Albert v. Erie Insurance Exchange
65 A.3d 923
Pa. Super. Ct.2013Background
- Albert, insured by Erie, was involved in a 2007 motor vehicle accident; a civil action followed in Dauphin County.
- Erie issued an auto policy with a Liability Protection provision that reimburses certain reasonable expenses incurred at Erie’s request, up to a per-day limit for lost earnings.
- In June 2011 Erie hired counsel to defend Albert and urged her to attend a deposition, resulting in $114 in lost wages plus travel expenses.
- Albert did not allege in pleadings that she ever made a reimbursement claim to Erie; she asserted breach of contract, bad faith, and a declaratory judgment regarding notification duties.
- The trial court granted Erie’s preliminary objections, dismissing the second amended complaint in May 2012; Albert appealed.
- The court held that the policy imposes no duty on Erie to reimburse absent a claim by the insured, and the insured has a duty to notify when a loss occurs; Miller v. Keystone informs that there is no implied duty to advise regarding every potential benefit.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Must insured file a claim for reimbursement before payment? | Albert asserts no claim is needed; Erie must reimburse when requested. | Erie requires a claim or demand for reimbursement before liable. | Demurrer proper; no breach without a claim. |
| Does policy require notice of an accident or loss to trigger reimbursement duties? | Albert argues lack of notice obligation relates to reimbursement. | Policy requires notice when there is a loss, not specifically reimbursement. | No duty to notify regarding reimbursement; not controlling for reimbursement. |
| Does Albert state a breach of contract given she alleges all necessary obligations were triggered? | Albert alleged she did what was needed to trigger Erie’s duty to pay. | Complaint lacks facts showing breach by Erie for reimbursement. | Second amended complaint fails to plead breach; dismissal affirmed. |
| Is Miller v. Keystone controlling on duty to disclose reimbursement rights? | Miller supports an affirmative duty to advise about policy benefits. | Miller stands for a narrow duty; insurer need not disclose every potential benefit absent fraud or deception. | Miller rejects an affirmative disclosure duty; not liable. |
| Does failure to reimburse support a bad-faith claim when no duty to inform or pay exists? | Failure to inform/pay shows bad faith denial of benefits. | No basis for bad faith without a claim denial or unreasonable denial. | Bad-faith claim fails; dismissed. |
Key Cases Cited
- Miller v. Keystone, 535 Pa. 531 (Pa. 1994) (no affirmative duty to advise on every potential policy benefit absent fraud)
- Kilmore v. Erie Ins. Co., 407 Pa.Super. 245 (Pa. Super. 1991) (insured must engage with insurer; not required to explain every coverage detail)
- Kincaid v. Erie Ins. Co., 128 Ohio St.3d 322 (Ohio 2010) (insurer not required to reimburse without insured presenting a claim)
- Feingold v. Hendrzak, 15 A.3d 937 (Pa. Super. 2011) (demurrer standard; facts accepted as pled)
- Remas v. Duquesne Light Co., 371 Pa. Super. 183 (Pa. Super. 1988) (pleadings accepted; demurrer cannot add facts)
- Denton v. Silver Stream Nursing and Rehabilitation Ctr., 739 A.2d 571 (Pa. Super. 1999) (demo-principle on material facts in demurrer context)