Court Opinion

ID: 9479470
Source: CourtListenerOpinion
Date Created: 2023-08-05 07:19:40.476457+00
Date Added: 2024-06-11T17:47:04.053151
License: Public Domain

MERRITT, Circuit Judge,
dissenting.
The only issue on appeal is whether the post-termination of employment conversion provisions of the policy entitled the plaintiff to the double indemnity accidental death benefit.
Section G of the insurance policy, labeled “Conversion Privileges,” consists of five numbered paragraphs. The first paragraph entitles an employee, “to have issued to him ... without evidence of insurability, an individual policy of life insurance without disability or supplementary benefits. Application for the individual policy must be made, and the first premium paid to the Paul Revere, within thirty-one days after such termination.” (Emphasis added). The third paragraph provides for additional benefits to be added to the converted policy subject to evidence of insurability. The fourth paragraph defines the conditions and amount to be paid if death occurs during the conversion privilege period: “If an Employee dies during the thirty-one days while he is entitled to convert such insurance in accordance with the above paragraphs, the Paul Revere will pay the amount of insurance for which such Employee was entitled to make application for conversion.” (Emphasis added).
The Court frames the issue as whether the post-termination conversion provisions of Section G of the policy entitled the plaintiff to the double indemnity accidental death benefit despite the fact that plaintiffs husband did not make an application for this additional benefit prior to his death. Reviewing the relevant contract provisions, the Court concludes that the insurance contract is clear and unambiguous and finds that the first paragraph only of the five paragraph conversion section applied to the deceased. The Court reasons that because supplementary double indemnity benefits could be added to an already converted policy only if the insured could provide satisfactory evidence of in-surability, Paul Revere is only obligated to pay the amount of a policy without double indemnity benefits. The Court appears to concede that the deceased could have applied for double indemnity accidental death benefits “to be added” to the converted policy but nevertheless still concludes under paragraph 4 that Paul Revere is obligated to pay the plaintiff only $20,000. Dist.Ct.Op. at 4. Only after the conversion of a policy may an employee add double indemnity accidental death benefits.
The Court seems to ignore the clear and unambiguous literal language of paragraph 4 which expressly refers to the above parar graphs of the conversion privileges section, including the language of paragraph 3 addressed to additional benefits. My reading of the contract leads me to conclude that Paul Revere made a distinction between those benefits a terminated employee could obtain without evidence of insurability (paragraph 1) and those benefits for which he could apply only with evidence of insura-bility (paragraph 3). Paragraph 4 informs the reader that both paragraphs 1 and 3 apply to one who dies within the conversion period.
Policies such as the one at issue in this case are written for lay persons. In light of the literal language of paragraph 4 which appears explicitly to include the benefits for which one could apply in the above paragraphs, if Paul Revere meant to change the meaning of the sentence and to deny double indemnity coverage to one who died within the conversion period, the company should have written a proviso or exclusion which states its intent to limit that specific benefit.
Additionally, Ohio law provides that when interpreting an insurance contract, the contract should be construed liberally in favor of the insured if the language of the contract is ambiguous. Munchick v. Fidelity & Casualty Co., 2 Ohio St.2d 303, *943209 N.E.2d 167 (1965) (doubts arising from language used in automobile policy drafted by insurer were to be resolved in favor of insured). Ohio continues to adhere to this concept. Most recently the Ohio Supreme Court found that “[w]here provisions of a contract of insurance are reasonably susceptible of more than one interpretation, they will be construed strictly against the insurer and liberally in favor of the insured.” King v. Nationwide Ins. Co., 35 Ohio St.3d 208, 519 N.E.2d 1380, 1380-81 (1988) (citations omitted).
Even assuming arguendo that the language of paragraph 4 is not to be given a literal interpretation and can be said to be “ambiguous” as to the double indemnity benefits available to one who dies within the insurance period, Ohio law clearly dictates that this kind of ambiguity be resolved in favor of the beneficiary.
Accordingly, I respectfully dissent.