Insurance Contracts, Policy Interpretation, & Ambiguities

Mr Sequeira did not work on January 1, 2010—the day his supplemental policy was issued—because it was a paid holiday. He was hospitalized suddenly on Saturday, January 2 and died on Wednesday, January 6. His cause of death was related to a viral infection in his heart. He did not report to work between January 1 and his death on January 6.

Sacramento Personal Injury AttorneyMrs Sequeira submitted a claim to Lincoln for benefits under both the basic and supplemental policies. Lincoln paid out benefits under the basic policy only and claimed that since Mr Sequeira did not attend work on the start date of the supplemental policy his coverage never became effective.

Mrs Sequeira filed a complaint against Lincoln on August 31, 2010 on the ground that Lincoln was obligated to pay $275,000 under the supplemental policy but refused to do so, and an amended complaint on June 4, 2012. The judgment appealed from is reversed and the matter is remanded to the trial court for further appropriate proceedings consistent with this opinion. Mrs Sequeira shall recover her costs on appeal.

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