Generette v. Donegal Mutual Insurance CompanyGenerette v. Donegal Mutual Insurance Company
Lead Opinion
In this case, we consider the interaction between
On April 29, 1997, Josephine Generette (“Appellant”) suffered injuries while riding as a guest passenger in a motor vehicle that collided with a third-party tortfeasor’s vehicle. Appellant recovered $25,000 under the third-party tortfeasor’s liability insurance policy. As her injuries exceeded the liability coverage provided by the tortfeasor, Appellant also recovered $50,000 from Nationwide Insurance Company, which provided underinsured motorist (“UIM”) coverage for the car in which she was a guest passenger, hereinafter “Nationwide-UIM.” Appellant sought coverage for her remaining claims under her own policy with Donegal for underinsured motorist coverage, hereinafter “Donegal-UIM.”
Donegal denied coverage for the April 1997 accident based on a provision in the policy entitled “Other Insurance.”
Following Donegal’s denial of her claim, Appellant filed a declaratory judgment action in the Court of Common Pleas of York County. As is relevant to the issues before this Court, she asked the trial court to declare the “Other Insurance” clause of the Donegal-UIM policy void as against public policy and that Appellant could recover benefits under the DonegalUIM policy. In response, Donegal requested a declaratory judgment “that (1) the amount of UIM coverage available to [Appellant] under the Policy is $35,000 on a non-stacked basis and (2) [Appellant] is not entitled to receive any additional underinsured motorist benefits because of the non-stacked election in her Policy with Donegal Mutual.” Donegal Answer and New Matter, at 4. In so arguing, Donegal invoked the “Other Insurance” clause, which as previously stated, Donegal read to bar any additional coverage because her $35,000 coverage limit on her Donegal-UIM policy, the second priority policy, did not exceed the $50,000 of coverage provided by the Nationwide-UIM policy, the first priority policy.
As is relevant to the issues before this Court, in July 2002, the trial court denied Appellant’s motion for summary judgment finding that the waiver of stacking was valid and that the language of the Donegal-UIM policy did not violate public policy. In June 2003, the trial court granted Donegal’s motion for summary judgment concluding that Appellant’s waiver of stacking was valid and enforceable and not against public policy.
Appellant appealed the grant of summary judgment to the Superior Court. In her statement of matters complained of on appeal, Appellant asserted, “the trial court’s granting of summary judgment in favor of the Defendant as to Appellant’s waiver of stacking of underinsured motorist benefits was in error.”
A three-judge panel reversed the trial court’s decision in July 2004, finding the stacking waiver did not apply to the facts of Appellant’s case and instead, concluding that recovery under the Donegal-UIM policy was proper pursuant to the MVFRL’s priority of recovery provision,
Judge Joyce filed a dissenting opinion. The dissent framed the case as “another instance of an auto insurance customer who makes a coverage decision that results in monetary savings, and then sues the carrier after being injured and realizing that more or better coverage would have been available absent that cost-saving decision.” Super. Ct. Slip Op. at 1 (Joyce, J., dissenting). The dissent applied the “Other Insurance” clause, limiting recovery of UIM coverage to the amount by which the first priority policy’s coverage is exceeded by the coverage at the second priority level. Thus, according to the dissent, Appellant could not recover under the second priority Donegal-UIM policy because that
Donegal sought reargument en banc, which was granted. Upon reargument, the majority of the en banc panel adopted the former dissenting opinion with only minor revisions in September 2005. We will not restate the argument explained above, but merely note that the majority concluded that the Appellant could not recover under the Donegal-UIM policy because she waived stacking and the “Other Insurance” clause applied to bar recovery.
Judge Ford Elliott, however, authored a dissent joined by Judges Bender and Panella, which serves as the basis of Appellant’s current appeal.
Any of the following:
(1) An individual identified by name as an insured in a policy of motor vehicle liability insurance.
(2) If residing in the household of the named insured:
(i) a spouse or other relative of the named insured; or
(ii) a minor in the custody of either the named insured or relative of the named insured.
The dissent analogized the situation at bar to cases where this Court has forbade
After determining that the stacking waiver did not apply, the dissent considered the applicability of the “Other Insurance” clause in the Donegal policy, which provides “gap insurance” rather than “excess insurance.”
In September 2005, Appellant sought allowance of appeal from this Court asserting the following question:
Did the Majority of the en bane Superior Court err in affirming the trial court opinion holding that a named insured cannot collect any UIM benefits based on a waiver of stacking and an “Other Insurance” clause in her Donegal policy even though her policy only insured one vehicle and her damages exceed the amount of available UIM coverage?
While Appellant’s petition for allowance of appeal was pending, we decided Craley v. State Farm Fire and Casualty Co.,
We granted allowance of appeal in Generette and heard argument in March 2008. Appellant essentially adopts the reasoning presented by Judge Ford-Elliott in dissent below. She claims that we need not consider the validity of the stacking waiver because stacking does not apply in this case. Appellant argues that the stacking waiver language is limited to policies for which the injured person is an “insured” as defined by
Appellant argues that this case is governed by the MVFRL’s provision for priority of recovery,
In contrast, Donegal claims that stacking does apply, and that under Craley, Appellant waived stacking in return for a reduction in her premiums. Rejecting the technical definition of the term “insured” as relied upon by Appellant, Donegal contends that stacking, and the waiver thereof provided in
Donegal rejects Appellant’s claim that the “Other Insurance” clause is invalid based upon Alhvein. Instead, Donegal contends that the decision in Allwein did not contemplate a situation involving the priority of multiple UIM providers, but instead involved the interaction of the tortfeasor liability coverage and the primary UIM coverage, and held that the primary UIM had to be utilized as excess rather than gap coverage. It concluded that the court in Allwein was attempting to prevent the situation where an insured would receive no UIM coverage despite paying premiums for UIM coverage and having injuries that exceeded the coverage provided by the tortfeasor, if the tortfeasor’s liability coverage exceeded the UIM coverage. Donegal contrasts the feared situation in Allwein with this case where Appellant received the benefit of excess insurance when the Appellant received the full amount of the tortfeasor’s liability insurance and the full amount of the Nationwide-UIM policy. Donegal argues that she is not entitled to utilize her own secondary UIM as excess, especially where she has waived stacking.
Instead, Donegal argues that the “Other Insurance” clause moderates the impact of the stacking waiver by allowing the insured to receive at least the full amount of the UIM coverage limits, even if that is received in part through the first priority UIM policy. For example, if an insured recovered $15,000 under the first priority UIM policy as a guest passenger, and had purchased $50,000 of UIM insurance under her own policy, then the insured would recover $35,000 from her own policy ($50,000-$15,000) despite the waiver of stacking, thus guaranteeing that she receive at least $50,000 in UIM coverage. Indeed,
Donegal equates the setoff provision in the “Other Insurance” clause in this case with the setoff provision approved by this Court in Pennsylvania National Mut. Cas. Co. v. Black,
Upon review, we recognize that the questions presented, whether stacking applies in a guest passenger situation under the MVFRL and whether the “Other Insurance” clause is against public policy, are pure questions of law for which our scope of review is plenary and our standard of review is de novo. See Black,
Donegal, however, argues that Appellant should not recover under the Donegal-UIM policy because she waived stacking. As discussed in the arguments above, the application of the stacking waiver in this
We conclude that we are bound to apply the specific definition of “insured” provided by the General Assembly in
While we hold that Appellant’s recovery under the Donegal-UIM policy is not barred by her waiver of stacking, we must still consider whether it is prohibited by the “Other Insurance” clause included in the Donegal-UIM policy. Appellant does not assert that the policy clause is ambiguous. Instead, both parties agree that the clear language of the policy, as discussed above, would bar recovery by Appellant because her $35,000 of coverage under the Donegal-UIM policy does not exceed the $50,000 of coverage she received from the Nationwide-UIM policy, insuring the car in which she was injured. Instead, Appellant claims that the clause violates the public policy of the MVFRL requiring excess rather than gap UIM coverage as determined by the Superior Court in Allwein.
We have detailed the heavy burden required to declare an unambiguous provision of an insurance contract void as against public policy: “Generally, courts must give plain meaning to a clear and unambiguous contract provision unless to do so would be contrary to a clearly expressed public policy.” Colbert,
While we are wary to declare contractual language invalid as against public policy, we are obliged to find contractual
In this case, we must consider whether the “Other Insurance” clause violates the asserted public policy mandating that UIM coverage be excess rather than gap coverage. As suggested in a footnote in Black, we agree with the Superior Court’s decision in Allwein, that the structure of the MVFRL’s definition of an underinsured motorist requires the provision of excess rather than gap underinsured motorist coverage because the definition is framed in terms of the total of the injured’s losses rather than the injured’s own insurance coverage limits. We additionally acknowledge that the General Assembly has not seen fit to alter the language of the MVFRL since the Superior Court’s interpretation over a decade ago in Allwein.
We acknowledge, however, that the decision in Allwein is not directly applicable to the case at bar because Allwein addressed the interaction between a tortfeasor’s liability policy and an UIM policy, rather than the two UIM policies presently at issue. We conclude, however, that this is a distinction without a difference. We fail to understand why the public policy of providing excess rather than gap UIM insurance would cease to apply in a case involving two UIM policies. Although the MVFRL’s definition of underinsured motorist speaks in terms of the inability of the liability insurance to cover the injured’s losses and does not address the failure of first priority UIM insurance to cover the injured’s losses, we cannot ignore that the priority of recovery section,
Similarly, we reject Donegal’s claims that this case is controlled by our recent decision in Black, which we find plainly distinguishable. In Black, the plaintiffs argued that a policy violated the Superior Court’s decision in Allwein that the MVFRL required excess rather than gap insurance. In Black, however, we concluded that the policy provision at issue did not violate the provision of excess UIM insurance
In addition to the definition of underinsured motorist, we also consider the guiding purposes of the MVFRL. We discussed two of the purposes in Black, and noted, “it is beyond cavil that one purpose of the underinsured motorist provisions of the MVFRL is to provide coverage to those injured by a tortfeasor who lacks adequate coverage.” Black,
Therefore, we conclude that the “Other Insurance” clause violates the public policy as expressed in the MVFRL of requiring excess rather than gap UIM coverage. Accordingly, we reverse the decision of the Superior Court affirming the grant of summary judgment to Donegal, and remand to the trial court for further proceedings in accordance with this opinion.
Notes
. See, infra at 5, n. 7.
. See, infra at 7, n. 11.
. Although not at issue before this Court, the details of Appellant’s policy with Donegal evolved with the changing legislative requirements for vehicle insurance. When Appellant purchased her policy with Donegal in December 1982, the policy was governed by the No-Fault Motor Vehicle Insurance Act, and provided $100,000 of bodily injury liability coverage and $30,000 of uninsured motorist ("UM”) coverage. Appellant sought to renew her policy in December 1984, and in order to comply with the newly enacted MVFRL, she increased her UM/UIM coverage to equal her liability coverage of $100,000 per accident. In June 1985, she renewed the policy again with the same policy limits. In December 1985, however, Appellant executed a waiver form reducing her UM coverage from $100,000 to $35,000, in accordance with
. "Other Insurance”:
If there is other applicable similar insurance available under more than one policy or provision of coverage:
The following priorities of recovery apply:
First The [UIM coverage] applicable to the vehicle the "insured” was “occupying” at the time of the accident.
Second The policy affording [UIM coverage] to the "insured” as a named insured of family member.
1. When there is applicable insurance available under the First priority:
a. The limit of liability applicable to the vehicle the "insured” was "occupying,” under the policy in the First priority, shall first be exhausted; and b. The maximum recovery under all policies in the Second priority shall not exceed the amount by which the highest limit for any one vehicle under any one policy in the Second priority exceeds the limit applicable under the policy in the First priority.
Stipulation of Facts, Exhibit R, Underinsured Motorist Coverage— Pennsylvania (Non-stacked), at 3.
. Before the trial court and the Superior Court, the parties disputed whether Appellant's waiver of stacking on a single vehicle policy constituted a violation of public policy. After the filing of the Superior Court's opinion in this case, this Court determined in Craley v. State Farm Fire and Casualty Co.,
. By raising this broad issue regarding the error in applying the waiver of stacking in this case, Appellant did not technically or specifically set forth the issues presently before this Court regarding the inapplicability of the stacking waiver in guesl passenger situations or whether the "Other Insurance” clause violates public policy. However, because the arguments are encompassed in her broad question and were central to the analysis of both Superior Court panels in this case, we believe her current issues are properly before us for review.
.
(a) General rule. — Where multiple policies apply, payment shall be made in the following order of priority:
(1) A policy covering a motor vehicle occupied by the injured person at the time of the accident.
(2) A policy covering a motor vehicle not involved in the accident with respect to which the injured person is an insured.
(b) Multiple sources of equal priority. — The insurer against whom a claim is asserted first under the priorities set forth in subsection (a) shall process and pay the claim as if wholly responsible. The insurer is thereafter entitled to recover contribution pro rata from any other insurer for the benefits paid and the costs of processing the claim.
. Creating a hypothetical case where a policyholder paid premiums for $1,000,000 of UIM coverage and recovered $15,000 from the vehicle in which she was riding, the panel concluded that it would be absurd to deny the injured access to the $1,000,000 of coverage for which premiums were paid because they had waived stacking. This conclusion is arguably erroneous because the policy language would provide for the victim to receive the difference between the higher second priority policy and the lower first priority policy, thereby allowing recovery of $985,000 ($1,000,000-$15,000).
. The dissent also presented a strong argument in favor of the applicability of a stacking waiver in a single policy scenario. We will not address the logic of the argument, which we addressed in Craley,
. Concurring with Judge Ford-Elliott's dissent, Judge Gantman issued a dissenting statement, based on a contractual analysis and conclusion that payment of the full UIM coverage limits would provide Appellant the benefit for which she bargained.
.
(a) Limit for each vehicle. — When more than one vehicle is insured under one or more policies pi'oviding uninsured or uxiderinsured motorist coverage, the stated limit for uninsured or underinsured coverage shall apply separately to each vehicle so insured. The limits of coverages available under this subchapter for an insured shall be the sum of the limits for each motor vehicle as to which the injured person is an insured.
(b) Waiver. — Notwithstanding the provisions of subsection (a), a named insured may waive coverage providing stacking of uninsured or underinsured coverages in which case the limits of coverage available under the policy for an insured shall be the stated limils for the motor vehicle as to which the injured person is an insured.
. Former Chief Justice Cappy eloquently explained the difference between excess and gap insurance in his dissent in Pennsylvania National Mutual Casualty Co. v. Black:
The first category is referred to as "excess” UIM coverage, and aims to maximize the potential for full compensation to the injured insured. Thus, excess UIM gives to the injured insured a fund that supplements the fund provided by the tortfeasor’s liability coverage, up to the injured insured's UIM policy limits or until he is compensated for his losses. The second category is referred to as "gap” UIM coverage. It aims to place the injured insured in the same position he would have occupied had the tortfeasor carried liability coverage in an amount that matches the injured insured's UIM coverage. Thus, gap UIM coverage gives to the injured insured a fund that fills in any gap between the tortfeasor's liability coverage and the injured insured's UIM policy limit.
Pennsylvania Nat. Mut. Cas. Co. v. Black,
Suppose that an injured insured is legally entitled to damages of $100,000; that the tortfeasor’s liability insurance is $20,000; and that the injured insured’s UIM coverage limit is $50,000. Under excess UIM coverage, the injured insured's total recovery is $70,000, with UIM coverage of $50,000 being paid in addition to the amount the insured receives under liability coverage, $20,000. Under gap UIM coverage, the injured insured's total recovery is $50,000, with the first $20,000 coming from the tortfeasor's liability coverage and the remaining $30,000, coming from the injured insured’s UIM coverage, to fill in ihe gap between the tortfeasor’s liability coverage and the injured insured's UIM coverage.
Id. at n. 1.
. The cited passage provides,
In her opinion, the Commissioner concluded that the stacking premium was lawful because she found that single-vehicle policy holders could obtain a real benefit from the provision of stacking in at least two situations: (1) where the insured is injured in his own vehicle insured with uninsured motorist coverage and is also covered as an insured under another policy providing uninsured motorist benefits, and (2) where the individual is injured in a vehicle other than his own insured vehicle and is an insured under the non-owned vehicle's policy, which also has uninsured motorist coverage (such as an employer’s vehicle).
Craley v. State Farm Fire and Cas. Co.,
. We acknowledge, however, that
. With all due respect to the responsive opinion of Justice Saylor, we do not declare that
Concurrence Opinion
concurring and dissenting.
I join the majority’s holding and general reasoning concerning the limited application of inter-policy stacking under
I differ, however, with the majority’s decision to invalidate the “other-insurance” clause contained in Donegal’s policy. The majority offers four reasons in support of its decision. First, the majority invokes the rationale of the Superior Court’s decision in Allwein v. Donegal Mutual Insurance Company,
Second, the majority attempts to address the above weakness by asserting that the priority of recovery provisions of
Third, the majority references a “substantial deductable” arising from the presence of higher priority coverage, reasoning that this mitigates the application of the “cost-containment” rationale underlying the MVFRL. See Majority Opinion, op. at 524-25,
Finally, the majority reasons that an insured must be provided with coverage for which she paid to avoid a “windfall benefit” to the insurer. See Majority Opinion, op. at 525,
From a broader perspective, the majority opinion appears to accept the idea that, in
I have previously expressed the view that the MVFRL was experimental legislation, designed to further cost control in the
Notably, neither the extension of UM/UIM coverage to guest passengers (here, under the Nationwide policy) or the portability aspect of UM/UIM insurance permitting it to follow the person outside of insured vehicles (which, here, implicated the coverage by Donegal) is expressly delineated within the MVFRL. With regard to the former, just as
Uninsured coverage protects me and relatives living in my household for losses and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages.
* * :|;
Underinsured coverage protects me and relatives living in my household for losses and damages suffered if injury is caused by the negligence of a driver who does not have enough insurance to pay for all losses and damages.
In summary, other than in terms of priority of recovery where contractual terms apply, I do not believe that the Legislature has addressed the other-insurance scenario in the UM/UIM context. Further, it appears that this substantial void in the statutory scheme is being reasonably addressed in the administration of the regulatory scheme, in furtherance of both the cost-containment and remedial purposes of the MVFRL. Accord Hall v. Amica Mut. Ins. Co.,
. I recognize that there is an appeal pending before this Court questioning whether
. This is so, since the household vehicle exclusion generally forecloses coverage in circumstances in which the claimant is an "insured” under the relevant policy but is injured in another household vehicle (i.e., one as to which the claimant is also an "insured”) that is not covered under that policy. See generally Prudential Property and Cas. Ins. Co. v. Colbert,
. In response to the above, the majority clarifies that it is pointing only to
. The Insurance Department, however, as the regulatory body charged with the administration of the MVFRL, has been afforded tools to support such judgments. See
. Under the majority's rationale,
. This regulation was promulgated pursuant to the Uninsured Motorist Act, Act of August 14, 1963, P.L. 909, § 1 (codified as amended at
. Since the central concept of UM and UIM insurance centers on "insureds" (i.e. the named insured and defined household members), it is not surprising that the associated concept of UM/UIM stacking is also framed upon the same concept.
. I realize that this Court invalidated an other-insurance exclusion contained in the uninsured motorist provisions of an automobile policy in Harleysville Mutual Casualty Company v. Blumling,
As such, I do not believe that BLumling must be regarded as controlling precedent relevant to the present statutory scheme.
Dissenting Opinion
dissenting.
I respectfully dissent from the majority’s reversal of the Superior Court’s order. I believe Plaintiff maintained a right to stack coverage from the Donegal and Nationwide policies,
In Craley, this Court noted “single-vehicle policy holders ... obtain a real benefit from ... stacking ... where the individual is injured in vehicle other than his own insured vehicle and is an insured under the non-owned vehicle’s policy, which also has [UIM] coverage----” Id., at 537. Here, Plaintiff received a benefit from the non-owned vehicle policy— Nationwide indemnified her $50,000 in UIM benefits — she was an insured under this policy as well, but she remained an insured who waived her inter-policy stacking rights; Plaintiff’s coverage limits are thus the stated limits in the Nationwide-policy. See
I would not hold the “other insurance clause” void as against public policy; it does not contradict the MVFRL, which requires excess coverage. In Pennsylvania National Mutual Casualty Company v. Black,
It is not clear whether the MVFRL mandates the. offer of [UIM] coverage for guest passengers.... While the MVFRL does not define the class of persons for which [UIM] coverage must be offered, it does inform those desiring to waive ... coverage that “[UIM] coverage protects me and relatives living in my household for losses and damages suffered if injury is caused by the negligence of a driver who does not have enough insurance to pay for all losses and damages”75 Pa.C.S. § 1731 (emphasis added). This statement makes no reference to guest passengers. Absent any statement by the legislature requiring a minimum of [UIM] coverage to guest passengers ... we are unwilling to declare the unambiguous set-off provision in this policy void as against public policy.
Id., at 581 n. 8. The majority resolves this matter by characterizing Plaintiff as a “guest passenger.” Majority Op., at 521,
Further, a central policy behind “other insurance clauses” following the MVFRL’s enactment was to keep insurance premiums low while providing sufficient coverage to the insured. See id., at 18. We have often emphasized the propriety of the cost-containment policy underlying the enactment of the MVFRL: “ ‘The repeal of the No-Fault Act and the enactment of the MVFRL reflected a legislative concern for the spiraling consumer cost of automobile insurance and the resultant increase in the number of uninsured motorists driving on public highways.’ ” Black, at 580 (quoting Paylor v. Hartford Insurance Co.,
Here, the “other insurance clause” guaranteed Plaintiff would receive sufficient
Accordingly, I would affirm the Superior Court’s order.
. See