Court Opinion

ID: 9537437
Source: CourtListenerOpinion
Date Created: 2023-08-07 07:18:22.673768+00
Date Added: 2024-06-11T14:56:40.948784
License: Public Domain

TONGUE, J.,
Dissenting.
I must respectfully dissent from the opinion by the majority because it would ignore the rule well established by a long line of decisions by this court which have held that if the terms of an insurance policy are clear and unambiguous the insurance company is entitled to have it enforced as written, but that if the terms of an insurance policy are ambiguous "any reasonable doubt” will be resolved against the insurance company that wrote the policy and in favor of the insured. See, e.g., Allen v. Continental Casualty Co., 280 Or 631, 633, 572 P2d 617 (1977); Shadbolt v. Farmers Insur. Exch., 275 Or 407, 411, 551 P2d 478 (1976); Gowans v. N.W. Pac. Indem. Co., 260 Or 618, 620, 489 P2d 947, 491 P2d 1178 (1971); Farmers Mut. Ins. Co. v. Un. Pac. Ins., 206 Or 298, 305, 292 P2d 492 (1956); Clark Motor Co. v. United Pac. Ins. Co., 172 Or 145, 149, 139 P2d 570 (1943); Rossier v. Union Automobile Ins. Co., 134 Or 211, 214, 291 P 498 (1930), and Zurich Ins. Co. v. Carlton & C.R. Co., 133 Or 398, 406, 291 P 349 (1930).
This is a companion case to Perez v. State Farm Mutual Ins. Co., 289 Or 295, 613 P2d 32 (1980), also decided this day, in which this court properly held, "based on the language of ORS 743.800,” that the provisions of that statute, in which the term "injured person” is not defined, do not provide for payment of "income continuation expenses” in the event of the death of the insured in an automobile accident. It is expressly provided by ORS 743.820, however, that insurance companies may issue policies with provisions of "more favorable benefits” than those required by ORS 743.800 and 743.805.
*310The insurance policy issued by this insurance company provides for the payment of "income continuation payments” to "injured persons” for "loss of income from work during a period of disability caused by bodily injury sustained by such person in the accident.” Had the term "bodily injury” not been defined, as in Perez, the same result might well follow in this case, as in Perez. The insurance company that wrote this insurance policy, however, expressly defined the term r<bodily injury” to include death.
Defendants, as the survivors of the insured in this case, contend that:
"By virtue of the definitions of the policy, income continuation expenses are payable 'with respect to bodily injury sustained by an injured person and caused by an accident arising out of the * * * use of a motor vehicle * * 'Bodily injury’ is defined to include '* * * bodily injury, sickness or disease, including death at any time resulting therefrom.’ Injured person ’ is defined to mean 'any * * * person, who sustains bodily injury while occupying or using the insured motor vehicle.’
"Thus, under the declarations and definitions of the policy, an insured who is killed in an automobile accident is entitled to 'income continuation expenses’ because he or she is an 'injured person’ who has sustained 'bodily injury’ which is defined to include 'death.’ ”
The majority opinion reaches a contrary conclusion based upon the fact that "the phrase 'caused by [bodily injury, sickness or disease, including death at any time resulting therefrom]’ is preceded by the clause 'during a period of disability.’ ” The majority finds this clause to be "significant” because "disability” is not usually used to mean death. As stated in Perez, however, "death is undeniably the ultimate disability.”
It may be that the term "disability” is not "usually” used to mean death, but usually is used with reference to "injured persons.” The express terms of this insurance policy provide for the payment of *311"income continuation expenses” to "injured persons,” i.e., a person who has suffered "bodily injury,” which is defined as "including death.” It is also to be noted that the policy provides, in the alternative, that such payments shall continue until "such person is able to return to his usual occupation or upon the expiration of not more than 52 weeks * * *,” thus providing for a termination of such benefits for "bodily injury” when applied to "bodily injury” constituting "death,” as that term is defined in this insurance policy.
It is obvious that at least one of the reasons why an insured may desire to purchase an insurance policy providing for disability payments — one of his "reasonable expectations” — is to provide continuing income to support his family while he is unable to work because of injury suffered in an automobile accident, subject to some terminal period as provided by the terms of the policy. According to the majority, however, if the injury suffered by the insured is such as to disable him for 50 weeks, his family would receive such payments for that entire period, but if the injury to the insured is so serious that he died on the way to the hospital, his family would receive no such payments.
This, in my opinion, would defeat one of the reasons why a person would purchase such a policy when the term "injured person” has been defined by the insurance company to include "death” — thus offering coverage broader than that required by the statute as an inducement to the purchase of such a policy. A person purchasing such a policy is entitled to a "reasonable expectation” that such a policy will, in fact, provide such broader coverage, and that benefits payable will be payable in the event of the death of the insured in an automobile accident. Indeed, we have said that an insurance policy should be construed, if not in accordance with the "reasonable expectations” of its purchaser, at least "according to its character and its beneficient purposes.” See Borglund v. World Ins. Co., 211 Or 175, 181, 315 P2d 158 (1957), and Shadbolt v. Farmers Insur. Exch., supra, at 411.
*312It may be conceded that an insurance company may write an insurance policy which, in clear and unambiguous terms, requires the harsh result contended by this insurance company. This insurance policy does not do so, at least by clear and unambiguous terms. On the contrary, by defining the term "bodily injury” to include death, this insurance company has sold an insurance policy that, at the least, is ambiguous.
It may even be conceded, for purposes of argument, that the interpretation of this policy by the majority is fully as reasonable as that contended for by the survivors of the insured. In Shadbolt v. Farmers Insur. Exch., supra, however, this court rejected the contention by an insurance company that an "ambiguity” in an insurance policy can be construed in favor of the insured only when the interpretation contended for by him is "equally as reasonable as the interpretation favorable to the insurer.” On the contrary, this court held in Shadbolt (at 411), as in many previous cases, that:
"* * * if there is an ambiguity in the terms of an insurance policy, any reasonable doubt as to the intended meaning of such terms will be resolved against the insurance company and in favor of extending coverage to the insured.” (Emphasis added)
In my opinion, the least that can be said of this insurance policy is that there is a "reasonable doubt” whether the interpretation of the policy by the insurance company, as adopted by the majority, is the correct interpretation of this ambiguous policy, or whether the interpretation proposed by the survivors of the insured is the correct interpretation of those provisions of that policy. It is also my opinion that such an interpretation of the policy is a reasonable interpretation of its provisions, in view of the express definition of the term "bodily injury” to include death. It follows, in my opinion, that upon the application of the rule long recognized by this court, this ambiguity must be resolved in favor of extending coverage to the survivors of the insured in this case.
*313At the least, it was error by the trial court to allow the motion for summary judgment by the plaintiff insurance company, thus deciding the ambiguity in this insurance policy in favor of the insurance company as a matter of law. The majority appears to concede that this insurance policy was ambiguous. This court has previously held that when the terms of an insurance policy are ambiguous, the intention of the parties is a question of fact which should be submitted to and decided by the jury as trier of the facts. See, e.g., May v. Chicago Insurance Co., 260 Or 285, 292-93, 490 P2d 150 (1971). It follows that, at the least, the decision by the Court of Appeals in this case should be reversed and the case should be remanded to the trial court for trial.
LENT, J., joins in this dissent.