Zemelman v. Equity Mutual Insurance Co.

935 S.W.2d 673, 1996 Mo. App. LEXIS 1698, 1996 WL 587684
CourtMissouri Court of Appeals
DecidedOctober 15, 1996
DocketWD 52117
StatusPublished
Cited by38 cases

This text of 935 S.W.2d 673 (Zemelman v. Equity Mutual Insurance Co.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zemelman v. Equity Mutual Insurance Co., 935 S.W.2d 673, 1996 Mo. App. LEXIS 1698, 1996 WL 587684 (Mo. Ct. App. 1996).

Opinion

LOWENSTEIN, Judge.

Appellants, Leo and Rose Zemelman (Zemelman), appeal the trial court’s entry of summary judgment entered on behalf of their insurance company, the defendant-respondent, Equity Mutual Insurance Company (Equity Mutual). The Zemelmans assert that the underinsured motorist coverage of $50,000 per person in the insurance contract between the parties is ambiguous, and urge this court to apply the reasonable expectations doctrine to hold that the underinsured motorist coverage amounts to “excess coverage” and they are entitled to recover under their policy an amount over and above funds received from the tortfeasor. The sole question before this court is whether the underin-sured motorist coverage ($50,000) takes effect and covers the policy holder’s losses in excess of the tortfeasor’s automobile liability policy ($100,000). Leo Zemelman’s, loss of consortium claim will not be reviewed by this court since it was dismissed at the trial court.

In June of 1993, Rose Zemelman, while driving her insured automobile, was injured in a collision with another driver. She suffered serious injuries and ultimately, lost all use and control of her left arm such that she requires assistance to perform fundamental tasks. At the time of the hearing, she asserted considerable actual damages for health care costs totaling over $85,000.00. The trial court did not make a finding with regard to damages however, because that court found the policy plain and unambiguous and denied plaintiff/appellant’s claim for un-derinsured motorist coverage. The Zemel-man policy with Equity Mutual defined an underinsured vehicle as one with less coverage than the underinsured limits, and further read to allow Equity Mutual a set off for all sums paid by the tortfeasor.

Zemelman collected the $100,000 limit in a suit against the negligent driver who had automobile insurance liability limits of $100,-000 per person and $300,000 per occurrence. The Zemelman’s policy of automobile insurance covered three vehicles and included an underinsured motorist clause with recovery *675 limits of $50,000 per person and $100,000 per occurrence. There is no claim here for stacking underinsured policies.

Zemelman asserts that the policy is ambiguous with respect to the definition of under-insured, the “anti-stacking” set-off language under the limit of liability clause, and the “other insurance” clause. The pertinent provisions of the Zemelman’s policy read as follows:

“We will pay compensatory damages which an insured is legally entitled to recover from the owner or operator of an underin-sured vehicle because of bodily injury: (1) sustained by an insured; and (2) caused by an accident ...
We will pay under this coverage only after the limits of liability under any applicable bodily injury liability bonds or policies have been exhausted by payment of judgments of settlements ...
Underinsured motor vehicle means land motor vehicle or trailer of any type to which a bodily injury bond or policy applies at the time of the accident but it’s limit for bodily injury liability is less than the limit of liability for this coverage.
The limit of liability shown in the Schedule for this coverage is our maximum limit of liability for all damages resulting from any one accident. This is the most we will pay regardless of the number of:
1. ‘Insureds.’
2. Claims Made,
3. Vehicles involved in the accident.
However, the limit of liability shall be reduced by all sums paid because of the ‘bodily injury5 by or on behalf of persons or organizations who may be legally responsible. This includes all sums paid under Part A of this policy.
Other Insurance
If there is other applicable similar insurance we will pay only our share of he loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own shall be excess over any other collectible insurance.” [Emphasis added]

In determining whether there is an ambiguity in the policy, the court must abide certain rules of construction. Where insurance policies are unambiguous, the rules of construction are inapplicable, and absent a public policy to the contrary, the policy will be enforced as written. American Family Mutual Ins. Co. v. Ward, 789 S.W.2d 791, 795 (Mo. Banc, 1990). Courts will not create an ambiguity in order to distort the language of an unambiguous insurance policy. Rodriguez v. General Accident Ins. Co., 808 S.W.2d 379, 382 (Mo. Banc 1991). However, where provisions of an insurance policy are ambiguous, they are construed against the insurer. Behr v. Blue Cross Hospital Service, Inc., 715 S.W.2d 251, 255 (Mo. Banc 1986). Language is ambiguous if it is reasonably open to two different constructions and the language used will be viewed in the meaning that would ordinarily be understood by the layman who bought and paid for the policy. Robin v. Blue Cross Hospital Service, Inc., 637 S.W.2d 695, 698 (Mo. Banc 1982).

Appellants urge the court to apply the reasonable expectation doctrine in interpreting the insurance policy at issue. That doctrine provides that where there is an ambiguity, the insured are entitled to a resolution of the ambiguity consistent with their objective and reasonable expectations. Estrin Construction Co. Inc. v. Aetna Casualty & Surety Co., 612 S.W.2d 413 (Mo.App.1981). In order to apply the reasonable expectation doctrine, the court must first determine that the policy contains an ambiguity or is a contract of adhesion.

An adhesion contract is a form contract created by the stronger of the contracting parties. “It is offered on a ‘take this or nothing’ basis.” Robin v. Blue Cross Hosp. Service, Inc., 637 S.W.2d 695, 697 (Mo. Banc 1982). Underinsured motorist coverage is optional coverage and therefore, the underin-sured motorist clause is not a contract of adhesion. There are no statutory nor public policy requirements in Missouri for underin-sured motorist coverage. Rodriguez, 808 S.W.2d at 383.

*676 This ease must be distinguished from cases cited by Appellants where the term underinsured was not clearly defined in the automobile insurance policy. In Krombach v. Mayflower Ins. Co. 785 S.W.2d 728

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Bluebook (online)
935 S.W.2d 673, 1996 Mo. App. LEXIS 1698, 1996 WL 587684, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zemelman-v-equity-mutual-insurance-co-moctapp-1996.