#Plain Meaning Rule
How to read a policy


How to read and figure out the law or Insurance Policy Provisions – Evidence of Coverage

  • Read the Statute – Policy
  • Read the Statute – Policy
  • Read the Statute – Policy
  • Then when you think you understand it, read it again
  • Scroll down for more…
  • Felix Frankfurther – Wikipedia

    felix franfurter

Plain language makes it easier for the public to read, understand, and use government communications.


Modern insurance policies, as a result of state statutes, are required to be written in plain language or easy to read language sufficient for anyone with a fourth-grade education can understand.  “Sesame Street English.” Merlin Law Group

The Plain Writing Act of 2010 was signed on October 13, 2010. The law requires that federal agencies use clear government communication that the public can understand and use.

While the Act does not cover regulations, three separate Executive Orders emphasize the need for plain language: E.O. 12866E.O. 12988, and E.O. 13563.

More on How to read a contract – Insurance Policy 

The language of the text of the statute or  Evidence of Coverage EOC  should serve as the starting point for any inquiry into its meaning.    To properly understand and interpret a statute, [first] you must read the text closely, keeping in mind that your initial understanding of the text may not be the only plausible interpretation of the statute or even the correct one, per Justice Felix Frankfurter . Guide to Reading & Interpreting  *  American Society of Healthcare Risk Management    and * Wikipedia.

The starting point in statutory construction is the language of the statute – Evidence of Coverage itself. The Supreme Court often recites the “plain meaning rule,”  as in, King vs Burwell Subsidies in Health Care.Gov upheld, that, if the language of the statute is clear, there is no need to look outside the statute to its legislative history in order to ascertain the statute’s meaning.

Parol Evidence Rule Wikipedia – Contract stands by itself – can’t bring up discussions or agreements that were prior to actually signing the written Contract

The plain meaning of the contract will be followed where the words used—whether written or oral—have a clear and unambiguous meaning. Words are given their ordinary meaning; technical terms are given their technical meaning; and local, cultural, or Trade Usage of terms are recognized as applicable. The circumstances surrounding the formation of the contract are also admissible to aid in the interpretation.  West’s Encyclopedia of American Law,

Specimen Individual Policy #EOC with Definitions

Employer Group Sample Policy

It's often so much easier and simpler to just read your Evidence of Coverage EOC-policy, then look all over for the codes, laws, regulations etc!  Plus, EOC's are mandated to be written in PLAIN ENGLISH!

Specimen Policy with Definitions

VIDEO Steve Explains how to read EOC

Videos by Steve Shorr

A cardinal rule of construction is that a statute should be read as a

Harmonious Whole,

with its various parts being interpreted within their broader statutory context in a manner that furthers statutory purposes.  A provision that may seem ambiguous in isolation is often clarified by the remainder of the statutory scheme — because the same terminology is used elsewhere in a context that makes its meaning clear, or because only one of the permissible meanings produces a substantive effect that is compatible with the rest of the law.”

In Edgar v. MITE Corp., 457 U.S. 624 (1982), the Supreme Court ruled: “A state statute is void to the extent that it actually conflicts with a valid Federal statute.” In effect, this means that a State law will be found to violate the supremacy clause when either of the following two conditions (or both) exist:[3]

  1. Compliance with both the Federal and State laws is impossible, or
  2. “…state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress…”

Supreme Court – FINAL Ruling – Plain Meaning – No Jiggery Pokery 47 Pages, view our highlights, annotations & bookmarks


doctrine of privity in contract law

provides that a contract cannot confer rights or impose obligations arising under it on any person or agent except the parties to it.

The premise is that only parties to contracts should be able to sue to enforce their rights or claim damages as such. However, the doctrine has proven problematic due to its implications upon contracts made for the benefit of third parties who are unable to enforce the obligations of the contracting parties. en.wikipedia.org

 In tort law, a duty of care is a legal obligation imposed on an individual requiring that they adhere to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be established to proceed with an action in negligence. The plaintiff must be able to show a duty of care imposed by law which the defendant has breached. In turn, breaching a duty may subject an individual to liability in tort. The duty of care may be imposed by operation of law between individuals with no current direct relationship (familial or contractual or otherwise), but eventually become related in some manner, as defined by common law (meaning case law). wikipedia.org/


the foreseeability of harm to the injured party;
the degree of certainty he or she suffered injury;
the closeness of the connection between the defendant’s conduct and the injury suffered;
the moral blame attached to the defendant’s conduct;
the policy of preventing future harm;
the extent of the burden to the defendant and the consequences to the community of imposing a duty of care with resulting liability for breach;
and the availability, cost, and prevalence of insurance for the risk involved.[6]
  the social utility of the defendant’s conduct from which the injury arose.[7]wikipedia.org/

Health Insurance unfortunately is very complicated

President Trump February 27, 2017

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#Fool & Folly

The purpose of the book of Proverbs is to transmit insights whereby one might learn to cope with life (1.2-6). Its emphasis is on teachings gathered from tradition of the elders (e.g., 4.1-4) and from experience (e.g., 6.6-11).

  1. “Fool” is the word used over and over again in Proverbs for one who lacks sense, who does not judge things according to their proper value.
  2. What good will it do to argue with a fool?
    1. “Do not answer a fool according to his folly, Lest you also be like him.” Prv. 26.4
    2. No matter how many defenses you come up with …, no matter how many times you deny or refute his accusations, he has more. If you multiply words in return, you are answering him like a fool (according to his folly)

Every language has pithy sayings or maxims that express a truth crisply and forcefully. Because proverbs frequently express only one side of a truth, it happens that mutually contradictory proverbs may circulate, each of which is true when applied to the appropriate life-setting. The common saying, “Penny wise, pound foolish,” correctly describes one who is scrupulous about small transactions, but is extravagant in great ones. On the other hand, the proverb, “Take care of the pennies, and the dollars will take care of themselves,” is also true.

More than once the Bible presents two proverbs that, though contradictory, are both true when applied to appropriate circumstances. In Proverbs 26.4 the writer cautions his reader, “Do not answer fools according to their folly, or you will be a fool yourself”; in the very next verse, however, he advises, “Answer fools according to their folly, or they will be wise in their own eyes.”Prv. 26.5  It is left to the reader to know when it is appropriate to heed one or the other of these two antithetical proverbs. missouriwestern.edu

Other sayings about Fools

The more someone says and the louder he says it, the less likely his words are worth listening to (which is why he’s talking so loud). Speech is a gift – not to be wasted or overused. We learned recently: “say little and do much” (1:15 Mishna 15) We are ultimately judged, both by G-d and by man, not by our big talk and brash promises but by our deeds and accomplishments.  Torah.org


  • It is dangerous to be right in matters on which the established authorities are wrong.
  • All the reasoning’s of men are not worth one sentiment of women.
  • He must be very ignorant for he answers every question he is asked.
  • He who thinks himself wise, O heavens! is a great fool.
  • I do not agree with what you have to say, but I’ll defend to the death your right to say it.
  • Judge a man by his questions rather than his answers.
  • Man is free at the moment he wishes to be.
  • Now, now my good man, this is no time for making enemies.
  • The art of medicine consists in amusing the patient while nature cures the disease.
  • The safest course is to do nothing against one’s conscience. With this secret, we can enjoy life and have no fear from death
  • To hold a pen is to be at war.
  • We have a natural right to make use of our pens as of our tongue, at our peril, risk and hazard  keepinspiring.me/voltaire-quotes

Resources & Links

Maxims of Law – Proverbs


Calif. Civil Code §3509 – 3548

The maxims of jurisprudence hereinafter set forth are intended not to qualify any of the foregoing provisions of this Code, but to aid in their just application.

3510.  When the reason of a rule ceases, so should the rule itself.
3511.  Where the reason is the same, the rule should be the same.
3512.  One must not change his purpose to the injury of another.
3513.  Any one may waive the advantage of a law intended solely for his benefit.  But a law established for a public reason cannot be contravened by a private agreement.
3514.  One must so use his own rights as not to infringe upon the rights of another.3515.  He who consents to an act is not wronged by it.
3516.  Acquiescence in error takes away the right of objecting to it.
3517.  No one can take advantage of his own wrong.
3518.  He who has fraudulently dispossessed himself of a thing may be treated as if he still had possession.
3519.  He who can and does not forbid that which is done on his behalf, is deemed to have bidden it.
3520.  No one should suffer by the act of another.
3521.  He who takes the benefit must bear the burden.
3522.  One who grants a thing is presumed to grant also whatever is essential to its use.
3523.  For every wrong there is a remedy.
3524.  Between those who are equally in the right, or equally in the wrong, the law does not interpose.
3525.  Between rights otherwise equal, the earliest is preferred.
3526.  No man is responsible for that which no man can control.
3527.  The law helps the vigilant, before those who sleep on their rights.
3528.  The law respects form less than substance.
3529.  That which ought to have been done is to be regarded as done, in favor of him to whom, and against him from whom, performance is due.
3530.  That which does not appear to exist is to be regarded as if it did not exist.
3531.  The law never requires impossibilities.
3532.  The law neither does nor requires idle acts.
3533.  The law disregards trifles.
3534.  Particular expressions qualify those which are general.
3535.  Contemporaneous exposition is in general the best.
3536.  The greater contains the less.
3537.  Superfluity does not vitiate.
3538.  That is certain which can be made certain.
3539.  Time does not confirm a void act.
3540.  The incident follows the principal, and not the principal the incident.
3541.  An interpretation which gives effect is preferred to one which makes void.
3542.  Interpretation must be reasonable.
3543.  Where one of two innocent persons must suffer by the act of a third, he, by whose negligence it happened, must be the sufferer.
3545.  Private transactions are fair and regular.
3546.  Things happen according to the ordinary course of nature and the ordinary habits of life.
3547.  A thing continues to exist as long as is usual with things of that nature.
3548.  The law has been obeyed.


Links & Websites to explain what the above means…


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