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The Sixth Circuit Court of Appeals rendered a final judgment in an extremely unique Florida medical injury case that involved driving while under the influence of alcohol on January 26, 2018. The case had lasted five years.

This case is a very important example of what wording and interpretation can mean in insurance claims. The case also shows what the persistence of a personal injury attorney in Florida may mean financially to an insured person who elects to fight an insurance company.

The man at the center of the case was rather severely injured while riding a dirt bike in a field not far from his home in Florida. He had consumed alcohol prior to riding the dirt bike. Tests after his injury showed that his blood alcohol level was close to twice the legal limit for a person to operate an off road bike according to state law. The man did not contest his state of intoxication or being in violation of state laws against driving while intoxicated.

The man filed forms with his life insurance company to pay for the substantial cost of his medical bills. The insurance company denied his claim. The basis of the insurance company’s denial of the claim was wording in the policy that excluded any payment for injuries that arose from the illegal use of alcohol.

The man went through the long process of administrative appeals that the insurer required. All of his efforts were denied by the insurer so he filed suit. It is worth noting that both the district court and the court of appeals decided in favor of the man who was denied payment for his medical claims. The insurance company appealed the verdict. The man received $200,000 after five years of court fights.

A prominent personal injury attorney in Florida has pointed out the failings of the insurance company’s arguments. These points are important for individuals and attorneys who may face similar situations. Reference to this Florida case may prevent a long legal struggle. Precedent can be established in Florida and other jurisdictions due to the appeals court decision.

The concept of illegal use of alcohol is wrongly interpreted by the insurance company in terms of definition. The statement in the policy terms does not specify when the illegal act will occur. The man involved in this case does not deny that he committed an illegal act of driving while intoxicated.

Both courts involved in the case see the insurance company’s terms of illegal use as too vague. The man involved did not use alcohol illegally. Illegal use of alcohol would be drinking if a person is under 21, making alcohol without the proper licenses for personal consumption, or purchasing alcohol for the specific purpose of distribution to a minor. The man did none of these acts.

The case shows that wording can make an extreme difference in how an insurance company considers claims payment. The case also shows that persistence pays off.