A and (2) B with respect to C. Id. at 324 n. 7. However, the last-antecedent rule is not an absolute and can assuredly be overcome by other indicia of meaning. Pilosi, 393 F.3d at 365 (quoting Barnhart v. Thomas, 540 U.S. 20, 26, 124 S.Ct. 376, 157 L.Ed.2d 333 (2003)). The Medical Exclusion Provision at issue states: [B]enefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from ... [s]ickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food. (App. at 83.) Plaintiff argues that the placement of the comma immediately preceding the term bacterial or viral infection suggests that the term medical or surgical treatment thereof would not be extended to the other terms sickness, disease, bodily or mental infirmity. In other words, Plaintiff contends that the Policy excludes coverage only for medical treatment of bacterial or viral infection[s] and does not exclude coverage for medical treatment of bodily infirmities like atrial fibrillation. The District Court agreed with Plaintiff's literal application of the last-antecedent rule. However, the District Court ultimately concluded that there were sufficient indicia of meaning that contradicted Plaintiff's interpretation. Specifically, the District Court pointed out that: (1) the term Covered Accident does not include an injury or accident contributed to by disease, Sickness, mental or bodily infirmity; (2) the cover page of the [ ] Policy states that it is a group accident policy and does not pay benefits for loss caused by sickness; and (3) the scope of the [ ] Policy deals with accidental death and dismemberment. Viera, 2010 WL 1407312, at . The District Court appropriately looked to and analyzed the indicia of meaning in the Policy so as not to contort the language beyond its limits. Pilosi, 393 F.3d at 365. Where the meaning of the contract language is clear, the last-antecedent rule should not be used to create ambiguity. Plaintiff also argues that the inherent ambiguity in the plan must be construed against LINA under the doctrine of contra proferentem. Whether an ambiguity exists is a question of law. 12th St. Gym, Inc. v. Gen. Star Indem. Co., 93 F.3d 1158, 1165 (3d Cir.1996). Under Pennsylvania law, an insurance contract is ambiguous where it: (1) is reasonably susceptible to different constructions, (2) is obscure in meaning through indefiniteness of expression, or (3) has a double meaning. [13] Lawson v. Fortis Ins. Co., 301 F.3d 159, 163 (3d Cir.2002). To be sure, we must construe ambiguous policy provisions against the drafter of the contract once a determination of ambiguity has been made, but the language at issue here is not ambiguous. Pilosi, 393 F.3d at 363; 12th St. Gym, 93 F.3d at 1166. As noted above, Plaintiff's alternative reading of the provision under the last-antecedent rule is not reasonable. Disagreement between the parties over the proper interpretation of a contract does not necessarily mean that a contract is ambiguous. 12th St. Gym, 93 F.3d at 1165. Where there is only one reasonable interpretation of a contract, that interpretation controls because [s]traightforward language in an insurance policy should be given its natural meaning. Lawson, 301 F.3d at 162. The District Court correctly interpreted the Medical Exclusion Provision.