Suppose the contract or booklet is ambiguous or unclear?
UPDATED: January 3, 2011
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The law generally provides that the plain meaning of an insurance policy, plan or evidence of coverage governs its meaning and construction. The policy or plan must be read as a whole in order to determine the reasonable meaning of the terms and the intent of the parties, and be consistent with the intended goal of the insurance or plan. If, a policy or plan term is ambiguous, or there is a conflict between terms in the policy and/or evidence of coverage the law generally provides that the policy or plan language should be construed in favor of the insured or member and against the insurer or plan. Because the insurance company drafted the contract, any ambiguity will be read in whatever way is most favorable to you.