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PER CURIAM: This case involves a dispute between Plaintiff-Appellees Sydelle Ruderman, Sylvia Powers, and other class members (âthe insuredsâ) and Pioneer Life Insur *1210 anee Company, which is succeeded in this action by Defendant-Appellant Washington National Insurance Corporation (âWashington Nationalâ). The controversy is over the proper interpretation of certain similar insurance contracts under Florida law. Washington National appeals the District Courtâs grant of summary judgment for the insureds. The District Court concluded that the policies in question were ambiguous and that, under Florida law, they were then to be construed against Washington National. We agree that the policies are ambiguous, but we conclude that Florida law is unsettled on the proper way to resolve the ambiguity. To establish the proper approach to take under Florida law in interpreting the ambiguity, we need some help; so we certify a question to the Supreme Court of Florida. Background The insureds each purchased a Limited Benefit Home Health Care Coverage Policy (âPolicyâ) from Pioneer Life Insurance Company providing reimbursement for certain Home Health Care expenses. 1 For purposes of this appeal, the body of each Policy contains identical language but attached to each Policy is a Certificate Schedule (âCertificateâ) that sets forth the exact coverage amounts specific to each of the insureds and provides a level of differentiation between each Policy. The Policy provides for reimbursement through a maximum daily benefit called the âHome Health Care Daily Benefitâ (âDaily Benefitâ). The provision of the Daily Benefit is limited by a âPer Occurrence Maximum Benefitâ (âPer Occurrence Capâ) for each illness, and a âLifetime Maximum Benefitâ (âLifetime Capâ) for all injuries and sicknesses over the life of the Policy. In addition to the Daily Benefit, the Per Occurrence Cap, and the Lifetime Cap, the Policy also provides for an âAutomatic Daily Benefit Increaseâ which is defined this way: âAUTOMATIC DAILY BENEFIT INCREASE: On each policy anniversary, we will increase the Home Health Care Daily Benefit payable under the policy by the Automatic Benefit Increase Percentage shown on the schedule page.â On the Certificate, the words âHome Health Care Daily Benefit,â âLifetime Maximum Benefit Amount,â and âPer Occurrence Maximum Benefitâ are each listed on a separate lineâin chart formânext to a corresponding monetary value. Directly below these lines is an identically formatted line with the words âAutomatic Benefit Increase Percentageâ andâwhere the other lines have a monetary valueâthe words âBenefits increase by 8% each year.â 2 This controversy focuses on the application of the Policyâs âAutomatic Benefit Increase Percentageâ (âAutomatic Increaseâ) provision. The language from the body of the Policy and the language from the Certificate create a potential ambiguity in the Policy about whether the Automatic Increase applies only to the Daily Benefit or whether it also applies to the Lifetime Cap and Per Occurrence Cap in addition to the Daily Benefit. The Plaintiffs represent a *1211 class of insureds who have not yet been denied any coverage, but who are seeking to establish the correct amount of their Lifetime Cap and Per Occurrence Cap under the Policy. The District Court concluded that an ambiguity exists in the Policy and granted Summary Judgment for the insureds based on the courts understanding that policy ambiguities should be construed against Washington National as drafter of the Policy. Discussion Under the Florida law of insurance contracts â[i]f the relevant policy language is susceptible to more than one reasonable interpretation, one providing coverage and the [sic] another limiting coverage, the insurance policy is considered ambiguous.â Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29, 34 (Fla.2000). In searching for meaning in an insurance contract under Florida law âcourts should read each policy as a whole, endeavoring to give every provision its full meaning and operative effect.â Id. We agree with the District Courtâs conclusion that the Policy is ambiguous about whether the Lifetime Cap and Per Occurrence Cap increase each year or whether only the Daily Benefit increases each year. The way the âBenefitsâ section of the Policy and the Certificate are drafted, it is reasonable to read the Certificate language âBenefits increase by 8% each yearâ as applying solely to the Daily Benefit; but it is also reasonable to read the Certificate language to mean that all the amounts listed within the Policyâs âBenefitsâ sectionâincluding the âPer Occurrence Maximum Benefitâ and the âLifetime Maximum Benefitââincrease annually. Under Florida law, because âthe relevant policy language is susceptible to more than one reasonable interpretation, one providing coverage and the [sic] another limiting coverage, the insurance policy is considered ambiguous.â Id. For us, the correct approach under Florida law in resolving the ambiguity in the Policy is unclear. The chief case out of the Florida Supreme Court on the interpretation of an ambiguity in insurance contracts seems to be Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29 (Fla.2000). Anderson was a response to a question certified from this Court and has been repeatedly cited by state and federal courts for the principle that â[a]mbiguous policy provisions are interpreted liberally in favor of the insured and strictly against the drafter who prepared the policy.â Id. at 34 . While Anderson seems to support the District Courtâs entry of Summary Judgment against Washington National, another principle of Florida law supports looking to extrinsic evidence to resolve the ambiguity before construing any remaining ambiguity against the drafter of the policy. In Excelsior Ins. Co. v. Pomona Park Bar & Package Store, 369 So.2d 938 (Fla.1979), the Florida Supreme Courtâmany years before Andersonâqualified the longstanding rule of construing an ambiguity against the drafter, stating that â[o]nly when a genuine inconsistency, uncertainty, or ambiguity in meaning remains after resort to the ordinary rules of construction is the rule apposite.â Id. at 942 . This position has been the basis for many Florida state trial and appeals courts looking to extrinsic evidence to resolve policy ambiguities. See, e.g., Reinman, Inc. v. Preferred Mut. Ins. Co., 513 So.2d 788 (Fla. 3rd Dist.Ct. App.1987). With the Excelsior line of cases in mind, Washington National offered in District Court extensive extrinsic evidence to explain the marketing of the Policy and to show the understanding of various of the *1212 insuredsâboth when the Policy was purchased and during the life of the Policyâ about what benefits in the Policy increased annually. There is at least a colorable position that Washington Nationalâs proffered extrinsic evidence would resolve any ambiguity in the Policy about what benefits increase annually and would support Washington Nationalâs position that only the Daily Benefit increases annually. While a line of cases exists in Florida supporting the use of extrinsic evidenceâ such as that provided by Washington Nationalâto attempt to resolve ambiguity in insurance contracts before construing any ambiguity against the drafter, the recent Anderson opinionâwhile citing Excels iorâsays nothing about this attempt-to-resolve position in reaching its determination that â[a]mbiguous policy provisions are interpreted liberally in favor of the insured and strictly against the drafter who prepared the policy.â See Anderson, 756 So.2d at 34 . Given the state precedents, the proper approach to take in resolving an ambiguity in an insurance contract seems to us to be an unsettled question of Florida law. While certification of questions has immense value, it has been our practice to show restraint in certifying questions to state courts. But for truly debatable questions âa federal court should certify the question to the state supreme court to avoid making unnecessary Erie 3 âguessesâ and to offer the state court the opportunity to interpret or change existing law.â Mosher v. Speedstar Div. of AMCA Intâl, Inc., 52 F.3d 913, 916-17 (11th Cir.1995). So, instead of attempting to Erie âguessâ how the Florida Supreme Court would resolve the ambiguity in an insurance contract like the one in this Policy, we certify the following question to the Florida Supreme Court, pursuant to Fla. Const. art. V, § 3(b)(6). See Pendergast v. Sprint Nextel Corp., 592 F.3d 1119, 1143 (11th Cir.2010). Question Certified I. In this case, does the Policyâs âAutomatic Benefit Increase Percentageâ apply to the dollar values of the âLifetime Maximum Benefit Amountâ and the âPer Occurrence Maximum Benefitâ? We understand answering this question might include answering the three following sub-questions: A. Does an ambiguity exist about whether the Policyâs âAutomatic Benefit Increase Percentageâ applies only to the âHome Health Care Daily Benefitâ or whether it also applies to the âLifetime Maximum Benefit Amountâ and the âPer Occurrence Maximum Benefitâ? B. If an ambiguity exists in this insurance policyâas we understand that it doesâshould courts first attempt to resolve the ambiguity by examining available extrinsic evidence? C. Applying the Florida law principles of policy construction, does the Policyâs âAutomatic Benefit Increase Percentageâ apply to the âLifetime Maximum Benefit Amountâ and to the âPer Occurrence Maximum Benefitâ or does it apply only to the âHome Health Care Daily Benefitâ? Our statement of the question is not intended to limit the inquiry of the Florida Supreme Court in addressing the issues as it perceives them in considering the record in this case. See Pendergast, 592 F.3d at 1144 . To assist the Florida Supreme Court, we hereby order that the entire record in this case, together with the *1213 briefs of the parties, be transmitted to that high court. QUESTION CERTIFIED. 1 . Washington. National Insurance Corporation is the successor to Pioneer Life Insurance Company for tire purposes of this case. 2 . The pertinent portion of the Certificate appears this way (dollar amounts provided are illustrative only): CERTIFICATE SCHEDULE HOME HEALTH CARE DAILY BENEFIT $ 180/Day LIFETIME MAXIMUM BENEFIT AMOUNT $ 250,000 PER OCCURRENCE MAXIMUM BENEFIT $ 150,000/Illness AUTOMATIC BENEFIT INCREASE PERCENTAGE Benefits increase by 8% each year 3 . Erie R.R. Co. v. Tompkins, 304 U.S. 64 , 58 S.Ct. 817 , 82 L.Ed. 1188 (1938).
Case Information
- Court
- 11th Cir.
- Decision Date
- February 17, 2012
- Status
- Precedential