National Chiropractic Mutual Insurance v. Morgan

WARREN, P. J.,

dissenting.

The majority suggests that the interpretation of a term in an insurance policy is always a question of law and that, whenever a term is not defined in the policy, the insurer is bound by the common understanding of that term. That is a gross oversimplification of the analytical process developed in a long line of precedents, including the recent cases of Joseph *202v. Utah Home Fire Ins. Co., 313 Or 323, 328, 835 P2d 885 (1992), and Hoffman Construction Co. v. Fred S. James & Co., 313 Or 464, 470, 836 P2d 703 (1992). Those cases indicate that fact issues can arise in the construction of an insurance contract and that an insurer is not bound by the common understanding of a term, unless an ambiguity is not otherwise resolvable. Because that is the case here, I dissent.

An insurance contract must -be construed to effectuate the parties’ intent. 313 Or at 470. Moreover, because this is a summary judgment proceeding, plaintiff, the moving party, must show that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law. ORCP 47C; Seeborg v. General Motors Corporation, 284 Or 695, 699, 588 P2d 1100 (1978).

The threshold question is whether an ambiguity exists. That is a question of law. Adams v. Northwest Farm Bureau Ins., 40 Or App 159, 164, 594 P2d 1256, rev den 287 Or 123 (1979). If the court determines that the contract terms clearly reflect the parties’ intentions, see State Farm Mutual Auto Ins. Co. v. White, 60 Or App 666, 672, 655 P2d 599 (1982), it is unambiguous and construction is unnecessary. If, on the other hand, the court determines that the contract is ambiguous and evidence that presents a genuine issue of material fact is properly admitted to show meaning, determining what the parties intended is a question of fact. Timberline Equip. v. St. Paul Fire and Mar. Ins., 281 Or 639, 643, 576 P2d 1244 (1978). The evidence may take the form of information regarding the parties’ negotiations, see Joseph v. Utah Home Fire Ins. Co., supra, 313 Or at 328; trade usage, Timberline Equip. v. St. Paul Fire and Mar. Ins., supra, 281 Or at 643; or any other extrinsic evidence regarding the circumstances under which the agreement was made. See, e.g., Collins v. Farmers Ins. Co., 312 Or 337, 360, 822 P2d 1146 (1991); Adams v. Knoth, 102 Or App 238, 243, 794 P2d 796, rev den 310 Or 422 (1990).

The declarations page of the policy provides limits of liability of “$100,000/$300,000” for “each occurrence/ aggregate. ’ ’ (Emphasis supplied.) It does not provide a limit of liability for “each person.” However, the “Limits of Liability” provision of the policy, which refers to the declarations page, provides:

*203“Regardless of the number of (1) insured [sic] under this policy, (2) persons or organizations who sustain injury, or (3) claims made or suits brought on account or [sic] injury, the limit of liability stated in the declaration as applicable to ‘each person’ is the limit of the company’s liability for all damages sustained by all persons including any derivative claim of a spouse or parent because of injury sustained by any one person. The limit of liability stated as ‘aggregate’ is, subject to the above provision respecting each person, the total limit of the company’s liability for all damages. The aggregate limit applies separately to each consecutive annual period.” (Emphasis supplied.)

Because the “each occurrence” limit of liability stated on the declarations page is different from the “each person” limit ofliability specified in the body of the policy, the policy is ambiguous. To aid in resolving that ambiguity, the parties submitted affidavits. Plaintiffs affidavit focuses on the circumstances surrounding the execution of the policy. It asserts that, before 1988, the declarations page did provide an “each person” limit but that an automated systems change inadvertently caused the phrase “each occurrence” to be substituted for the phrase “each person” when Meece renewed his policy.1 Defendant submitted an affidavit from Meece stating that he was unsure about the effect of the change from “each person” to “each occurrence” but that he thought that the change meant that he was “entitled to some form of coverage beyond the scope of that which” he had when the declarations page referred to “each person,” because his premium increased.

Defendant’s affidavit focuses on Meece’s subjective interpretation of the policy. However, “[t]he law of contracts is not concerned with the parties’ undisclosed intents and ideas.” Kitzke v. Turnidge, 209 Or 563, 573, 307 P2d 522 (1957). Consequently, we cannot consider Meece’s self-serving assertions. See Biomass One, L.P. v. S-P Construction, 103 Or App 521, 525 n 2, 799 P2d 152 (1990).

Because defendant failed to present any competent evidence to rebut plaintiffs assertions concerning the circumstances surrounding the execution of the contract, we *204must accept those assertions as true. Poirier v. United Grocers, 110 Or App 592, 596, 824 P2d 1158, rev den 313 Or 210 (1992). That evidence shows that the change in the declarations page was unintended and that the phrase “each occurrence” was intended to read “each person” as that phrase is used in the “Limits of Liability” section of the policy.2 The terms of that provision clearly limit plaintiffs liability for injury to any one person to $100,000. Accordingly, the court did not err in granting summary judgment for plaintiff.

Even if we did not accept plaintiffs evidence, I would still conclude that the ambiguity can be resolved by interpreting the policy as a whole. If a contract is ambiguous, but there is no genuine issue of material fact, either because the evidence reveals no such issue or because the parties failed to present any competent evidence regarding their intentions, the construction of the contract remains a question of law. To resolve that question, a court must evaluate the plausible interpretations of the contract in the light of “the particular context in which the [ambiguous] term is used in the policy and the broader context of the policy as a whole.” Hoffman Construction Co. v. Fred S. James & Co., supra, 313 Or at 470. If the court is able to resolve the ambiguity by that process, it must interpret the contract without resort to any further aids to construction. However, if the court is unable to resolve the ambiguity by that method, it may interpret the contract according to what it perceives to be the understanding of the ordinary purchaser of insurance. Joseph v. Utah Home Fire Ins. Co., supra, 313 Or 328; see also Botts v. Hartford Acc. & Indem. Co., 284 Or 95, 585 P2d 657 (1978). That is just a way of saying that, if the ambiguity remains after reviewing an ambiguous term in context, the term will be construed against the insurer. See Hoffman Construction Co. v. Fred S. James & Co., supra, 313 Or at 470.

The “Limits of Liability” provision in the body of the policy refers to.an “each person!aggregate” limits of the declarations page. (Emphasis supplied.) However, the declarations page only contains an “each occurrence/aggregate ’ ’ limits. (Emphasis supplied.) Because the ambiguity exists between the general language of the declarations page and *205the specific language in the “Limits of Liability,” the specific language should be viewed as resolving the ambiguity. It is apparent that the “Limits of Liability” provision was intended to fix the rights of the parties and that the declarations page only specifies the amount of coverage, not entitlement to that coverage. That is the only construction that gives effect to all of the provisions of the policy. Consequently, the majority errs by resorting to the rule requiring that we construe insurance policies against the drafter. By resorting to that rule, the majority has read the specific “Limits of Liability” provision out of the policy, solely to give its supposed “ordinary” meaning to a single word. That is hardly a construction of the policy as a whole.

I dissent.

The record contains a copy of the previous version of the declaration page issued with Meece’s policy, which bears out plaintiffs contention.

That contention is bolstered by the fact that the “Limits of Liability” provision refers to a term in the declarations page that does not appear on that page.