This appeal concerns interpretation of an exclusion provision in a medical insurance cоntract. The trial judge ruled that the provision excluded from coverage certain charges for crowns and inlays the insured incurred.
The parties did not dispute the facts before the trial court. Appellant suffered from temporomandibular joint syndrome *727 (TMJS), an inflammation of the jaw joint due to improper alignment of the upper and lower jaws. A dentist, an oral surgeon, treated appellant’s TMJS in two stages. First, the dentist inserted a plastic splint in аppellant’s mouth. The splint brought appellant’s jaws into the correct alignment. In order to make the new alignment permanent, the dentist, at the second stage, could have installed either a steel splint or crowns аnd inlays. Appellant and his dentist chose the latter. The treatment was successful.
Prudential reimbursed appellant for the cost of the splint, but denied liability for the costs of the crowns and inlays. The company said that the chаrges for the crowns and inlays fell within the “Mouth Conditions Charges” exclusion in the policy. That exclusion reads:
Generally Excluded Charges:
Mouth Conditiоns Charges — charges for Physicians’ services or x-ray examinations in connection with mouth conditions due to periodontal or periapical disease, or involving any of the teeth, their surrounding tissue or structure, the alveоlar process or the gingival tissue; unless the charges are in connection with the treatment or removal of malignant tumors and would, except for this part (6), be covered under the coverage.
Appellant sued thе company in Superior Court for the charges, arguing that the exclusion’s language did not cover the $4,075.10 at issue. On cross-motions for summary judgment, the trial court ruled that as a matter of law the company’s construction of the еxclusion’s language was more reasonable than appellant’s. He granted summary judgment for the company.
We consider the exclusion’s language ambiguous. The parties’ arguments focus on the phrase “involving any of the teeth” and the question of what previous words that phrase modifies. Appellant’s interpretation connects “involving” with “mouth conditions.” Under his reading, the policy would exclude
Mouth Conditions Charges — charges for Physicians’ serviсes or x-ray examinations in connection with mouth conditions
[1) ] due to periodontal or periapical disease,
or
[2) ] involving any of the teeth, their surrounding tissue or structure, the alveolar process or the gingival tissue.
The charges for correcting TMJS would be compensable under appellant’s construction, because TMJS is not a mouth condition involving the teeth, but rather a condition of the jaws. The company argues that “involving any of the teeth” describes “charges for services.” Thus, under the company’s reading, the policy would exclude
Mouth Condition Charges — charges for Physicians’ services or x-ray examinаtions
[1) ] in connection with mouth conditions due to periodontal or periapical disease, or
[2) ] involving аny of the teeth, their surrounding tissue or structure, the alveolar process or the gingival tissue.
Because insertion of crowns and inlays is a service involving the teeth, the company’s reading would exclude charges for that serviсe.
Appellant’s construction appears to us the more reasonable. We are not persuаded by the company’s argument that the exclusion must link “involving” with “charges” because all the policy exclusions focus on charges. The mouth conditions exclusion’s general concern with charges does not dictate thе interpretation of the detailed language defining what sorts of charges will be excluded. Indeed, appellant’s construction preserves the focus on charges; charges for services connected with mouth conditions will be excluded, with one sort of mouth condition being a condition involving the teeth.
*728
Appellant can аlso draw some support for his construction from
Goss v. Medical Service of the District of Columbia,
But we need say no more than that Prudential’s рolicy exclusion is ambiguous. While the company may exclude TMJS-related charges from coverage if it wishes, it must do so clearly. Ambiguous language in an insurance contract will be construed against the company.
E.g., Vaulx v. Cumis Insurance Society, Inc.,
The company stipulаted at oral argument before this court that if we ruled that the policy covered appellant’s crown and inlay charges, then appellant would be entitled to $4,075.10, the amount he sued for. We therefore remand this сase to the trial court with directions to enter judgment for appellant in the amount of $4,075.10 and appropriate interest and costs.
So ordered.
Notes
. Prudential argues that this rule should not benefit an insured that bargained from strength and at arm’s length with the insurance carrier before entering the contract. Prudential made no showing in the trial court about the nature of the negotiations that led to the contract in question.- We cannot, therefore, consider that argument on this record. In any event, contractual language is generally construed against the drafter of the language.
Vaulx,