FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND
DISPOSITION THEREOF IF FILED
appeal from the Circuit Court for Okaloosa County. William F.
Charles F. Beall, Jr. of Moore, Hill & Westmoreland,
P.A., Pensacola, and Woodburn S. Wesley, Jr. of Woodburn S.
Wesley, Jr., & Associates, Fort Walton Beach, for
Klein and Brian Lee Ellison of Conroy Simberg, Hollywood, for
Thornton and her mother, Connie Thornton, appeal the final
judgment in favor of American Family Life Assurance Company
of Columbus (AFLAC). The Thorntons assert error in the trial
court's finding that Karma was not a covered dependent
under the Specified Health Event Insurance Policy purchased
by Connie. We reverse the trial court's judgment based on
the plain language of the policy and, alternatively, on the
requirement that any ambiguity in the policy definition of
"dependent children" must be resolved against
AFLAC, the drafter, and in favor of coverage.
Thornton purchased the AFLAC policy for "Two-parent
Family" coverage, effective January 1, 2008. According
to the policy, "Two-parent Family" coverage
provided coverage to the insured (Connie), her spouse, and
Connie's dependent children. The policy defined
"dependent children" in pertinent part:
E. DEPENDENT CHILDREN: your natural children, . . . who are
unmarried, who are under age 25, and who qualify as legal
dependents for tax exemption purposes under the United States
Internal Revenue Service Tax Code.
her mother purchased the policy, Karma Thornton was aged 22,
unmarried, and financially dependent upon and living with her
parents. The covered "primary specified health
events" were also defined in the policy.
September 11, 2008, at age 23, Karma Thornton suffered severe
injuries when she fell from a motorcycle travelling at a high
rate of speed. Based on conflicting evidence presented at
trial, including witness testimony, medical records, and
depositions, the trial court determined that her injuries
constituted covered specified health events - specifically
"coma" and "major third-degree burns" -
as defined in the policy. However, the trial court ruled that
Karma did not qualify as a "dependent child" under
the policy, concluded that she was not covered, and ruled
that no benefits were payable by AFLAC. The Thorntons appeal,
and our standard of review of the trial court's
interpretation of the AFLAC policy is de novo. Allstate
Fire & Cas. Ins. v. Stand-Up MRI of Tallahassee,
P.A., 188 So.3d 1 (Fla. 1st DCA 2015).
explained by the Florida Supreme Court in Fayad v.
Clarendon National Insurance Co., 899 So.2d 1082, 1086
(Fla. 2005), "[w]e begin with the guiding principle that
insurance contracts are construed in accordance with 'the
plain language of the polic[y] as bargained for by the
parties.'" (Citations omitted). The policy here
plainly and expressly requires that the covered dependent be
unmarried and "under age 25." These specific
qualifications are followed by the general reference to
"legal dependents for tax exemption purposes under the
United States Internal Revenue Service Tax Code, "
without a quotation of particular language or citation to a
particular section of federal statutes. At trial, counsel for
the parties agreed that the phrase "qualify as legal
dependents for tax exemption purposes under the United States
Internal Revenue Service Tax Code" was a reference to
Internal Revenue Code (I.R.C.) section 152.
position at trial and on appeal is that the policy's
definition, including the phrase "under age 25, "
is further limited by the policy's general reference to
the "Tax Code, " which cuts off eligibility for
"dependents for tax exemption purposes" at age 19,
unless the person is a student under age 24 or is disabled.
At the time she fell off the motorcycle, Karma Thornton was
not a student, was not disabled, and was over age 19.
However, it is well-settled that "[s]pecific provisions
of a contract control over general conditions" and
"[t]his is equally true with regard to insurance
contracts." State Farm Fla. Ins. Co. v.
Phillips, 134 So.3d 505, 508 (Fla. 5th DCA 2014). In
addition, "courts should read each policy as a whole,
endeavoring to give every provision its full meaning and
operative effect." Auto-Owners Ins. Co. v.
Anderson, 756 So.2d 29, 34 (Fla. 2000). An insurance
contract "will not be interpreted in such a way as to
render a provision meaningless when there is a reasonable
interpretation that does not do so." Universal Prop.
& Cas. Ins. Co. v. Johnson, 114 So.3d 1031, 1036
(Fla. 1st DCA 2013).
the specific policy provision "under age 25" to
expand the class of persons who would otherwise qualify as
legal dependents under the I.R.C. Under the plain language of
the policy, and giving full meaning and operative effect to
both the age limit in the policy and the policy's
reference to the Tax Code addressing "legal dependents
for tax exemption purposes, " the specific age limit
stated in the policy prevails over any contrary, more
restrictive age limit in the generally referenced Tax Code.
The policy's reference to the Tax Code retains the
I.R.C.'s meaning and operative effect for the
relationship, residency, and economic details which do not
conflict with the policy's age provision.
curtail AFLAC's specific age provision in its definition
of "dependent children" by applying a more
restrictive and complex age provision within the I.R.C.,
which is only generally referenced in the policy,
"amounts to a sleight-of-hand withdrawal of coverage
following explicit provisions allowing coverage."
Mathews v. Ranger Ins. Co., 281 So.2d 345, 349 (Fla.
1973). A plain reading of the policy leads the average
purchaser to believe that unmarried, financially dependent
offspring under the age of 25 are covered. We find that AFLAC
is bound by its own specific statement of the policy age
limit, "under age 25, " and that the general
reference to the Tax Code for other factors of dependence
does not replace the policy's specific age requirement.
See Washington Nat'l Ins. Corp. v. Ruderman, 117
So.3d 943, 951 (Fla. 2013) (explaining insurance company has
duty to limit liability under policy "clearly and
unambiguously"). "To hold otherwise would encourage
the proliferation of insurance ...