Plaintiff appealed the Superior Court of Los Angeles County (California) decision granting defendant insurer summary judgment, denying coverage for treatment for temporomandibular joint syndrome under a policy exclusion.
Table of Contents
Overview
Plaintiff was diagnosed with temporomandibular joint syndrome (TMJ) and was referred to a hospital clinic for treatment, where she was treated by an oral surgeon. Defendant insurer denied coverage under the dental care exclusion. Plaintiff sought declaratory relief. The lower court granted the insurer summary judgment based on its finding that it was not an adhesion contract and there was no vagueness. On appeal, the court found that TMJ could have been treated by either a dentist or a doctor. It further found that the contract was an adhesion contract for insurance and a standard insurance contract. employment lawyer Any exclusion from coverage was required to be presented in a conspicuous manner in language which was plain and clear, meaning comprehensible to the lay person. The court then ruled that the TMJ exclusion failed the conspicuous test because of its placement in the fine print. It also failed the plain and clear test because of the undefined technical terminology.
Outcome
The court reversed the decision for summary judgment and remanded the matter as it found the clause ineffective to exclude coverage for the services provided as the clause was neither conspicuous, nor plain and clear to the lay person.
Procedural Posture
Plaintiff, real property purchasers, appealed an order of the Superior Court of San Luis Obispo County (California), that denied their motion for attorney’s fees after they received a judgment against respondent sellers.
Overview
Plaintiff, real property purchasers, brought an action against respondent sellers for falsely representing that the real property they purchased could be subdivided. Plaintiffs’ complaint originally included a breach of contract cause of action, but plaintiffs dismissed that cause of action and proceeded only on a fraud cause of action. After the trial court rendered judgment in favor of plaintiffs, the trial court denied their motion for attorney’s fees. The court reversed the trial court’s order that denied attorney’s fees because pursuant to Cal. Civ. Proc. Code § 1021, the parties to a contract could agree to allow for an award of attorney’s fees, even if a suit was based on tort rather than contract. Because plaintiffs and respondents did enter into such an agreement, plaintiffs could recover attorney’s fees. The court held that attorney’s fees were not recoverable under Cal Civ. Code § 1717 because plaintiffs voluntarily dismissed their contract cause of action before trial and proceeded only on a tort theory. The matter was remanded for the trial court to determine reasonable attorney’s fees at trial and on appeal under § 1021.
Outcome
The trial court’s order that denied attorney’s fees for plaintiff, real property purchasers, was reversed and remanded because plaintiffs, as the prevailing party, were entitled to recover reasonable attorney’s fees and costs pursuant to the terms of the agreement they entered into with respondent sellers.