Rourke v. Pennsylvania National Mutual Casualty Insurance
116 A.3d 87
Pa. Super. Ct.2015Background
- In January 2010 Frederick Rickard III (age 19) — a former foster child who had lived with Betty and James Rourke since 2003 — was severely injured as a passenger in an automobile accident.
- The Rourkes held an auto policy with Pennsylvania National Mutual Casualty Insurance Co. (Penn National). Penn National denied first-party and UIM coverage for Frederick, asserting he was not an “insured” under the policy.
- The policy’s definition of “family member” included “a ward or foster child” but did not define the terms “ward” or “foster child.”
- Appellant (Betty Rourke, guardian) sued for declaratory judgment asserting Frederick was a family member (ward/foster child) and alternatively that she had a reasonable expectation that he would be covered due to representations by the insurer’s agent and a retroactive policy change.
- The trial court granted Penn National partial judgment on the pleadings (holding Frederick was not a family member/insured) and later granted summary judgment for Penn National on the reasonable-expectation claim. Appellant appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Frederick was a “ward” (or foster child) under the policy so as to be a family member entitled to coverage | Frederick lived with and was supported by the Rourkes for years; even after formal dependency ended he remained integrated into their family and thus was a de facto ward | A ward requires formal legal recognition / Frederick was an adult at the time and dependency had been terminated | Court reversed: accepting pleadings as true, relationship facts sufficiently pled to establish a de facto ward; term “ward” ambiguous and must be construed for insureds — judgment on pleadings was erroneous |
| Whether a “ward” must be a minor or require a court order | Plaintiff: neither is required; Raymond permits de facto ward status without court order or minority | Defendant: ward status requires court order and/or the person must be a minor; Frederick was 19 and dependency terminated | Court: term not defined in policy and dictionary shows “usually a minor”; Raymond supports nonformal creation of ward relationship; age and court order not dispositive |
| Whether policy ambiguity requires construction against insurer | Plaintiff: lack of definition of “ward”/“foster child” creates ambiguity, so policy construed in insured’s favor | Defendant: policy terms unambiguous and exclude coverage given facts | Held for plaintiff on ambiguity: ambiguous term construed for insured; insurer cannot add post-loss limitations not in policy |
| Whether Rourkes had a reasonable expectation of coverage based on agent representations / retroactive policy change | Plaintiff: agent (via insurer’s file and her testimony) indicated a retroactive addition; Rourkes paid increased premium; these facts create a genuine issue whether they reasonably expected Frederick covered | Defendant: agent did not recall calls and retroactive addition did not confer insured status; no reasonable expectation | Court reversed summary judgment for insurer: factual dispute (agent statements, retroactive change, premium increase) creates a triable issue on reasonable-expectation doctrine |
Key Cases Cited
- Donegal Mutual Insurance Co. v. Raymond, 899 A.2d 357 (Pa. Super. 2006) (endorses recognition of de facto ward/foster-child status without formal court order for insurance coverage purposes)
- Pa. Nat’l Mut. Cas. Ins. Co. v. St. John, 106 A.3d 1 (Pa. 2014) (policy interpretation principles; ambiguous insurance terms construed for insured)
- Tonkovic v. State Farm Mut. Auto Ins. Co., 521 A.2d 920 (Pa. 1987) (explains reasonable-expectation doctrine and importance of agent representations)
- Pressley v. Travelers Prop. Cas. Corp., 817 A.2d 1131 (Pa. Super. 2003) (discusses reliance on agent statements and reasonable expectations in insurance disputes)