What is the test for an exclusionary clause in a personal injury policy?

California, United States of America


The following excerpt is from Hefner v. Farmers Ins. Exchange, 211 Cal.App.3d 1527, 260 Cal.Rptr. 221 (Cal. App. 1989):

"Any reasonable doubt as to uncertain language will be resolved against the insurer whether that doubt relates to the peril insured against or other relevant matters. [Citation.] The policy should be read as a layman would read it and not as it might be analyzed by an attorney or an insurance expert. [Citation.] An exclusionary clause must be conspicuous, plain and clear [citation] and must be construed strictly against the insurer and liberally in favor of the insured [citations]." (Crane v. State Farm Fire & Cas. Co. (1971) 5 Cal.3d 112, 115-116, 95 Cal.Rptr. 513, 485 P.2d 1129.)

A further cardinal rule is: "The provisions of the policy as a whole as well as the exceptions to the liability of the insurer must be construed so as to give the insured the protection which he reasonably had a right to expect." (Abellon v. Hartford Ins. Co. (1985) 167 Cal.App.3d 21, 31, 212 Cal.Rptr. 852.)

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