OPINION
We consolidated these two cases on appeal because they each raise the question of whether an automobile insurance policy definition that limits uninsured motorist coverage to only those spouses or relatives who live with a named insured at the time of an accident violates public policy. We hold that such a definition does not necessarily violate public policy, but that under the facts of each of these cases before us, coverage must extend to the plaintiffs.
Ramiro Loya appeals from a summary judgment denying Loya class-one coverage 1 under an uninsured motorist policy issued by State Farm Mutual Insurance Company to Ramiro and his wife, Sallie Loya. The narrow and dispositive issue in his appeal is whether, by defining “spouse” in a manner in which the spouse may at a future point during the life of the policy fail to meet a requirement of coverage, an insurance company may require a class-one insured to forfeit coverage. The uncontroverted evidence shows that at the time Sallie purchased the policy, Ramiro met the policy definition of insured spouse, the couple paid a premium for coverage for both spouses, they purchased the policy with community property, and the parties intended to provide class-one coverage for the couple and their son. We hold that because Ramiro qualified for and the couple paid for class-one coverage for both Ramiro and Sallie when they contracted for insurance coverage, State Farm cannot deny coverage to Ramiro during the policy period simply because he moved from the residence where Sallie lived and thereby no longer met the policy definition of “spouse.” We reverse.
In the second case, State Farm appeals from a summary judgment issued in favor of Wayne Smyth and his son, Sean Smyth. The court held that policy language requiring minor children to live with a named-insured parent in order to be protected under the uninsured motorist coverage is void as violative of public policy. The uncontroverted evidence shows that Wayne intended to provide uninsured motorist protection for all of his children including Sean (who lived with Wayne’s former wife), that Sean was dependent upon Wayne for support and that Wayne was a joint legal custodian for Sean. We hold that an insurance company may not exclude from uninsured motorist coverage an unemancipated minor child that the named insured is legally obligated to financially support by inserting a general definition applicable to other relatives in the policy. We affirm the trial court.
Facts and proceedings — the Loyas. The Loyas married in 1986 and experienced marital difficulties, separating three times after December 1989. In March 1991, during a period of reconciliation, they used community funds to purchase two automobile insurance policies from State Farm. The policies were for a car (“the Honda”) and a truck they jointly owned and both drove. The Honda policy listed only Sallie as the named insured but expressly included Ramiro as an insured on the declarations page and on the proof of financial responsibility card issued for that car. The truck policy listed both Sallie and Ramiro as named insureds, in that order. The automobiles were titled in both the Loyas’ names; Sallie drove the Honda most of the time.
The policies defined the “named insured” as the “first person named in the declarations” regardless of whether both spouses were named in the declarations as insureds. The policies provided class-one coverage for “the first person named in the declarations” and “his or her spouse.” In á separate section of the policies (on a different page) the definition of “spouse” was limited to “your husband or wife while living with you.” The policies were renewed for another six months in September 1991 while the couple was still living together.
In October 1991, the Loyas separated for the third time. Ramiro moved out of the marital residence and went to stay with his brother. Ramiro and Sallie each called State Farm and asked to have the other removed as a “named insured” on the policy of the respective automobiles they were driving. State Farm apparently did not refund any premium amounts reflecting a reduction in liability or uninsured motorist coverage on each auto from two covered drivers to one; nor did it issue a new policy on the Honda or notify Ramiro that he was no longer insured under the Honda policy. State Farm did issue a new policy listing only Ramiro as the named insured on the truck.
In December 1991 the couple met to discuss the dissolution of the marriage. Ramiro drove the couple around in the Honda while they were talking. At some point Sallie pulled a gun, they struggled over it, Ramiro threw the gun away, and he got out of the car. Sallie then ran over Ramiro with the car, severely injuring him.
State Farm paid Ramiro the uninsured motorist policy limits on the truck for which he was now designated as the named insured, but denied him the right to stack the Honda policy with the truck policy. Ramiro brought a declaratory judgment action to determine his rights under the Honda policy. After cross-motions for summary judgment were filed, the court held that the Honda policy was clear and unambiguous, that there were no material issues of fact, and that Ramiro should be denied the right to stack because he was not a class-one insured under the definition of “spouse” in the policy at the time of the accident.
Class-one uninsured motorist coverage is determined at the time the policy is purchased. When a married couple contracts for insurance coverage for the family, there is a presumption that the coverage applies with equal effect to both parties unless one of them is expressly excluded from coverage. Each person is considered to be a purchaser of the contract. See, e.g., Schmick v. State Farm Mut. Auto. Ins. Co.,
Further, the parties designate who is to be covered under the insurance contract, and the number of persons insured by thát contract establishes the amount of the premium, which must be paid in advance. If there is a disagreement between the parties, a court looks at the intent of the parties at the time the contract was executed to determine who the parties intended to insure. See, e.g., Jaramillo v. Providence Wash. Ins. Co.,
It is uncontroverted that at the time the insurance contract was executed, Ramiro was a class-one insured under the policy. State Farm contends that Ramiro lost his rights under the contract of insurance for the Honda solely because he was not living with Sallie at the time of his injury. It convinced the trial court to examine the facts at the time of the injury rather than at the time the contract was executed in order to determine who was an insured. In essence, State Farm is arguing that it should be relieved from the risks it was paid to insure against because of a personal conflict between beneficiaries independent of the initial risks insured against. This theory has been soundly rejected in other jurisdictions when construing insurance contracts.
For example, in United Farm Bureau Mutual Insurance Co. v. Brantley,
The Brantley opinion cited to United States Fidelity & Guaranty Co. v. Winkler,
taking away the coverage from her would be in the nature of a forfeiture. It is of course well-established that forfeitures are strictly construed. The policy is far from clear in containing any express statement that the status of the named insured once acquired is lost by a subsequent event such as separation.
Id. Therefore, the court held that reformation of the contract would be justified. Id. at 689.
The Brantley and Winkler cases are founded upon the principle that a husband and wife each have contractual rights in an insurance policy that, once established and paid for, may not be invalidated because of the language the insurance company chooses to use to describe the parties. Because Ramiro was a class-one insured under the policy at the time it was executed, he is entitled to have the insurance contract construed in his favor. See Jaramillo,
The application of the policy definition of “spouse” is ambiguous. We agree that the meaning of “while living with” is unambiguous. We find ambiguity in this policy, however, when attempting to determine to whom the policy definitions apply and when to apply them. See, e.g., Schmick,
Ambiguity in coverage is resolved in favor of the reasonable expectations of the insured. We are compelled to resolve this ambiguity in favor of coverage. The Court in Sanchez v. Herrera,
Exclusions that purport to limit uninsured motorist coverage of class-one insureds are void. Even if the definition of “spouse” could be considered an express exclusion that limits Ramiro’s coverage, we would not give effect to it. It has long been established that in uninsured motorist coverage policies even unambiguous exclusions that limit class-one coverage will not be enforced. Id. (holding that exclusion denying coverage if insured was riding in an uninsured vehicle was not valid because “it is not the intent of the [uninsured motorist] statute to limit coverage for an insured to a particular location or a particular vehicle”). In Foundation Reserve Ins. Co. v. Marin,
This Court has consistently refused to enforce exclusions that attempt to limit uninsured motorist coverage to particular circumstances. Being separated from one’s spouse at the time of an accident is no different analytically than being in an uninsured vehicle at the time of an accident. In neither circumstance may the insurance company deny coverage to its insured after accepting premiums for uninsured motorist coverage. “If the [uninsured motorist] statute is to be meaningful and controlling in response to the nature and extent of the coverage ... all inconsistent clauses ... must be judicially rejected.” Sloan,
We do not today decide the question of whether an insurance company, by expressly precluding coverage to those spouses who do not live with the named insured, may validly deny insurance coverage from, the outset. The resolution of that question depends upon the contract language, who was contracting for insurance, and who were the intended beneficiaries of that contract. That question is not raised by the facts in the dispute involving Ramiro Loya.
The Smyth case, however, directly raises the issue of whether an insurer may validly limit coverage for dependent minor children by simply including a limitation in its definition of “relatives.”
Facts and proceedings — the Smyths. Wayne Smyth contracted with State Farm for liability and uninsured motorist coverage for more than twenty years. Sean Smyth, Wayne’s natural son, lived with Wayne and his natural mother Jane from the time he was bom in 1974 until his parents’ divorce in 1981. During this time, Sean admittedly was covered under the provisions of his father’s uninsured motorist policy. After the divorce, Wayne and Jane agreed to joint legal and physical custody of Sean. Wayne provided monetary support, and Sean lived with his father every other weekend and during holidays for several years. State Farm agrees that Sean was also covered under his father’s policy during this time period. Wayne remarried and had two more children. Wayne testified that his intent throughout the years was to provide continuous uninsured motorist protection for all of his children, including Sean. When Sean was fifteen, he and his father had a disagreement and Sean did not live in Wayne’s house for about a year. Wayne, however, continued to support his son. During this period of estrangement, Sean was seriously injured in an automobile accident. Because Sean’s medical expenses exceeded the policy amounts of other policies available for Sean’s needs, a demand was made upon Wayne’s uninsured motorist policy. State Farm refused to pay on the basis that at the time of the accident Sean no longer met the definition of an insured under Wayne’s uninsured motorist policy.
The Smyth policy. Wayne’s uninsured motorist policy states that State Farm “will pay damages for bodily injury ... an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle.” Another section of the uninsured motorist policy states
Insured — means the person or persons covered by uninsured motor vehicle coverage.
This is:
1. the first person named in the declarations;
2. his or her spouse;
3. their relatives; and
4. any other person while occupying [the named insured’s car or a car driven by the named insured or his/her spouse].
To complicate matters, an “Amendatory Endorsement” was apparently sent to Wayne that states:
Section III — Uninsured and Unknown Motorists — Coverage U. The definition of ‘Insured’ under ‘Who is an Insured’ is changed to read: Insured — means the person or persons covered by uninsured and unknown motorists coverage.
The endorsement does not include parts 1-4 describing the individuals quoted above. To further complicate matters, another change notice was sent to Wayne stating that, regarding the uninsured motorist coverage,
Effective immediately, there now may be coverage for the first named insured and resident relatives when injured in a vehicle owned by or available for the regular use of you, your spouse or your relatives.
Finally, as in the Loya policy, in a section of the main policy, certain words are defined. In that section, “Relative” is defined as
a person related to you or your spouse by blood, marriage or adoption who lives with you. It includes your unmarried and unemancipated child away at school.
As a named insured, Wayne is entitled to recover amounts expended on behalf of his dependent child for damages suffered in an accident with an uninsured motorist. State Farm complains that the trial court did not set forth what public policy is violated by an insurance policy that limits a named insured’s right to recover damages on behalf of an injured child by providing coverage when the child lives with the named insured and taking it away when the child does not. We stated almost twenty years ago, however, that “the Legislature did not intend to allow the creation of a gap in coverage which is contrary to the purpose of the statute.” Chavez,
The policy is not clear regarding who is an insured. As mentioned in the above discussion regarding the definition of “spouse” in the Loyas’ State Farm policy, a policy may give rise to an ambiguity because it requires the party seeking insurance to untangle a web of provisions and related definitions in order to determine who the policy actually covers. See, e.g., Schmick,
As noted above, there is no ambiguity in the meaning of “lives with”; the ambiguity arises in determining whether that limitation applies, and if so, how it is applied. Does it mean that only children who live with the named insured at all times are insured? Does it mean that coverage fluctuates depending on where the child is currently living, i.e. that coverage exists when a child is living with his dad for a week?
Consideration of the context in which this contract was made also reveals an ambiguity in the terms of this policy. See Mark V, Inc. v. Mellekas,
Conclusion. State Farm argues that in the Loya policy, “while living with” means that the individual must be actually and currently living in fact with the named insured on a daily basis at the time of the accident, and that Ramiro’s testimony that he had taken meals and slept with his wife during their separation period had no effect on that terminology. It argues that in the Smyth policy, however, the phrase “who lives with” means only that the individual must provide some “indication that he resides with his father at all.” Because State Farm has used language that may be ambiguously applied, it is able to argue both ways. It is exactly this kind of uncertainty of coverage that our rules requiring strict construction against the insurer and in favor of coverage are intended to guard against. In Pribble, we refused to charge the insured with the duty of reading and understanding a policy and then bar recovery by upholding a literal application of its terms and provisions. Instead, this Court held that the insured is bound to make such an examination of documents as would be reasonable under the circumstances and is held to that which he or she would be thereby alerted.
Given the fact that most individuals are not legally responsible financially for relatives other than their children or spouses and therefore do not normally intend to provide uninsured motorist coverage for those relatives, it is not necessarily against public policy for an insurance policy to preclude coverage to those other kinds of relatives not living with a named insured. However, for the reasons explained in this opinion, State Farm cannot preclude coverage to the named insureds, their spouses, and their children under the facts of these cases. Accordingly, we reverse the trial court in the Loya case and remand for entry of judgment in favor of Ramiro Loya, and affirm the trial court in the Smyth case.
IT IS SO ORDERED.
Notes
. Class-one coverage is discussed in Konnick v. Farmers Insurance Co.,
