• Determining 'Residency' Depends On More than the Facts
  • December 23, 2009
  • Law Firm: Marshall, Dennehey, Warner, Coleman & Goggin - Jacksonville Office
  • Florida’s Motor Vehicle No-Fault law does two important things. First, it establishes a limited exemption from liability for injuries caused to others in an automobile accident. Secondly, it establishes personal injury protection ("PIP") benefits to pay for certain losses resulting from an accident. Under the law, the insured, children and relatives who live with the insured, permissive drivers, and passengers are covered by PIP. Many times in personal injury cases a question arises as to what constitutes a “relative” under the policy language.

    Florida Statute 627.732(6) provides this definition: " 'Relative residing in the same household' means a relative of any degree by blood or by marriage who usually makes her or his home in the same family unit, whether or not temporarily living elsewhere.” A number of Florida cases have addressed whether an individual qualifies as a “[r]elative residing in the same household.” In construing the terms “household” or “residency” under an insurance policy, several courts have observed there are three material aspects in determining a resident, including: (1) close ties of kinship, (2) fixed dwelling unit, and (3) enjoyment of all the living facilities. Dwelle v. State Farm Mut. Auto. Ins. Co., 839 So. 2d 897, 899 (Fla. 1st DCA 2003).

    The 2nd DCA in a September 9, 2009, opinion weighed in on the issue. The opinion stemmed from a trial court’s summary judgment and final declaratory judgment entered in favor of the plaintiff Steven Fischer. Mr. Fischer was a passenger in a car driven by his friend when they were involved in an automobile accident, resulting in injuries. Mr. Fischer’s parents owned the car and insured it in their name. The insurance policy included $10,000 in PIP coverage and $50,000 in medical expense coverage ("med pay"). As a result of Mr. Fischer’s injuries, the insurer paid $10,000 in PIP coverage, but it denied a demand for payment of medical expenses in excess of $10,000.

    Mr. Fischer filed a declaratory judgment against the insurer, seeking a determination that he was entitled to the medical expense coverage under his parents’ policy. The insurer denied that Mr. Fischer was entitled to the medical expense coverage on the basis that he "was not a resident relative of the named insured at the time of the accident.” The insurance policy provided that it would pay medical expenses for bodily injury sustained by the first person named in the declarations, his or her spouse, and their relatives. Concerning medical expense coverage, the policy defined “relative” as “a relative of any degree by blood or by marriage who usually makes his home in the same family unit, whether or not temporarily living elsewhere.”

    Mr. Fischer filed a motion for summary judgment and argued that the applicable definition of “relative” in the policy was ambiguous and must be construed to extend coverage to him. In support of his motion, he filed his deposition and the depositions of his parents. The deposition testimony established that Mr. Fischer had a learning disability and worked sporadically in the construction industry. He lived in a mobile home four miles from his parents’ home. The mortgage and utility bills were in his name. However, he received some mail at his parents’ home address. Additionally, his parents testified that they paid approximately 95 percent of his bills.

    The trial court granted summary judgment and entered a final judgment in Mr. Fischer’s favor on the basis that the applicable definition of “relative” in the insurance policy was ambiguous and that “the undisputed facts of the case required an interpretation in favor of coverage under the medical payment provisions.”

    On appeal, the insurer argued that there was no ambiguity in the definition of the term “relative” and that the pertinent policy language is readily understood. However, the insurer conceded that a factual dispute existed as to whether Mr. Fischer was a relative within the meaning of the policy. Mr. Fischer argued that the insurer’s definition of “relative” was ambiguous because of the term “family unit” or the phrases “usually made his home in the same family unit” or “whether or not temporarily living elsewhere.” Alternatively, he argued that even if the policy was not ambiguous, the judgment should be affirmed based on the deposition testimony presented in support of his motion for summary judgment.

    The Court of Appeals held that the definition of “relative” contained in the policy was not ambiguous. The parties did not dispute that Mr. Fischer was related to his parents “by blood or by marriage.” However, they disagreed as to whether Mr. Fischer “usually makes his home in the same family unit, whether or not temporarily living elsewhere.”

    A number of cases have held that the concept of household does not require an individual to live at the same physical address as the insured relative. Patterson v. Cincinnati Ins. Co., 564 So. 2d 1149, 1151 (Fla. 1st DCA 1990) (noting that “it is not essential that the insured and the person claiming under the insured’s policy actually live within the same structure”); Sutherland v. Glens Falls Ins. Co., 493 So. 2d 87(Fla. 4th DCA 1986) (recognizing that “one can remain a resident of one’s former household while trying out different living accommodations”).

    After considering the case law, the 2nd DCA concluded that “[a] determination of residency for a relative involves consideration of both fact and intention." Mr. Fischer had close ties of kinship with his parents and was financially supported by them to a significant degree. However, he was not physically living with them at the time of the accident and was not living in his mobile home on merely a temporary basis. Instead, he maintained his residence separate from his parents and had been living at that residence for years, and he did not establish that he had full enjoyment of his parents’ home or that he ever intended to live there again. The court held that because there was evidence of residence in both directions, factual issues remained. As a result, the summary judgment and final declaratory judgment were reversed, and the case was remanded.

    Determining whether a non-resident relative should be covered under a policy is not always clear cut. This opinion reiterates the need to consider the facts and the intention of the insured or relative before deciding whether or not to extend coverage under a policy.