Court Opinion

ID: 9460796
Source: CourtListenerOpinion
Date Created: 2023-08-04 22:00:38.471966+00
Date Added: 2024-06-11T17:36:47.303852
License: Public Domain

DUNIWAY, Circuit Judge
(concurring and dissenting):
For the purpose of this opinion, I assume that Judge Wright is correct in holding that the governing law is that of the State of Washington.
No Washington case cited to us is even remotely in point. I therefore look to the general rules applied by courts to the construction of insurance policies, which are followed in Washington. The major rule is well stated in Aschenbrenner v. United States, 1934, 292 U.S. 80, 54 S.Ct. 590, 78 L.Ed. 1137, in which Mr. Justice Stone (as he then was), writing for the Court said:
The phraseology of contracts of insurance is that chosen by the insurer and the contract in fixed form is tendered to the prospective policy holder who is often without technical training and who rarely accepts it with a lawyer at his elbow. So if its language is reasonably open to two constructions, that more favorable to the insured will be adopted, (at 85, 54 S.Ct. at 592)
This is the law in almost every American jurisdiction, including the State of Washington. See, e. g., V. Van Dyke Trucking, Inc. v. “The Seven Provinces” Ins. Ltd., 1965, 67 Wash.2d 122, 406 P.2d 584, 588:
If it can be said that there is any ambiguity in this provision, then under standard horn-book law, the ambiguity is to be construed against the drafter of the contracts or policy.
I can perceive no good reason why this rule is not applicable to the question before us, namely, whether the United States, which provided medical service “for” the insured, is a beneficiary of the policy. I suggest that, to apply rules applicable to contracts, the terms of which are negotiated, to this case, and to remand for a fact finding hearing as to the intent of the insured when he bought the policy, will prove to be an exercise in utter futility. It seems to me almost certain that the insured had no intent in relation to the question before us, and I would have little, if any, confidence in the reality or veracity of anything that he might now say, after the fact.
Moreover, the policy itself seems to prohibit it. It provides:
8. CHANGES’; CONFORMITY TO STATUTES
The terms of this policy may not be waived or changed by notice to or *1360knowledge possessed by any agent or other person, but only by policy endorsement.
To me, this means that the Insurance Company, having chosen the words of its policy, wishes to be governed by those words and nothing else. I would take it at its word, and construe the words under the rule of construction that applies to all such policies.1
In my opinion, the words of the policy, quoted in Judge Wright’s opinion, are readily susceptible to the construction that the Company’s obligation is to pay the insured’s medical expenses to the insured or to whatever person or organization has incurred such expenses in his behalf, i. e., “for” him. And so say the cases construing similar language: United States v. Government Employees Ins. Co., 4 Cir., 1972, 461 F.2d 58; United States v. State Farm Mut. Auto. Ins. Co., 10 Cir., 1972, 455 F.2d 789; United States v. United Services Auto Ass’n, 5 Cir., 1970, 431 F.2d 735.
I also am of the opinion that the exclusion quoted in Judge Wright’s opinion does not plainly refer to the government’s statutory obligation to provide medical care to retired servicemen. Clearly, the government’s obligation is not “insurance” (subd. (2)) nor a “workman’s compensation or disability law or any similar law” (subd. (4)).2 The trial judge thought that subdivision (3) applies: “Medical, surgical, hospital or funeral service benefit or reimbursement plan.” This is a closer question, but to it I would apply another universal rule, relating to exclusions in insurance policies. Because they limit the coverage elsewhere apparently granted and because they tend to defeat the natural expectations of the insured and his beneficiaries, the rule of strict construction applicable to insurance policies is most strongly applicable to exclusions. Applying that rule, I cannot hold that the government’s statutory obligation is a “benefit or reimbursement plan” within the meaning of subdivision (3). The apparent purpose of the exclusion is to prevent a possible double recovery by the insured; if he is compensated by a benefit or reimbursement plan, he cannot collect again from Nationwide. ,-That is not what is involved here. It would be a strained construction of subdivision (3) to say that the United States government, furnishing medical care under a statutory command, is a “benefit or reimbursement plan.”
There are a large number of servicemen who, like the insured in this case, are entitled to medical care at government expense. If the Insurance Company desires to exclude the expense of such care from the coverage of its policy, it could do so expressly. It is not entitled to rely on ambiguous language such as it has used to achieve the same result.
I concur in the reversal, but I would remand with directions to enter judgment for the United States.

. Gillespie v. Travelers Ins. Co., 9 Cir. 1973, 486 F.2d 281, is not in point. In that case we said that “the meaning of words used in a contract [of insurance] is normally an issue of fact to be decided by the trier of fact rather than the court.” But we held, first as a matter of law, not fact, that the helicopter there involved was not a “public conveyance” within the meaning of that phrase as used in the policy, thus overruling a jury verdict, and second, again as a matter of law, not fact, that the helicopter was being used for “the sole purpose of transportation,” within the meaning of that phrase as used in the policy. In the second holding, we relied upon the following rule: “Since Alaska law requires the adoption of the reasonable interpretation which favors the insured there was nothing for the jury to decide.” In the case at bar, I would apply Gillespie’s holding, not its dictum.

. United States v. Government Employees Insurance Co., 5 Cir., 1971, 440 F.2d 1338, 1339; United States v. United Services Auto. Ass’n, D.Conn., 1970, 312 F.Supp. 1314, 1316; United States v. Commercial Union Ins. Group, S.D.N.Y., 1969, 294 F.Supp. 768, 771.