Edmondson v. Solomon

Opinion

IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE

ROBERT EDMONDSON,

Plaintiff/Appellee,

)

) FILED ) Davidson Circuit No. 96C-4092 ) January 14, 1999 VS. ) Appeal No. 01A01-9802-CV-00097 ) Cecil W. Crowson MARCUS P. SOLOMON and ) Appellate Court Clerk BRENDA SOLOMON, and )

)

HAULERS INSURANCE COMPANY, ) INC., )

)

Defendant/Appellant. )

APPEAL FROM THE CIRCUIT COURT OF DAVIDSON COUNTY AT NASHVILLE, TENNESSEE

THE HONORABLE WALTER C. KURTZ, JUDGE

CYNTHIA D. PLYMIRE ORTALE, KELLEY, HERBERT & CRAWFORD, LLP Nashville, Tennessee Attorney for Appellant

SARA STEIN Nashville Attorney for Appellee

AFFIRMED

ALAN E. HIGHERS, J.

CONCUR: W. FRANK CRAWFORD, P.J., W.S. DAVID R. FARMER, J.

Defendant Haulers Insurance (“Haulers” or “Appellant”), appeals the trial court’s denial of Haulers’

Motion for Partial Summary Judgment seeking a setoff against the total amount of uninsured motorists coverage due under the Haulers policy, for disability amounts paid to Plaintiff, Robert Edmondson (“Edmondson” or “Appellee”), by his employer and under a disability policy.

I. Factual and Procedural History

ThePlaintiff, Robert Edmondson, and the Defendants, MarcusP. Solomonand BrendaSolom were on,

involved in an automobile accident on February 12, 1996, in Nashville, Davidson County, Tennessee. At the time of the accident, Edmondson was insured by a policy of insurance with Haulers Insurance Company, Inc. with $25,000 in uninsured/underinsured motorist coverage.

Following the accident, Edmondson received $5,054.30 in Accident and Sickness benefits from his employer pursuant to his employment contract, and $3,253.33 under an additional disability insurance policy.

Plaintiff filed an action against Defendants Solomon and Haulers seeking damages arising from injuries in the accident. On October 20, 1997, Haulers filed a Motion for Partial Summary Judgment seeking a setoff against the total amount of uninsured motorists coverage due under the Haulers’ policy for disability amounts paid by Edmondson’s employer and under a disability policy of insurance. In support of thismotion, Haulers relied on the following policy provisions:

B. The limit of liability shall be reduced by all sums:

2. Paid or payable because of the “bodily injury” under any of the following or sim law:

ilar

a. Workers’ compensation law; or b. Disability benefits law.

F. We will not pay for any elem of loss if a person is ent entitled to receive payment for the same element of loss under any of the following or sim law:

ilar

1. Workers’ compensation law; or 2. Disability benefits law.

Thus, Haulers argued that its $25,000.00 limit of liability should be reduced by the $8,307.63 disability payments already received by Edmondson from other sources.

Edmondson filed a response in opposition to this motion. Edmondson argued that the exclusionary

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language in the policy specifically refers to benefits paid under workers’ compensation law, disability benefits

law or sim law. It was Edmondson’s contention that the Haulers policy refers to benefits created by ilar

legislative enactment, suchasSocial Securitydisability or workers’ compensation andtherefore does not refer to the type of benefits Edmondson received because his benefits were paid by operation of contract and not operation of law.

Following argum of counsel, the Fifth C ent ircuit for Davidson County entered an Order denying

Haulers’ Motion for Partial SummaryJudgment. On January 16, 1998 Haulers filed a Motion for an Interlocutory Appeal for determination of the issue of setoff. This motion was denied on January 21, 1998.

An Agreed Judgment Order was filed in favor of Edmondson against the unnamed Defendant Haulers in theamount of $25,000.00and dismissingthecaseagainst the Solomons on January 29, 1998. Haulersthen

paid to Edmondsonthejudgm am ent ount with the exception of the disputed $8,307.63, which waspaid directly

into the Court pending this Court’s decision on appeal.

II. Setoff Under the Haulers Policy

Appellant contends that the trial court erred in not allowing Haulers, pursuant to its policy provisions, to reduce its limit of liability for disability benefits paid to Edmondson by other sources.

Haulers contends that the clear intent of the limiting provisions is to allow setoff against uninsured motorist coverage for payments already paid by other sources. Edmondson argues that the word “law” is not ambiguous. It refers tobenefits createdbylegislativeenactment, suchasSocial Security disability or workers’ compensation. The benefits paid to Edmondson were paid pursuant to contract and not due to any legislative enactment.

Contracts of insurance are to be interpreted like other contracts. That is, they should be construed according to the usual, natural, and ordinarymeaning of thelanguage employed. American National Property and Cas. Co. v. Gray, 803 S.W.2d 693, 696 (Tenn. App.1990). The ordinary meaning of “workers’ compensation law” or “disability benefits law” would encompass workers’ compensation or disability benefits

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paid by operation of law. Haulers wants this Court to extend the meaning of these terms to include benefits paid by operation of contract. This Court is of the opinion that the terms used are clear and should be given their ordinary meaning.

This case bears some similarity to Elsner v. Walker, 879 S.W.2d 852, (Tenn. App. 1994). In Elsner,

the UninsuredMotorists policy provided that “thelimit of liability shall be reduced by all sum paid because of

s

bodily injury or property damage by or on behalf of persons or organizations who may be legally responsible.” The insurer sought asetoff for medical insurance coverage provided to the plaintiffs by their medical insurance carrier. The court interpreted the language “persons or organizations whomaybelegallyresponsible” to mean

exactly what it said and nothing m The Court noted that nowhere in the policy is there an explicit, plain ore.

statement that [the insurer’s] liability will be reduced by sum paid by an insured’s m s edical insurance carrier.

If the insurer had intended that they beentitledto areductionfor payments of aninsured’smedical insurance, it could have included such a provision. Id. at 854.

In the Elsner case the insurer sought to have the court, in essence, nullify the qualifying term “by or on behalf of persons or organizations who may be legally responsible” and allow setoff for benefits paid by other sources. In the case before this Court, Haulersseeks tohave thiscourt nullify the word“law” from the clause and allow setoff for benefits paid by other sources. Haulers’ argument only can be that the policy language is unclear and should be sufficiently inclusive to cover setoff for benefits paid by operation of contract, even though not specifically stated in the policy.

An “ambiguity” in a contract or insurance policy is doubt or uncertainty arising from the possibility of

the sam language beingfairly understoodin more ways thanone. NSADBABenefit Plan, Inc. v. Connecticut e

General Life Ins. Co., 968 S.W.2d 791 (Tenn. App. 1997). This Court does not find the terms “workers’ compensation law” or “disability benefits law” to be ambiguous. The rule of strict construction does not authorize a perversion of language, or the exercise of inventive powers for the purpose of creating an ambiguity where none exists. Conley v. Pacific Mutual Life. Ins. Co. of California, 8 Tenn. App. 405 (1928).

Even if this Court were to find that the language used was ambiguous, Haulers’ argument would not have merit. Tennessee law is well settled that any ambiguity in contracts, including insurance contracts, must

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be construed in favor of the insured. Elsner at 854. See also Allstate Ins. Co. v. Watts, 811 S.W.2d 883 (Tenn. 1991) (exceptions, exclusions and limitations in policies must be construed against the insurer and in favor of the insured); U.S. Fidelity & Guar. Co. v. Murray Ohio Mfg. Co., 693 F.Supp. 617, 620 (M.D. Tenn. 1988) (exclusion clauses must be strictly construed in a manner most favorable to the insured).

An insurer may limit risk or coverage as it deem best. Horace Mann Mut. Ins. Co. v. Burrow, 373

s

S.W 469 (Tenn. 1963). Under Tennessee’s uninsured motorist statutes and the comm law, insurers may .2d on

include offsets which are designed to avoid duplication of insurance and other benefits. See Tenn. Code Ann. §56-7-1205. This Court does not in any way seek to abridge Haulers’ right to create such an exclusion reducing its liability by sumspaid pursuant to law, contract and/or any other sources. However,thisCourt holds that Haulers did not create such a broad exclusion in the policy at issue here. Insureds should not have to consult a long line of cases or consult law review articles or treatises to determine the meaning of policy

language. Elsner at 855. If the limitation contended by Haulers is to be part of the contract, it m be clearly ust

written into the policy.

The ordinary meaning of the terms used in this policy allows Haulers an offset only for disability and workerscompensation benefits paid pursuant to law. Under the language of the uninsured motorist coverage limitation, we find no limitation or setoff available toHaulersfordisability or workerscompensation benefits paid to Edmondson pursuant to his employment contract and/or his own disability insurance policy. For the foregoing reasons, the trial court did not err in denying Haulers’ Motion for Partial Summary Judgment.

III. Conclusion

The judgment of the trial court is hereby affirmed. Costs of this appeal are taxed to Appellant, for which execution may issue if necessary.

HIGHERS, J.

CONCUR:

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CRAWFORD, P.J., W.S.

FARMER, J.