Corgatelli v. Globe Life & Accident Insurance Co.

533 P.2d 737, 96 Idaho 616, 1975 Ida. LEXIS 459
CourtIdaho Supreme Court
DecidedJanuary 28, 1975
Docket11513
StatusPublished
Cited by64 cases

This text of 533 P.2d 737 (Corgatelli v. Globe Life & Accident Insurance Co.) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Corgatelli v. Globe Life & Accident Insurance Co., 533 P.2d 737, 96 Idaho 616, 1975 Ida. LEXIS 459 (Idaho 1975).

Opinions

SHEPARD, Justice.

This is an appeal from a decision of the district court reversing a judgment of the magistrate’s division on a claim under an insurance contract and remanding the matter for further proceedings in the magistrate court. We in turn reverse the decision of the district court and add to the body of Idaho law the so-called “doctrine of reasonable expectations” in litigation involving interpretation of insurance contracts.

Plaintiff-appellant Randolph Corgatelli was a part-time rodeo performer and a member of an association made up of such performers. That association sanctioned the activities of agents of defendant-respondent Globe Life and Accident Insurance Company in selling what is styled an “accident insurance policy” to members of the association. Upon being solicited Corgatelli purchased such a policy in May 1971.

The insuring clause of that policy provided :

“[Gjlobe’ hereby insures the applicant * * * subject to the terms, provisions and limitations of this policy, against (1) loss of life, limb, or sight or (2) specific injury, resulting directly and independently of all other causes from accidental bodily injury * * *

Thereafter a schedule of benefits was set forth in Part 2 of the policy, stating:

“If the Insured shall sustain an accidental bodily injury occurring while this policy is in effect as to such person, [618]*618which shall directly and independently of all other causes and within thirty days from the date of such accident result in any of the following losses or conditions and is so diagnosed by a licensed physician, the Company will pay the amount specified in the schedule below:
[Amounts payable for loss of eye or limb]
“For Complete Dislocation of:
Hip Joint $1,200.00
Knee Joint (except Patella) $ 600.00
Bone or Bones of the Foot, other than Toes $ 600.00
Ankle Joint $ 600.00
Wrist Joint $ 500.00
Elbow Joint $ 400.00
Shoulder Joint $ 300.00
Bone or Bones of the Hand, other than fingers $ 200.00
Collar Bone $ 200.00
Two or More Fingers $ 100.00
Two or More Toes $ 100.00
One Finger $ 50.00
One Toe $ 50.00
“For Complete Simple or Closed Fracture of Bone or Bones of:
Skull (except bones of face or nose) both tables $1,300.00
Hip-Thigh (Femur) $1,200.00
Pelvis (except Coccyx) $1,000.00
Arm between shoulder and elbow shaft $ 800.00
Shoulder Blade (Scapula) $ 800.00
Leg (Tibia or Fibula) $ 800.00
Ankle $ 600.00
Knee Cap (Patella) $ 600.00
Collar Bone (Clavicle) $ 600.00
Forearm (Radius or Ulna) $ 60Q.00
Foot (except Toes) $ 500.00
Hand or Wrist (except Fingers) $ 500.00
Lower Jaw (except Alveolar Process) $ 300.00
Two or More Ribs, Fingers or Toes $ 200.00
Bones of Face or Nose $ 200.00
One Rib, Finger or Toe $ 100.00
Coccyx $ 100.00
“For Complete Open or Compound Fracture the Amount Payable will be One and One-Half Times the Amount Payable for Simple Fracture.

“For an Open Operation with Bone Grafting or Metallic Fixation at Point of Fracture the Amount Payable will be Twice the Amount Payable for Simple Fracture.

“Only one of the amounts, the largest, named in this Part 2 will be paid for losses due to any one accident and shall be in lieu of all other benefits under this policy.”

While participating in a rodeo in June 1971 Corgatelli boarded an ill-tempered Brahma bull. He was promptly bucked off, injuring his right shoulder. That injury was diagnosed as an “acromioclavicular separation” of the right shoulder. As is common in such injuries treatment required open surgery and the insertion of metal fixation.

Corgatelli filed a claim with Globe and was tendered a check for $57.14, the amount allegedly representing two-sevenths of the weekly benefit payable for unspecified injuries that required hospitalization. Corgatelli then made a written demand upon Globe for $1,200 contending that amount was due under the policy for an injury to the collar bone where open surgery with metallic fixation was required. Globe refused that demand and Corgatelli instituted this action. Following trial in the magistrate’s division a decision was entered awarding Corgatelli $1,200, plus $750 attorney fees. The basis for that decision appears to have been that the insurance contract contained an ambiguity to be resolved against the insurer.

Upon appeal to the district court it was again recognized that there was a patent ambiguity in the policy since a collar bone could not be “dislocated.” The district court believed the only question to be whether Corgatelli should be reimbursed for dislocation of his shoulder joint ($300) or for “dislocation of his collar bone” ($200). The district court remanded the case for resolution of that' question and for [619]*619a redetermination of appropriate attorney fees. This appeal resulted.

Corgatelli urges, and we agree, that the so-called “doctrine of reasonable expectations” (alias the doctrine of adhesion contracts) should be adopted in Idaho.1 That doctrine was articulated in the case of Gray v. Zurich Insurance Company, 65 Cal.2d 263, 54 Cal.Rptr. 104, 419 P.2d 168 (1966). Gray involved the duty of an insurer under a personal liability policy to defend the insured against personal injury or property damage lawsuits. That court held that any exception to the basic underlying obligation of the insurer must be set forth in such a manner that the insured is clearly informed of its import. The court stated:

“These principles of interpretation have found . . . restatement in the doctrine of the adhesion contract . . . [A] contract entered into between two parties of unequal bargaining strength, expressed in the language of a standardized contract, written by the more powerful bargainer to meet its own needs, and offered to the weaker party on a ‘take it or leave it basis’ carries some consequences that extend beyond orthodox implications. Obligations arising from such a contract inure not alone from the consensual transaction but from the relationship of the parties.

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Cite This Page — Counsel Stack

Bluebook (online)
533 P.2d 737, 96 Idaho 616, 1975 Ida. LEXIS 459, Counsel Stack Legal Research, https://law.counselstack.com/opinion/corgatelli-v-globe-life-accident-insurance-co-idaho-1975.