Insurance Coverage Dispute Over Policy Exclusion Interpretation
Synthèse Legislator
Généré par l'IAA dispute arose regarding a policy's scope concerning coverage for certain expenses and the interpretation of related policy language, leading to litigation over whether the specified costs were excluded or required to be covered. The court reasoned that the relevant policy language, when read in its entirety and in context with standard insurance interpretations, did not unambiguously exclude the costs in question, thus finding in favor of the policyholder because any ambiguity in an insurance contract must be construed against the drafter and in favor of coverage for the insured.
Regeste Legislator
Officiel; AI(ASSURANCE) ; LOI FÉDÉRALE SUR L'ASSURANCE-INVALIDITÉ ; OBLIGATION DE RÉDUIRE LE DOMMAGE ; SOMMATION ; DEMEURE ; TRAITEMENT(EN GÉNÉRAL) ; REFUS DE LA PRESTATION D'ASSURANCE ; TRAITEMENT FORCÉ | LPGA21.4; LAI10.2a
Mots-clés
Généré par l'IADispositions légales citées
Généré par l'IADécisions connexes
Généré par l'IAQuestions juridiques clés extraites par Legislator
Généré par l'IACited in the dispositive for regulating the distribution of court costs.
Texte complet
!"#$%!#&&' (!)*%!#&&'
(
( + +(+ +
,- # "# .- #&&'
!!!!!!!!!!"#$% &
&
'' ( ) "# &$% *+,"-&./0"1/11 12
)/36) + / (
17 !!!!!!!!!! 8)-9 &:" % 1+0," & && #( &;&;%#%#-&%#-&<=&$&7 >1+++"#%-% #$# # -&& -9 # ('' ( )
8)-9 : >& $& # > -;?$&#-&%#&>#-(&$1++67
/7 --&$%##8)-9 @%&<$&A-&@:" %-&$& #AB"#1.#%$<1++6"&"?&&&A%--#" %&% -%% 1++4 & C ;& # (A$% BA7 -#& - &>#$%&#-&<=&$&D?(1++6"$B%A& #E-&F&7&-BG%#>?&#&#&7 G& #&>#&&"2#%$<"#($<B"$%# &&&#(-#&>#9,#%$<1++67
27 --& # !!!!!!!!!!!" # -*? # @%&<$& A-&@"#14$1+++"#B&&H777&&A%- #-1++,"*-A%B?1+6,"&&%"A*-A&?-A*B% 1++6" -$ 1++," ## )-A*B% 1++," && -9 &%*&A9 # (A$% BA 1++4" $<B B #%$< 1++67 &$&"-&&-&#(&A%>#&###&> ? # # < BA7 ?& &; E -&% -;" $%# 9> ($-<&% - & #(;;& # B-C-#"#-&#%-#AB;%?$$&"#;# $>$& %-%&&; # $$< # #" #(> A # &> %B#&" A&>#?# A&7 -; #%DCE%-&%#&>&#?&A-D>#$& -%><#144I7&-;&-&&>&& D%7
.7 --& # 1+ ;%> /441" @%&<$& A-&@ ;$& (&A%" & 9>& # %& $&- # > H777 & $%#$&" & -<9$ # $- $%#$&" % C $# # > %B & C -<< ; -*AB? # $#7 $&& ;& & ;$%" E? (D&& -& -" > # <&" & ;& # <7 & -; -&%#&>&$&&;E%C#$D%"$(--%&# -&%#&>#-&#>-$& $&?&?;% #<" #;E&>>H777
07 ;"#--+#%$</44/"@%&<$&A-&@;& %&&#(&&-&%#&>#-J&/444"(%&&#&%%&&?;% #&&7
31/.03/445 )236)
57 ( #B&% E-& $%# # &" ;% C !!!!!!!!!!!"-%&AB&A-%#?7--$ /442"(E-&&&$$#B&*&#%--&%# &> H777 &# 2 & &A%- #- 1++,7 ? (A$% BA" (E-& && ? &< & -%& #- 1++/ & ? & - -# &>&% D?( 1++5" & ?( ( - - #(&>&% #- 7 A%?$&" ? -#&A # (A$%" &>&% -; C 144 I $$ -& &-" #&" -&G&E%7 &#B&--"(E-&9>$? # $- &&$&" ? -&& #$&7 %&& #%-; & )
D&7;;&#E$%#$&&?;&B<&%"$E#&G&" #A%" & $-&< > &&$& -&7 (E-& #? - ->#%&$-&%&>?&<"(%&& -*A&$%#&&7
,7 & # # ? && E-& ( %&% > #(&& $-%$&##%#(&#;#-&&7 $#D /440" & % ( " - (&$%# # >&" & &$--&$%#%#B%14$/440- !!!!!!!!!!!7
--&" (%&& # &% # & (& BB>%7 (* - # AB$&##B&$%&&#($$#%-%>9#C -&#>&A%-&?7-&&&&9;&B%#-"$-(& - -&$" (E$ ? & -&&%" -& <D&> & <D&>%"$;$%-%&&<B?7 ;" -& &&9$&#%-#&#$-&&$&7
67 #% # 6 J& /440" ( ;% && -&& &" -& && &" $&; ? #B% #(>#&% %&& # 5 I7 (;; & ? (&>&% A<& # -& <=&$& %&& &D EB< #( -&#>&A-%#?"&?(&&&C&%&#%&#($? #$-&&$&7
+7 &C(--&#&"( ;$%#%/6;%>/4457
147 # 2 > /445" & && G& -;&$& -& C E &>&% -;7 && -& # > H7 7 7" & ;;< && - -A*? ? -*AB?7 & &&$&" (B& #( &&$& $%#$&E C >7 & > ?( &> -; # -%# # #%B$& & #(<&&$&" &&; D$ C B7 &-%<$&C?(#%&#%-$-%& &;->#&;&$%#E7>&$&"?(E-&&AB% ##%&$&E#(>#&%7 ;#"?#%&B&% &?(&&#%-#%#%&$%7
31/.03/445 ).36)
117 %-#12D/445"( &D& ;&->#;&>"&#%&B*&%&%- < # --& #" *% - > $%# %B # ( " #&G&;$%7
1/7 ;$%$&E-%<#&" <;E%"- - # // D /445 & -9 > $$?% %- & $ -9 -#& C #-&" #% 10 J& /445 - -# && --& $%#-&<#(%&<#7
127 - # 24 J& /445" < ;$% -&" ?(C #%;& #(%& #%-%##%;E%"%&&B#%CDB7
+ (
17 B>KB&D#8:%&%$#;%&&&%"#9 1J&/442" <&#"$-%#0DB" #&-%#&&>)-%#&"0--%&&15DB8&71&7 &05 :7
&CK&#K%DB"- <;%#% /,D>/44.8 '124145:"# B>#-&%"12;%>" #-&&&B&-$&&& <&# # %B C & DB &&" " # K&&& # K%&#>EDB7
;$%$& C (&7 05 7 1 &7 A7 / " < & # L&&?#&&&-%>CK&705 #;%#%-&B%%##&##5&< /444 ?&&>CK)>#&%#1+D1+0+7
$-%&-DB##(-9	%&<7
/7 & &% >B 1 D> /442" &L& $#;& # $< #-& %B # #$ # 7 -$&%"-&#>?#&(--?#&G&&A%C$9 #--?9B--<&>B$$&M ;&D#?$&#%&$&&-#&8 '124/24#7171N 220#717/N '1/+.#717/N '1/,.5,#71"1/5125 #7.<&%;%:79B#-%#?&C(--?& %>#9D#&%>B8 '11,+2#75<"11/254 #7.N 1++6O2,-7215#72<:7 K--?# #K-97
31/.03/445 )036)
27 "&D&%#;$&#%-%>-"&><8&705C 54 :
.7 E &$ # (&7 6 " & %-&% >#&% (-&% # B && -&?&-%$%-$&#B#%7
(%#&C&(&>#C.4I$"(&7/671 7 &#&C&"-#-&F&C#	?(% -%& -&% # B #< # .4I $" -%&%" $*" -&% # &> # .4I $ -#& % &-&&<8&7/+71 :7
07 ->#B%#(>#&%"(#$&&8DB"(* : < # #$& ? $%#" %>&$& #(& -%&"#>&;7&=A#$%#&C-&DB$& (%&&#&%&C#?#?$&-?&>&%(% &-<#&>7 &"#%$%#&&&%%$& & - #%&$ ? &>E -& " <$&" EB # (%8 '1/0/51#7."11012.#7/"11.21.#72"140 106#71:7
?"-">-<&#(--&$%#"?& #%&$&(&?-&&BE&;&(<D&#(%&#&%" ? --& ;# # E$ $-&" ?( - %B$& #%&-&E-$%--E$%"?(&%&%%&< - # ($9" ? #-& # &E& $%# & (--%&#&&$%#&&;?# (E-& & #J$& $&>%7 #$&" (%%$& #%&$& - > -<& (& (B # $* # -> #%B& $$ --&$$E-&"$<&<&8 '1/020/#7 2"1//154#71&%;%:7
"DB";#&--%&#-> ; - >&B& E? #& -%# #(;;" & > ? & ;& -%&& #B% # >$< -%-#%& & ? #(& $ -<& -& - $#; && --%&" & -; #(#$& #(& -> 8--%& &-% # ->N O " P&B>;A # Q>AB" -7 /1/" R .04N OST3HU " P&B>;A # P&BA&-;B # #" /%#7"-72+"R111&-711,"R2/4NV"#>P&BA&-;B"/ %#7"-7/,.N;7 '1//.5+#7."1////2#72"1/4<//+ #7/<"11+2..#72&%;%:7&$9#-%# >-#&#(G&&#(&7/+7/ &78 /441R14-7/6
31/.03/445 )536) #7 .<:" D-# # ($- # (&7 . &7 %&& &D ><8 '1/.+.#7.<"1//15/#71#&(G&&%:7
57 (-9 D-#" --? # $9 B%% # #$ # ()>#&%--?>##&">&#?%# -&&#()>#&%"&-##--A;&&?( -& <$& &&# # - &&% $E -< %? # >#&%N (& -? % ( - #& C & ?(&$"<AB&#-;"#(<&> E& >#&% >& #& C & 8 -- B%% # #& #"> '1/2/22#72"11,/,6#7/<".44 #7 .< & G& &%:7 %#-&& - )$G$ & -& # (<B& # #$ #$$B & -$ < #& C & ?(C #$#%#-&&8&7/17. :7
,7 (-9"&;;"#(-&"##<BA7 &< -#& ;& (<D& #( E-& $%# ? >G& - > -<&&?&"?(C&&"-&%#&>#&&&9" *$-#$%&&&#&7&(9B#( -?(&&<?;#-&%#&>7
&;;%B$&"&--$&"$&#>H777 $ # ;;& # & ?( &A%" # $E # &G&" ;&B<&%" &$$&7 E-? ? &&$& ?( #& >" C >" & #&&B&7&>?(-&%&#&>#&"# $G$ ? (BB>& # %&& # &%" >% # # --& $%#-#&"#14$/440"->&&&-&#($> $- E $%#$&7 !!!!!!!!!!! * $& E-%$&?W-&&&9$&#%-#&#$- &&$&X"?%&%-$/4407 -%%B$&"(B&# -&%#&><$&EB<#&"?(-&(B#( &> # < $ ?( -& - - $$& > < B#&7
&>#D-#$&%"(%(<B&#$& $E$$#$$B&-%?&-&%#&>7 (&<" -#&"9B%B#(&7/17. "?-#&#( &7147/ &#D-#*&>"?-%>&?&Y
@ -&& ->& G& %#& ;% &$-$& #%;&>$& K% && K--" -&- - -&%$&"#$&#?-&G&EB%#"C&&$&C $ # %& -; <$& EB< & -&< #K$%&<$&-&%#&>#K;;>-<&%
31/.03/445 ),36) #B7$#$%&K>&&#%?D#?& $-&& #% # %;E >< #& > %&% #%7 &&$&&$#%#-&&?-%&&#B-> -&%->&G&EB%7@
"(-9"-9><-&#%#(E$##"( % && #& C & & $&; # (< # $- $%#$&"?(& #J$&&#$&#;$ &&$&(;$&# %?-<7" %#& ;#-&&-$&;-&>?-(>7"( (-E$%?%&&-&%#&>#&"(%&&"? %&%%>&&#%-F&##$#&#%7
%?&"#$"#%%&#>*%C ( ->#%7
( / ( + +(+ +
01232-- 4 .2 2 2 56 "'# 7
32-
17 %><7
32
/7 (#$&&#%#6J&/440&#/6;%>/445#('' ( ) 7
27 >-&&$-%$&##%&7
.7 &?-%#&B&&7
07 ;$ -& # ?K ->& ;$ & -%& G& # #% # 24 D #9 &;& - - $$#% #% < ;%#% # " APQA;? 5" 544. " & E$-7 #% -& G& -B%7 $%$ #&Y : #? E&$&?#%&#%<&&-##% &&?%N <: E- - ? $&; &$ -> #$# && & #%N : -& B& # -%&&7 $%$ && - & %%$& %$%% && : <: & : )#"
31/.03/445 )636) <;%#%#--&$&9?K #>#%><7$%$#$&$* # ->" ? & D&" ? #% &&?% & K>-- # ?%&%E-%#%&8&712/"145&146:7 B;;9 -%#& VZ T <
-;$#-%&G&&&;%E-&?KCK;;;%#% #-B;;
31/.03/445