Ruderman Ex Rel. Schwartz v. Washington Nat. Ins.
671 F.3d 1208
11th Cir.2012Background
- insureds allege policy ambiguity regarding Automatic Benefit Increase applying to daily, lifetime, and per-occurrence benefits.
- policies contain Daily Benefit, Per Occurrence Cap, Lifetime Cap, and Automatic Benefit Increase Percentage with 8% stated in certificate.
- Certificate Schedule differentiates amounts but language on increases may apply to all benefits or only daily benefit.
- District Court granted summary judgment for insureds, reading ambiguity against drafter Washington National.
- This court agrees policies ambiguous but Florida law unsettled on resolution method; certifies Florida Supreme Court question.
- Court preserves extrinsic-evidence consideration tensions and certifies questions to state court to avoid Erie guesses.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does the policy apply Automatic Increase to Lifetime and Per Occurrence? | Certificate suggests broad annual increase of all benefits | Increase may apply only to Daily Benefit | Question certified to Florida Supreme Court |
| Should extrinsic evidence resolve ambiguity before interpreting against drafter? | Extrinsic evidence relevant to understanding marketing and insureds' understanding | Extrinsic evidence not required before construing ambiguities | Florida Supreme Court to decide extrinsic-evidence role |
| What is the proper Florida-law approach to interpret ambiguous insurance contracts? | Follow traditional liberal interpretation favoring insured | Consider extrinsic evidence; then interpret under standard rules | Unsettled Florida law; certified to Florida Supreme Court |
Key Cases Cited
- Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29 (Fla.2000) (ambiguous provisions interpreted liberally in favor of insured; against drafter)
- Excelsior Ins. Co. v. Pomona Park Bar & Package Store, 369 So.2d 938 (Fla.1979) (extrinsic evidence used to resolve ambiguity before construing against drafter)
- Reinman, Inc. v. Preferred Mut. Ins. Co., 513 So.2d 788 (Fla.3d Dist.Ct.App.1987) (extrinsic evidence considered in ambiguity resolution)
- Mosher v. Speedstar Div. of AMCA Int'l, Inc., 52 F.3d 913 (11th Cir.1995) (certification and avoiding Erie guesses guidance for state-law questions)
- Erie R.R. Co. v. Tompkins, 304 U.S. 64 (1938) (federal courts must apply state law on substantive issues)