Third Appellate District Court rules in favor of insurance company in bodily injury case

By Charmaine Little | Nov 6, 2018

Justice Elena Duarte   California Courts

AMADOR – On Sept. 25, the Court of Appeal for the 3rd Appellate District affirmed a lower court’s judgment in favor of an insurance company after a couple impacted by an accident were denied additional damages.

Justice Elena Duarte authored the opinion. Justices Harry E. Hull Jr. and William J. Murray Jr. concurred. 

“When a wife sues for loss of consortium after her husband is seriously injured in an automobile accident that is the defendant’s fault, is her claim subject to the same per person limit of the defendant’s insurance policy as her husband’s claim for bodily injury?” the appeals court asked. This was the foundation of the appeal. 

The language of the policy in question reads, “The bodily injury liability limits for each person is the maximum we will pay as damages for bodily injury, including damages for care and loss of service, to one person per occurrence,” according to the opinion.

"As we explain, the language makes clear that the damages for bodily injury include loss of consortium," the court ruled. "Further, the policy language provides that so long as only one person suffered bodily injury, the per person limit applies."

It added that as long as only one person suffered bodily injury, the per person limit is still valid. While the plaintiffs Mark Alan Jones and Melanie Jones said in their appeal that the “to one person” changes “the maximum we will pay” and not “bodily injury” in the policy, the court didn’t agree and backed the lower court’s ruling in favor of defendant IDS Property Casualty Insurance Co.

The court pointed out the language was the main question of the appeal and reiterated that IDS includes the loss of consortium in the $250,000 limit as it makes plain that the policy states damages “for care and loss of services” are a part of the damages award for bodily injury.

The Appeals Court also shut down the plaintiffs' allegations that the policy was ambiguous.

“If a claim for loss of consortium always triggered the per occurrence limit, there would be no need to define damages for bodily injury to include loss of consortium,” the appeals court determined.

The Amador County Superior Court initially ruled against Janet and Richard Buhler, who were involved in the accident that injured Mark Jones. He was awarded $1.35 million while his wife, Melanie Jones, was awarded $150,000 for loss of consortium. The ruling states the Buhlers were insured by IDS.

The Joneses filed a suit against IDS and the Buhlers seeking declaratory relief after IDS paid the plaintiffs $250,000, which is the per person limit. In their lawsuit, the plaintiffs wanted a declaration that IDS had to pay the full per person limits of $250,000 to both of them. IDS moved for summary judgment, which the lower court denied.

The plaintiffs filed an amended complaint and included allegations of fraud and negligent misrepresentation in their claim, alleging IDS committed false representation when it said the applicable policy limit was $250,000. IDS had a motion for nonsuit or judgment for the false representation claims, stating the previous declaratory ruling already determined the claims weren’t false. The lower court concurred and granted the motion, leading to the appeal.

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