Court Opinion

ID: 9477323
Source: CourtListenerOpinion
Date Created: 2023-08-05 06:20:09.497932+00
Date Added: 2024-06-11T17:45:48.870526
License: Public Domain

PER CURIAM.
Defendant-appellant Rogell Burchett (Burchett) appealed from the district court’s grant of summary judgment in favor of plaintiffs-appellees Travelers Insurance Company, Allstate Life Insurance Company, and Continental Insurance Company (Insurers) in this action commenced by the Insurers seeking an order declaring that Burchett was not entitled to proceeds under accidental death and dismemberment policies. The record disclosed the following facts.
Burchett was insured against accidental death and dismemberment under three separate insurance policies issued by the Insurers. Each policy contained a definition of “loss” within its description of dismemberment coverage. The Travelers policy provided:
Loss shall mean, with regard to hands and feet, dismemberment by severance through or above wrist or ankle joints; with* regard to eyes, entire and irrevocable loss of sight.
The Allstate policy provided:
‘Loss’ as used with reference to hand or foot, means severance at or above the wrist or ankle joint, and as used with reference to eye, means total and irrevocable loss of entire sight of eye.
The Continental policy provided:
‘Loss' shall mean with regard to hands ahd feet actual severance through or above wrist or ankle joint; with regard to eyes, entire and irrevocable loss of sight; with regard to leg or arm, actual severance through or above knee or elbow joint; ...
On June 25, 1985, Burchett was involved in an automobile accident and suffered a severe injury to his left arm. His injury was described as an “incomplete amputation,” i.e,, “it was being held by skin, subcutaneous tissue, the nerve and the artery, on the radial side and that’s about it ..., for all intents and purposes [it] was a functional amputation.” Burchett underwent several surgical operations in which tendons, muscles, and skin from his back were grafted into the arm. The record did not disclose the extent to which Burchett has since regained the use of his arm, but one of Burchett’s physicians stated that “we’ve left him with an arm which is marginally better than a prosthesis....”
Burchett filed claims with each of the three Insurers claiming entitlement to proceeds under the dismemberment coverage of the policies. Each of the Insurers denied the claims because Burchett’s arm was never physically severed from his body. Travelers thereafter commenced this diversity action for declaratory relief seeking an order determining that it was not liable to Burchett under the terms of the policy. Allstate and Continental later intervened as plaintiffs, and by agreement of the parties, the matter was referred to a magistrate for decision. Burchett then filed counterclaims alleging bad faith denial of coverage by each of the three Insurers.
The Insurers moved for partial summary judgment on the issue of coverage, and on December 8, 1986, the district court granted the motion. The Insurers then moved for summary judgment on Burchett’s counterclaims, which motion was granted on February 20, 1987. Final judgment was entered accordingly, and Burchett thereafter commenced this timely appeal asserting only that the district court incorrectly concluded as a matter of law that his injury was not covered under the terms of the three policies.
In Fowler v. Brotherhood of R.R. Trainmen, 253 Ky. 786, 70 S.W.2d 669 (1934), the plaintiff suffered a severe injury to his hand resulting in the amputation of several fingers and the loss of the use of his hand. He sought recovery under the constitution of his union which provided insurance coverage against “the amputation or severance of an entire hand at or above the wrist joint....” 253 Ky. at 787, 70 S.W.2d at 670. The plaintiff asserted that he was *157entitled to proceeds because he had “lost the use of the whole hand and arm....” Id. (emphasis in original). Kentucky’s highest court rejected this assertion:
We are mindful of the rule that in construing policies of insurance and benefit certificates wherein the language is uncertain or ambiguous, the courts will adopt that construction more favorable to the insured. But the rule of liberal construction does not mean that the court may add to or strike from the conditions of the policy and thereby make a contract for the parties which they did not make for themselves.
It is our view that the language used in the policy is plain and unambiguous. The language employed could not be construed to mean that the appellee insured appellant against the loss of the use of the hand without the loss of the hand by physical severance or amputation “at or above the wrist joint.” It does not insure against disability to earn money or to pursue any particular occupation.
253 Ky. at 790, 70 S.W.2d at 671. (citations omitted) (emphasis in original). See also Brotherhood of R.R. Trainmen v. Wilkins, 257 Ky. 331, 78 S.W.2d 6 (1935) (quoting Fowler, supra). These cases clearly indicate that under Kentucky law, which this court sitting in diversity is required to apply, Beams v. John Hancock Mutual Life Ins. Co., 325 F.2d 887 (6th Cir.1964), the term “severance,” as used in the insurance contracts in question, is unambiguous and does not include the “loss of use” of the limb. Rather, it means actual physical severance.
Burchett nevertheless argued that the definition was ambiguous because the term “severance” was not defined in the contracts as “actual physical severance.” Accordingly, construing the insurance contracts in his favor, the term should have been interpreted to include what he calls “functional severance,” i.e., the loss of the use of the limb. Burchett relied upon decisions from other jurisdictions in which the courts concluded that the term severance was ambiguous, and therefore construed the term favorably to the insured to include “functional severance.” See, e.g. King v. Metropolitan Life Ins. Co., 20 Tenn.App. 246, 97 S.W.2d 651 (1936). The law in Kentucky, however, unambiguously indicates that “severance” means actual physical severance. See Reid v. Life Ins. Co. of N. Am., 718 F.2d 677, 680-82 (4th Cir.1983) (citing Wilkins, supra, for the proposition that “severance,” as used in dismemberment policies, “clearly and unambiguously requires an actual cutting off of the member at the place indicated”). Accordingly, the judgment of the district court is hereby AFFIRMED.