Summary
In Danzig v. Dikman, 53 N.Y.2d 926, 440 N.Y.S.2d 925, 423 N.E.2d 402 (1981), the New York Court of Appeals upheld the Appellate Division's application of a contra proferentem construction to a group health policy purchased by the plaintiff subscriber through his association in the Queens County and Nassau County Bar Associations. See Danzig v. Dikman, 78 A.D.2d 303, 434 N.Y.S.2d 217 (1980).
Summary of this case from Lessard v. Metropolitan Life Ins. Co.Opinion
Argued May 4, 1981
Decided May 14, 1981
Appeal from the Appellate Division of the Supreme Court in the First Judicial Department, ISRAEL RUBIN, J.
Jerrold I. Ehrlich and Ann-Marie Hartline for appellant.
Richard A. Danzig and Douglas J. Danzig for respondents.
MEMORANDUM.
The order of the Appellate Division should be affirmed, with costs, for the reasons stated in the opinion of Justice VINCENT A. LUPIANO in that court ( 78 A.D.2d 303). In view of the recognition of the difference in determining when the liability of the insurer attaches under group medical insurance policies between the time of the occurrence of the event insured against and the time of the incurring of the expenses occasioned thereby — which determinations are generally resolved on the basis of the specific language used in the policies (e.g., Ann., 66 ALR3d 1205, 1208-1218; 68 ALR2d 249, 275-283) — the failure of the insurer to make unmistakably explicit provision in this policy as to which shall control creates an ambiguity which under familiar principles of construction is to be resolved against the insurer.
Chief Judge COOKE and Judges JASEN, GABRIELLI, JONES, WACHTLER, FUCHSBERG and MEYER concur.
Order affirmed, with costs, in a memorandum.