Court Opinion

ID: 9642088
Source: CourtListenerOpinion
Date Created: 2023-08-22 17:48:02.90586+00
Date Added: 2024-06-11T18:10:42.891338
License: Public Domain

RENDLEN, Judge,
dissenting.
In this ease, we must determine the meaning and effect which should be given the word “irrecoverable.” My position is articulated in the opinion filed by Judge Wasserstrom in the Western District of the Court of Appeals.
James R. Crim instituted suit on a group policy of life, accident and health insurance when a claim for benefits payable for loss of sight of one eye was denied. On stipulated facts, the trial court found respondent entitled to payment on his claim, entered judgment and the insurer appeals.
Applicable policy language provides a benefit payment of one-half the principal sum, in this case $5,000.00, for accidental loss of sight of one eye. The critical phrase in this regard states: “With respect to eyes, ‘loss’ means the entire and irrecoverable loss of sight.” By its judgment, the trial court held that Crim had suffered the entire and irrecoverable loss of sight of one eye as the term was used in the policy and was entitled to payment of the benefits.
Appellant argues that the visual loss caused by the accident has in fact been recovered through use of a contact lens and that Crim’s practical and functional sight has been restored to normalcy. Respondent *79construes the word “irrecoverable” as meaning incapable of regeneration of the physical eye structure and function by natural means or medical procedure and would exclude recovery of sight by artificial means. On this premise, respondent contends the word “irrecoverable” is ambiguous and cites Reese v. Preferred Risk Mut. Ins. Co., 457 S.W.2d 205 (Mo.App.1970), as authority for the familiar proposition that an ambiguous insuring agreement will be construed against the insurer.
Each of the opposing constructions placed by the parties upon the word “irrecoverable” is reasonable. Thus, appellant’s interpretation has been accepted by Home Life Ins. Co. of New York v. Stewart, 114 F.2d 516 (10th Cir.1940); J. W. Smith v. Great American Life Ins. Co., 125 Ga.App. 587, 188 S.E.2d 439 (1972); and Wallace v. Insurance Co. of North America, 415 F.2d 542 (6th Cir. 1969). However, that interpretation was rejected in Knuckles v. Metropolitan Life Ins. Co., 25 Utah 2d 319, 480 P.2d 745 (1971). See also Boone v. United Founders Life Ins. Co., 565 S.W.2d 380 (Tex.Civ.App.1978). Inasmuch as the term is reasonably capable of being understood in either of two possible senses, it is ambiguous. Chamberlain v. Mutual Ben. Health & Acc. Ass’n., 260 S.W.2d 790, 793 (Mo.App.1953); O’Brien v. Missouri Cities Water Co., 574 S.W.2d 13, 19 (Mo.App.1978). If appellant wanted to exclude coverage in a case such as this, it could have easily clarified the situation and eliminated any problem by modifying the word “irrecoverable” with the phrase “not including vision accomplished by artificial means.” Knuckles v. Metropolitan Life Ins. Co., supra, 480 P.2d at 747.
Moreover, the conflict of judicial opinion on this subject brings into play the principle that differing court rulings concerning a term in an insurance policy strongly indicates the existence of a real ambiguity. Jones v. Insurance Co. of North America, 264 Or. 276, 504 P.2d 130 (banc 1972); Federal Ins. Co. v. P. A. T. Homes, Inc., 113 Ariz. 136, 547 P.2d 1050 (banc 1976). In the case last cited the opinion holds:
“[Wjhere various jurisdictions reach different conclusions as to the meaning, intent, and effect of the language of an insurance contract ambiguity is established.
“ ‘If Judges learned in the law can reach so diametrically conflicting conclusions as to what the language of the policy means, it is hard to see how it can be held as a matter of law that the language was so unambiguous that a layman would be bound by it.’ Alvis v. Mutual Benefit Health & Accident Association, 210 Tenn. 198, 297 S.W.2d 643, 645-6 (1956).”
547 P.2d at 1052.
This result finds further support in the rule that an insurance policy should be construed to meet the reasonable expectation of the layman who purchased the policy. Stafford v. Travelers Ins. Co., 530 S.W.2d 23 (Mo.App.1975); Adams v. Covenant Sec. Ins. Co., 465 S.W.2d 32 (Mo.App.1971); N. W. Electric Power Coop., Inc. v. American Motorists Ins. Co., 451 S.W.2d 356 (Mo.App.1970).
The trial court reached the correct result, and its judgment should be affirmed.
I respectfully dissent.