American Insurance Company v. Tutt

314 A.2d 481
CourtDistrict of Columbia Court of Appeals
DecidedFebruary 14, 1974
Docket7158
StatusPublished
Cited by14 cases

This text of 314 A.2d 481 (American Insurance Company v. Tutt) is published on Counsel Stack Legal Research, covering District of Columbia Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
American Insurance Company v. Tutt, 314 A.2d 481 (D.C. 1974).

Opinion

YEAGLEY, Associate Judge:

In this appeal the appellant (hereinafter the “company”) seeks relief from a decision by the trial court denying its motion for summary judgment in its action seeking a declaratory judgment that it was not obligated to pay appellee anything under the terms of the uninsured motorist coverage in his automobile insurance policy. The trial court granted summary judgment to appellee (hereinafter the “insured”), holding, in effect, that he was entitled to recover. We affirm.

On or about December 12, 1968, the insured paid a premium to the company on a comprehensive automobile insurance policy. In return for a part of that premium the company promised “[t]o pay all sums [$15,000 policy limit] which the insured . shall be legally entitled to recover as damages from the owner or operator of an uninsured automobile . . . . ” (Emphasis added.)

*483 On June 5, 1969, the insured was involved in an accident while operating a police motorcycle in the course of his employment in Washington, D. C. As a result of that accident the insured sued the other party to the accident (hereinafter the “tortfeasor”). That action resulted in a decision that the insured was “legally entitled to recover as damages” $57,350.00 from the tortfeasor. That judgment was not satisfied and it developed that the tortfeasor was “uninsured”.

Due to the fact that the insured sustained his injuries in the course of his employment, he was awarded benefits by the District of Columbia Policemen and Firemen’s Retirement and Disability [Fund], D.C.Code 1973, § 4-501 et seq.

The parties stipulated that the benefits received by the insured were “in excess of $15,000”. They have not set forth the exact total value of those benefits. However, they did agree that “[t]he Defendant did not receive any compensation for pain and suffering pursuant to said act”. Consequently, the item, in the judgment he obtained for damages of $25,000, for pain and suffering 1 remains unsatisfied, unless the proceeds from the uninsured motorist policy are to be applied to it.

The insured filed a claim with the company pursuant to his insurance policy. The company denied liability contending that the “Limits of Liability” clause, Condition 4(b)(2), required that its liability ($15,000) be reduced by the amount of benefits the insured realized from workmen’s compensation or any similar law. The company then filed this action for a declaratory judgment in the Superior Court asking that the rights of the parties to the insurance contract be adjudged.

The various types of coverage in the contract are set forth in “Parts”. (Part I —Liability; Part II — Expenses for Medical Services; Part III — Physical Damage; and Part IV — Protection Against Uninsured Motorists.) 2 Each “Part” specifies the coverage which it affords and the exclusions therefrom. Additionally, there are “Conditions”, which further limit and modify the coverage as set forth in the various “Parts”. Some of these “Conditions” apply to all “Parts” and some apply only to specified “Parts”.

Condition number 4, 3 is broken down into sections which bear the Part numbers *484 to which they apply, i. e., Condition 4 Part I is a condition which applies to Part I coverage. Likewise Condition 4 Part IV is a condition which applies to Part IV coverage. 4

The company claims that the “Limits of Liability” clause, Condition 4(b)(2), requires that its liability under the face value of the policy be reduced by the amount of benefits (at least $15,000) the insured received from the District of Columbia if they were in the nature of workmen’s compensation or disability law benefits. The insured contends that even if the benefits 5 he received from the District of Columbia were in the nature of workmen’s compensation within the meaning of Condition 4(b)(2), those benefits should be applied to the total damages he suffered at the hands of the uninsured motorist rather than being set off against the face amount of his policy.

The following illustrates the two conflicting positions.

Insured’s Position:
Insured's total damages $ 57,350.00
Workmen's compensation received —15,000.00
Uncompensated damages 42,350.00
Uninsured motorist Insurance $ 15,000.00
Company’s Position:
Insured's total damages $ 57,350.00
Uninsured motorist insurance $ 15,000.00
Workmen's compensation received —15,000.00
Amount insurance company is obligated to pay 0.00

The question is whether the words “any amount payable” at the beginning of Condition 4(b) (representing the figure which is to be reduced by the amount of workmen’s compensation received) refer to the company’s liability limit ($15,000) as set forth in Condition 4(a) (see the “Company’s Position”, supra) or whether they refer to the company’s promise “to pay all sums” etc. in Part IV, Coverage G “which the insured ... is legally entitled to recover”.

It seems significant to us that Condition 4(a) does not read in terms of an “amount payable” but, similar to 4(b), only purports to deal with limitations on the company’s liability under the policy. The nature of the uninsured motorist coverage provided by the company and its obligation “to pay” is to be found in schedule G.

It seems clear, therefore, that the $15,000 in payments received by the insured from the District of Columbia workmen’s compensation fund should be used to reduce the amount represented by the company’s promise “[t]o pay all sums which the insured . . . shall be legally entitled to recover as damages from the owner” per Part IV, Coverage G. See note 2, supra.

It is the duty of the insurer “to spell out in plainest terms — terms understandable to the man in the street — any exclusionary or delimiting policy provisions . .” Raley v. Life & Casualty Insurance Co., D.C.Mun.App., 117 A.2d 110, 113 (1955), quoted with approval in Holt v. George Washington Life Insurance Co., D.C.Mun.App., 123 A.2d 619, 621 (1956). That is, they shall use “language which unambiguously conveys such an intent to the mind of an ordinary layman. Failing such unambiguous language, doubt should be resolved in favor of the insured.” Buchanan v. Massachusetts Protective Association, 96 U.S.App.D.C. 144, 146, 223 F.2d 609, 611, cert. denied, 350 U.S. 833, 76 S.Ct.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

North Carolina Counties Liability & Property Joint Risk Management Agency v. Curry
662 S.E.2d 678 (Court of Appeals of North Carolina, 2008)
William Sims v. Eddie Stewart
Court of Appeals of Tennessee, 1999
Vaughan v. Nationwide Mutual Insurance Co.
702 A.2d 198 (District of Columbia Court of Appeals, 1997)
Caberto v. National Union Fire Insurance Co.
881 P.2d 526 (Hawaii Supreme Court, 1994)
Potomac Electric Power Co. v. California Union Insurance
777 F. Supp. 968 (District of Columbia, 1991)
Sproles v. Greene
394 S.E.2d 691 (Court of Appeals of North Carolina, 1990)
Yamaguchi v. State Farm Mutual Automobile Insurance
515 F. Supp. 186 (D. Hawaii, 1980)
Thamert v. Continental Casualty Co.
621 P.2d 702 (Utah Supreme Court, 1980)
Vaulx v. Cumis Insurance Society, Inc.
407 A.2d 262 (District of Columbia Court of Appeals, 1979)
Poulos v. Aetna Casualty & Surety Co.
379 A.2d 362 (Supreme Court of Rhode Island, 1977)
McKoy v. Aetna Casualty & Surety Co.
374 A.2d 1170 (Court of Appeals of Maryland, 1977)

Cite This Page — Counsel Stack

Bluebook (online)
314 A.2d 481, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-insurance-company-v-tutt-dc-1974.