After Rehearing, Fourth Circuit Resolves Policy Ambuguity in Favor of Insured

NEWS ARTICLE EXCERPT

By: Gregory Froom, South Carolina Lawyers Weekly, March 2, 2009

The term "actual charges" in a South Carolina woman's supplemental cancer insurance policy was ambiguous and must be construed in her favor, the Fourth Circuit ruled Nov. 29.

The unpublished decision followed a rehearing after the panel issued an opinion in October.

The dispute centered on what the undefined term "actual charges" meant. The plaintiff contended she was entitled to recover what the doctors billed, while the insurer said it had to pay her only the discounted rate providers would accept from primary health insurers.

In its earlier ruling, the appeals court said the term was ambiguous and it reversed the trial court's finding that the term meant what the insurance company said it did. The appeals panel then remanded the case, apparently for a jury to resolve the ambiguity.

After the plaintiff's request for a rehearing, the judges reviewed the case and said that South Carolina law required the ambiguous policy language to be construed in favor of the insured.

The result: Summary judgment in favor of the plaintiff on her breach of contract claims.

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Contact South Carolina Lawyers Weekly, http://www.sclawyersweekly.com/, for the full article.