Clements v. Connecticut General Life Insurance

40 Fla. Supp. 121
CourtCircuit Court of the 11th Judicial Circuit of Florida, Miami-Dade County
DecidedDecember 18, 1973
DocketNo. 71-24724
StatusPublished

This text of 40 Fla. Supp. 121 (Clements v. Connecticut General Life Insurance) is published on Counsel Stack Legal Research, covering Circuit Court of the 11th Judicial Circuit of Florida, Miami-Dade County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clements v. Connecticut General Life Insurance, 40 Fla. Supp. 121 (Fla. Super. Ct. 1973).

Opinion

RAYMOND G. NATHAN, Circuit Judge.

Memorandum opinion and final judgment: This cause was tried before the court without a jury on November 1, 1973, at which time four issues were presented to the court pursuant to the complaint as amended on April 13, 1972, February 9, 1973, and at the outset of the trial. The issues framed by the complaint as amended and defendant’s answer and affirmative defenses filed June 23, 1972 revolve around a long-term disability insurance policy issued by defendant to the plaintiff’s former employer, Eastern Airlines. The policy in question is generally known as a group disability policy and plaintiff was insured pursuant to a certificate issued to her under the policy.

A joint stipulation of facts was presented to the court at the trial, along with certain exhibits, including the policy in question. These items reflect the following salient facts —

The plaintiff suffered an injury at her place of work on August 12, 1970. As a result of that injury, she was prevented from performing the duties of her occupation from that date up until February 12, 1973. (The question of disability subsequent to February 12, 1973 has been reserved by the parties to this suit.) Because of this disability, plaintiff became entitled to receive benefits under the aforementioned policy. The policy provides that long-term disability benefits will be 50% of basic monthly earnings reduced by other income benefits which are defined on page 6 of the policy as follows —

“Any periodic cash payments provided on account of the employee’s disability: ... by the Federal Social Security Act. . . under or on account of any workmen’s compensation or similar law which becomes payable on or after the commencement of the disability for which monthly income is payable.”

It is further provided in the policy, however, that in no case, shall the monthly benefits payable be reduced below the amount of $50.

As a result of the disability suffered by plaintiff, she began receiving social security benefits in the amount of $201 a month and, from August 1970 through June 1972 workmen’s compensation benefits in the amount of $49 a week. In June of 1972, the workmen’s compensation claim was settled as indicated by the industrial claims [123]*123court order presented herein as exhibit 2. The parties have stipulated that this settlement was a negotiated amount based upon the benefits which would have been due to the plaintiff had she not received them as a lump sum. The order of the industrial claims court provides that $8,750 of the total settlement represents future medical expenses, $11,625 represents attorneys’ fees, and that $30,000 represents future payments for compensation.

Plaintiff’s basic monthly earnings pursuant to the policy definition were $731. By calculating 50% of $731 and reducing the amount obtained, $365.50, by monthly social security benefits and weekly workmen’s compensation benefits, defendant’s liability under its policy was reduced to a sum less than the minimum benefits payable of $50 a month. Accordingly, from the point at which policy benefits became payable to plaintiff, up until October 1971, defendant paid plaintiff $50 a month.

Plaintiff first alleges that defendant’s reduction of its policy benefits as set forth above violates Florida Statute §627.635. This statute provides as follows —

(1) No provision of this chapter shall be deemed to prohibit an insurer from issuing a policy as, or including in a policy a provision providing for, excess insurance; that is, to the effect that the insurer’s liability for benefits payable on account of expenses incurred for any hospitalization, medical, surgical and other service resulting from covered sickness or injury of the insured, shall be limited to that part of such expense, if any, which is in excess of all benefits payable on account thereof by policies covering the same insured and by all other insurers and service organizations by whom benefits are payable as to the same such expense.
(2) Any such policy, or any policy containing any such provision, shall have imprinted or stamped conspicuously upon the face thereof the designation “excess insurance” or appropriate words of similar import approved by the department:

Plaintiff argues that defendant’s policy provisions which allow it to reduce its benefits by amounts received by the insured from social security or workmen’s compensation is a provision providing for excess insurance. Defendant’s policy has no imprint or stamp on its face with the designation ‘'excess insurance” in accordance with the statute. The plaintiff therefore urges that defendant may not reduce benefits payable under its policy as described.

The court finds for defendant on this point. It is clear that the clause in defendant’s policy is not an excess insurance clause under the terms of Florida Statute §627.635, and that the statute does not apply to policies providing for payment of disability benefits. Additional authority for this conclusion is supplied by our sister [124]*124jurisdiction of Alabama in the case of State Farm Mutual Automobile Insurance Company v. General Mutual Insurance Company, 210 So.2d 688 (1968) at 693, wherein the Supreme Court of Alabama stated that an

“excess insurance clause contemplates a provision providing that a company shall be liable only for the amount of a loss in excess of coverage provided by another company’s policy.”

Plaintiff’s next contention also involves the reduction of benefits by defendant pursuant to the policy provisions discussed above. Plaintiff argues that, as the policy allows reduction on account of “periodic cash payments,” that the lump sum workmen’s compensation settlement reached in June of 1972 may not be used to reduce benefits payable by defendant. In support of her position, plaintiff has submitted to the court the case of Jewel Tea Company v. Florida Industrial Commission, 235 So.2d 289 (Fla. 1969). This case involves a unilateral reduction of workmen’s compensation benefits by an employer in direct violation of Florida Statute §440.21, and is not relevant to the issues raised herein.

As a general principle, it is clear that the defendant is entitled to credit for payments made pursuant to the workmen’s compensation law. See for example Dowell v. Aetna Life Insurance Company, 468 F.2d 802 (4th Cir. 1972) and United Benefit Life Insurance Company of Omaha v. Zwan, 143 S.W.2d 977 (Tex. App. 1940). The specific question here is whether the policy language of defendant prevents it from taking plaintiff’s lump sum workmen’s compensation settlement into account. Florida Statute §440.20(10) specifically provides that periodic workmen’s compensation payments may be terminated by the payment of a lump sum equal to the present value of all future payments for both compensation and remedial treatment. As previously discussed, the workmen’s compensation settlement herein provides that $30,000 represents the present value of all future payments for compensation.

It is clear that the insurance policy in question in this case was issued to insure plaintiff a monthly income benefit in an amount equal to 50% of her monthly wages if she became totally disabled.

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

Related

William Fred Dowell v. Aetna Life Insurance Company
468 F.2d 802 (Fourth Circuit, 1972)
Southern v. Department of Labor & Industries
236 P.2d 548 (Washington Supreme Court, 1951)
Jewel Tea Company v. Florida Industrial Commission
235 So. 2d 289 (Supreme Court of Florida, 1970)
State Farm Mut. Auto. Ins. Co. v. General Mut. Ins. Co.
210 So. 2d 688 (Supreme Court of Alabama, 1968)
Sturgill v. Life Insurance Company of Georgia
465 S.W.2d 742 (Court of Appeals of Tennessee, 1970)
Williams v. INSURAMCE COMPANY OF NORTH AMERICA
434 P.2d 395 (Montana Supreme Court, 1967)
United Benefit Life Ins. Co. of Omaha v. Zwan
143 S.W.2d 977 (Court of Appeals of Texas, 1940)

Cite This Page — Counsel Stack

Bluebook (online)
40 Fla. Supp. 121, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clements-v-connecticut-general-life-insurance-flacirct11mia-1973.