Marotz v. HallmanMarotz v. Hallman
Lead Opinion
¶ 1. This is a review of an unpublished court of appeals decision,
¶ 2. Two issues are before this court.
I
¶ 3. On December 21, 2002, Marotz rode as a passenger in the vehicle of Arthur E. Hallman, Jr. (Hallman) as Hallman drove southbound on County-Highway J in Shawano County. Hallman entered the intersection of County Highway J and State Highway 29 without stopping at the posted stop sign. Donald J. Hilgemann (Hilgemann), who was driving eastbound on State Highway 29, struck Hallman's vehicle. As a result of the collision, Marotz sustained injuries. The injuries resulted in more than $250,000 in medical bills.
¶ 4. Hallman's vehicle was insured by a liability insurance policy, which ACUITY, a mutual insurance company (ACUITY), issued with a limit of $25,000 per person. Hilgemann's vehicle was also insured by a liability insurance policy, which IMT Insurance Company (Mutual) (IMT) issued with a limit of $250,000.
¶ 5. Marotz's parents, Joann K. and Orland O. Marotz, had a policy issued by Rural in effect at the time of the accident. Their policy provided UIM coverage for any "family member," such as Marotz.
¶ 6. The personal auto policy declarations provided the limits of liability for the various coverages included in the policy, as well as the premium for each. Before listing the limit of liability for the uninsured motorist (UM) coverage and UIM coverage, the following statement appeared: "THE LIMITS OF LIABILITY FOR THE FOLLOWING COVERAGES ARE PER POLICY LIMITS AND SHALL BE REDUCED AS A RESULT OF YOUR RECEIVING AMOUNTS FROM OTHER SOURCES BECAUSE OF YOUR 'BODILY INJURY.'"
¶ 7. The policy included an endorsement pertaining to UIM coverage in Wisconsin. The endorsement began by noting that "[w]ith respect to the coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement." Under an "INSURING AGREEMENT" heading, the endorsement stated the following:
We will pay compensatory damages which an "insured" is legally entitled to recover from the owner or operator of an "underinsured motor vehicle" because of "bodily injury":
1. Sustained by an "insured"; and
2. Caused by the accident.
The owner's or operator's liability for these damages must arise out of the ownership, maintenance or use of the "underinsured motor vehicle."
We will pay under this coverage only if 1. or 2. below applies:
1. The limits of liability under any bodily injury liability bonds or policies applicable to the "un-derinsured motor vehicle" have been exhausted by payment of judgments or settlements; or
2. A tentative settlement has been made between an "insured" and the insurer of the "underin-sured motor vehicle" which would exhaust the limits of liability under any applicablebodily injury liability bonds or policies and we:
a. Have been given prompt written notice of such tentative settlement; and
b. Advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after the receipt of notification.
The endorsement also stated that" 'Underinsured motor vehicle' means a land motor vehicle or trailer of any type to which a bodily injury liability bond or policy applies at the time of the accident but its limit for bodily injury liability is less than the limit of liability for this coverage." Because Hallman's vehicle had a liability coverage limit less than $100,000 (i.e., the limit of UIM liability in Marotz's policy), it constituted an "underin-sured motor vehicle."
¶ 8. Under a "LIMIT OF LIABILITY" heading, the endorsement included a reducing clause. It stated the following:
The limit of liability shall be reduced by all of sums:
1. Paid because of the "bodily injury" by or on behalf of persons or organizations who may be legally responsible. This includes all sums paid under Part A; and
2. Paid or payable because of the "bodily injury" under any of the following or similar law:
a. Workers' compensation law; or
b. Disability benefits law.
Under the same "LIMIT OF LIABILITY" heading, the following appeared: "We will not make a duplicate payment under this coverage for any element of loss for which payment has been made by or on behalf of persons or organizations who may be legally responsible."
¶ 9. Marotz filed a UIM claim with Rural. Rural denied the claim. It asserted that the policy's reducing clause applied to the payments made by ACUITY (i.e., $25,000 on behalf of Hallman) and IMT (i.e., $90,000 on behalf of Hilgemann), and therefore the payments Marotz received exceeded the $100,000 limit of UIM liability. Conversely, Marotz argued only ACUITY'S payment on behalf of Hallman was subject to the reducing clause, meaning Rural needed to pay Marotz at least $75,000 in UIM benefits.
¶ 10. Marotz commenced litigation and moved for declaratory judgment with regard to the insurance policy issued by Rural. He requested that the circuit court declare that (1) Rural was not entitled to reduce the limit of the UIM liability by the $90,000 that IMT paid on behalf of Hilgemann and (2) the policy's reducing clause was ambiguous when considered in the context of the entire policy and could not be enforced with regard to payments made by ACUITY and IMT.
¶ 11. The circuit court ruled that the reducing clause complied with
¶ 12. Marotz appealed to the court of appeals, which affirmed the circuit court. The court of appeals concluded that Marotz's policy had an unambiguous reducing clause that permitted Rural to reduce the amount it paid to Marotz by the amount Marotz received from both Hallman's insurer and Hilgemann's insurer. It also concluded that no contextual ambiguity existed when viewing the reducing clause in the context of the entire policy. Finally, it concluded that prior cases interpreting
¶ 13. Marotz filed a petition for review with this court, which was granted.
II
¶ 14. This review presents two issues. First, does
A. Wisconsin Stat.
¶ 15. We first address whether
¶ 16. As a preliminary matter, Rural contends that Marotz waived this issue. Before the circuit court and the court of appeals, Marotz did not argue that
¶ 17. The issue of the proper interpretation of
¶ 18. Whether
¶ 19. When a statute is ambiguous, courts look to extrinsic sources to ascertain the legislature's intent, such as legislative history. Kalal,
¶ 20. The language of
¶ 21. Because every possible scenario cannot be anticipated by the words selected by the legislature, an unambiguous statute in one context may be ambiguous in another. Teschendorf,
¶ 22. We agree with Rural: the context of this case does not render
(5) Permissible Provisions....
(i) A policymay provide that the limits under the policy for uninsured or underinsured motorist coverage for bodily injury or death resulting from any one accident shall be reduced by any of the following that apply:
1. Amounts paid by or on behalf of any person or organization that may be legally responsible for the bodily injury or death for which the payment is made.
2. Amounts paid or payable under any worker's compensation law.
3. Amounts paid or payable under any disability benefits laws.
Our examination of the language of the statute, and the context in which it appears, leads us to conclude that
¶ 23. The structure of
¶ 24. Wisconsin Stat.
¶ 25. The words "[a]mounts paid by or on behalf of any person or organization" restrict payments that will reduce the limit of UIM liability to those made by a tortfeasor, or by any other person or organization on the tortfeasor's behalf. The legislature's decision to modify "person or organization" with the word "any" indicates broad application when it comes to the persons and organizations that fall within the scope of the provision. It does not suggest that a "person or organization" need be a UIM tortfeasor for their payment to reduce the insured's UIM coverage. In this case, ACUITY paid $25,000 on behalf of Hallman and IMT paid $90,000 on behalf of Hilgemann for Marotz's bodily injuries that he suffered in the accident at issue in this case.
¶ 26. The scope of
¶ 27. The scope of
¶ 28. This case does not present an example of an unambiguous statute being ambiguous in a different context. Based on our review of the language of
¶ 29. Our interpretation of
¶ 31. We discussed the various theories of UIM coverage to highlight that there are different types of reducing clauses that the legislature deemed permissible in enacting § 632.32(5)(i)l. We did not discuss the theories to articulate the legislative purpose of § 632.32(5)(i)l. in every context that may arise. By taking our previous discussions out of context and failing to appreciate we were quoting a treatise, one may conclude that this court has already decided that the limit of UIM liability may be reduced only by payments from an UIM tortfeasor. That would be a mistake. This is the first case we have addressed whether § 632.32(5)(i)l. allows an insurer to reduce the limit of UIM liability by payments made to the insured by a non-UIM tortfeasor.
¶ 32. Based on the plain language of the statute and the context in which it appears, we hold that § 632.32(5)(i)l. does allow an insurer to reduce the limit of UIM liability by the amount paid by a non-UIM tortfeasor.
B. Policy Language
¶ 33. We now turn to whether the reducing clause in the policy issued by Rural unambiguously complies with § 632.32(5) (i)l. The interpretation of an insurance policy presents a question of law that we review de novo. Folkman v. Quamme,
1. The reducing clause in the policy issued by Rural
¶ 34. General principles of contract construction control the interpretation of an insurance contract. Taylor,
¶ 35. The reducing clause in this case states that the limit of liability will be reduced by amounts "[p]aid because of the 'bodily injury' by or on behalf of persons or organizations who may be legally responsible." The common, ordinary language establishes that the meaning of this language mimics the meaning of § 632.32(5)(i)l. See Ruenger v. Soodsma,
¶ 36. The phrasing of the reducing clause differs slightly from the language used in § 632.32(5)(i)l., but the difference does not affect the meaning. While § 632.32(5)(i)l. uses the phrase "for the bodily injury or death for which the payment is made," the first subsection uses "because of the 'bodily injury.'" Both phrases limit the scope of the provision to payments made for the injuries arising from the accident. Accordingly, like the statutory language, the scope of the reducing clause is set by whether a payor may be legally responsible, not the payor's UIM status.
¶ 37. The reducing clause unambiguously complies with § 632.32(5)(i). Based on the common, ordinary language, a reasonable person in the insured's position would understand the clause to have the effect of reducing the UIM liability limit by payments made by or on behalf of those legally responsible for the accident at issue, regardless of their UIM status.
2. The reducing clause in the context of the entire policy
¶ 38. Our inquiry does not end because of our conclusion that the language of the reducing clause is unambiguous. Schmitz,
¶ 39. Contextual ambiguity exists when a provision is reasonably susceptible to more than one construction when read in the context of the policy's other language. Folkman,
¶ 40. Other provisions of
¶ 41. Although the policy does not include an index or identify endorsements by their title, on the bottom of the first page of declarations, the forms and attachments are listed by their numbers. For instance, the UIM coverage endorsement is listed as "PP0427(10-01)." On the top right corner of the UIM coverage endorsement the following appears: "PP 04 27 10 01." The spacing is different, and there is a lack of parenthesis or a hyphen for (10-01), but a reasonable person in the insured's position would conclude that "PP0427(10-01)" and "PP 04 27 10 01" refer to the same document.
¶ 42. The endorsement pertaining to UIM coverage in Wisconsin begins by noting that "[w]ith respect to the coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement." Under the "INSURING AGREEMENT" heading, it states the following:
We will pay compensatory damages which an "insured" is legally entitled to recover from the owner or operator of an "underinsured motor vehicle" because of "bodily injury":
1. Sustained by an "insured"; and
2. Caused by the accident.
The owner's or operator's liability for these damages must arise out of the ownership, maintenance or use of the "underinsured motor vehicle."
We will pay under his coverage only if 1. or 2. below applies:
1. The limits of liability under any bodily injury liability bonds or policies applicable to the "under-insured motor vehicle" have been exhausted by payment of judgments or settlements; or
2. A tentative settlement has been made between an "insured" and the insurer of the "underinsured motor vehicle" which would exhaust the limits of liability under any applicable bodily injury liability bonds or policies and we:
a. Have been given prompt written notice of such tentative settlement; and
b. Advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after the receipt of notification.
The endorsement also states that" 'Underinsured motor vehicle
¶ 44. After the reducing clause, the policy states the following: "We will not make a duplicate payment under this coverage for any element of loss for which payment has been made by or on behalf of persons or organizations who may be legally responsible." Like the reducing clause, this provision addresses limits on the payments the insured will receive. A reasonable person in the position of the insured would appreciate that the provisions under the "INSURING AGREEMENT" address the broad terms of the coverage and then the subsequent provisions define the specifics of the coverage.
¶ 45. Considering context, Rural's policy "clearly sets forth that the insured is purchasing a fixed level of UIM recovery that will be arrived at by combining payments made from all sources." Dowhower,
III
¶ 46. Based on the plain language of § 632.32(5)(i) 1., UIM insurers may reduce the limit of UIM liability by amounts an insured receives from or on behalf of tortfeasors, regardless of the payors' UIM status. The reducing clause included in the policy issued by Rural unambiguously sets forth the coverage that Marotz's parents purchased, making it enforceable. Because the payments Marotz received from ACUITY and IMT exceed the limit of UIM liability in the Rural policy, Rural need not pay any benefit to Marotz.
By the Court. — The decision of the court of appeals is affirmed.
Notes
The issues presented and our respective holdings are the same in this case and Bailey v. State Farm Mutual Automobile Insurance Company,
Wisconsin Stat. § 632.32(5)(i) (2005-06) states:
A policy may provide that the limits under the policy for uninsured or underinsured motorist coverage for bodily injury or death resulting from any one accident shall be reduced by any of the following that apply:
1. Amounts paid by or on behalf of any person or organization that may be legally responsible for the bodily injury or death for which the payment is made.
2. Amounts paid or payable under any worker's compensation law.
3. Amounts paid or payable under any disability benefits laws.
All subsequent references to the Wisconsin Statutes are to the 2005-06 version, unless otherwise stated.
In the definitions section of the personal auto policy, the following appears:" 'Family member' means a person related to you by blood, marriage or adoption who is a resident of your household. This includes a ward or foster child."
The court of appeals filed its decision in this case within a month of filing a decision in State Farm Mutual Automobile Insurance Company v. Bailey, No. 2003AP2482, unpublished slip op. (Wis. Ct. App. December 1, 2005). In Bailey, the court considered the same issues, but interpreted § 632.32(5)(i)l. differently. The court held that § 632.32(5)(i)l. does not permit an insurer to reduce the limits of UIM liability by amounts the insured received from non-UIM tortfeasors. Additionally, the court held that the reducing clause in the policy issued by State Farm Mutual Automobile Insurance Company (State Farm) was unambiguous in the context of the entire policy, which allowed State Farm to reduce the limit of UIM liability by payments the insured received from a UIM tortfeasor. Id., ¶ 1. State Farm and Bailey both filed a petition for review with this court, which were granted.
The phrase "for the bodily injury or death for which the payment is made" prevents reductions in a number of different scenarios. For instance, it would prevent a reduction where an accident occurs between persons who had previously entered into an unrelated purchase agreement, and where the subsequent payment from the buyer to the seller is attributable to that purchase agreement and not to injuries arising from the accident. The phrase would also prevent reductions in a situation such as where the amounts paid by a person who may be legally responsible for an injury other than the one for which the payment is made. Such a situation might arise where Tortfeasor 1 settles a prior claim with an injured insured by paying current hospital costs for injuries arising from an accident involving Tortfeasor 2 and which costs would be properly attributable to Tortfeasor 2.
For instance, if a tortfeasor pays the injured party $10,000 for an injury he caused to her left leg in an October accident, that amount could not be used to reduce the UIM insurer's liability for the injury she incurred to her right arm in a separate November accident.
The dissent finds the court's interpretation of
The majority's contention that that this court discussed theories of UIM coverage in Dowhower, Badger Mutual, and Langridge merely to "highlight" different sorts of reducing clauses permissible under
Dissenting Opinion
¶ 47. (dissenting). Despite the conflicting interpretations of the court of appeals and without addressing the petitioner's interpretation of the statute, the majority declares
¶ 48. I disagree with the majority's conclusion that
¶ 49. It is surprising that the majority so readily claims that the meaning of
¶ 50. In State Farm Mut. Auto. Ins. Co. v. Bailey, the court of appeals concluded that
¶ 51. We have previously determined that when courts reach contradictory interpretations of a statute, it "is indicative of ambiguity." Teschendorf v. State Farm Ins. Cos.,
H-l I — 1
¶ 52. In addition to disregarding the opposing interpretations of the court of appeals, the majority's interpretation of
(i) A policy may provide that the limits under the policy for uninsured or underinsured motorist coverage for bodily injury or death resulting from any one accident shall be reduced by any of the following that apply:
1. Amounts paid by or on behalf of any person or organization that may be legally responsible for the bodily injury or death for which the payment is made.
2. Amounts paid or payable under any worker's compensation law.
3. Amounts paid or payable under any disability benefits laws.
(Emphasis added.)
¶ 53. The petitioner contends that the phrase "for which the payment is made" refers to payments made by an insurer under the applicable UM or UIM coverage. Without addressing the petitioner's interpretation, the majority asserts that the statute is unambiguous. Majority op., ¶ 22. It implicitly adopts the view that "for which the payment is made" refers to "[a]mounts paid by or on behalf of any person or organization that may be legally responsible for the bodily injury or death." What it fails to explain is why the words "for which the payment is made" are in the statute in the first instance.
¶ 54. The majority asserts that subsection 1. contains the words "for the bodily injury or death for which the payment is made" to "resolve [] a potential ambiguity." Id., ¶ 26. Specifically, it precludes insurers from reducing UIM limits "by amounts paid by a person who may be legally responsible in the accident, but whose payment is not made for a bodily injury arising from the accident." Id. No one else advances this interpretation —and for good reason.
¶ 56. Second, the majority maintains that the phrase prevents payments made to the insured by a tortfeasor in an entirely separate accident. It imagines a situation in which "Tortfeasor 1 settles a prior claim with an injured insured by paying current hospital costs for injuries arising from an accident involving Tortfea-sor 2 and which costs would be properly attributable to Tortfeasor 2." Id.
¶ 57. These scenarios are not only peculiar, but they are precluded by other language in the statute.
¶ 58. The majority's view that
¶ 59. The conclusion that the majority's interpretation renders the phrase "for the bodily injury or death for which the payment is made" superfluous is supported by the fact that the phrase is appended only to subsection 1. Subsections 2. and 3. permit reductions of UIM limits for worker's compensation and disability payments. However, those subsections do not explicitly limit reductions for worker's compensation and disability payments "for the bodily injury or death for which the payment is made." Such language is unnecessary precisely because
¶ 60. In contrast, the interpretation of the statute proffered by the petitioner avoids rendering part of
¶ 61. Under the petitioner's interpretation, the addition of "for which the payment is made" refers to payments made by an insurer under the applicable UM or UIM coverage. It therefore serves to limit which payments by or on behalf of tortfeasors may reduce UM or UIM coverage. Specifically, it provides that policies may reduce coverage limits only for payments made by or on behalf of tortfeasors whose actions require the insurer to make payments
¶ 62. Thus, the petitioner's interpretation also explains why
¶ 63. The majority has provided no explanation as to why the petitioner's interpretation is unreasonable, despite the advantage it holds over the majority's view insofar as it does not render part of the statute superfluous. In light of this failure to explain an alternative interpretation, and in light of the contradictory court of appeals decisions, I simply cannot see why the majority maintains that
I — I h — I
¶ 64. The majority's view also conflicts with this court's established interpretation of
¶ 65. More recently in State Farm Mut. Auto. Ins. Co. v. Langridge,
¶ 66. The consistent interpretation of Dowhower, Badger Mutual, and Langridge would entitle Marotz to coverage that pays the difference between the insured's higher UIM limit and the underinsured's lower liability limit. Under the Dowhower, Badger Mutual, and Langridge interpretation of UIM coverage, Marotz would be entitled to $75,000 of coverage under the Rural policy (that is, the $100,000 UIM limit minus the $25,000 he received from Hallman's insurer). Under the majority's new interpretation of UIM coverage, Marotz does not receive even a penny under the Rural policy. Clearly, this does not put him in the same position he would have occupied had Hallman's liability limits been the same as Marotz's UIM limits.
¶ 67. Without overruling or withdrawing any language from our prior cases, the majority simply ignores the precedent. It instead adopts a new interpretation. It now contends that "the statutes establish that contributions from all legally responsible
¶ 68. UIM coverage limits may be reduced by only those sources recognized under
¶ 69. For the reasons stated above, I conclude that the language of the statute is ambiguous. Questions of ambiguity aside, we should follow our precedent in interpreting it. Doing so requires following the principle that UIM coverage serves "to put the insured in the same position as he [or she], would have occupied had the tortfeasor's liability limits been the same as the underinsured motorist limits purchased by the insured." Langridge,
¶ 70. Accordingly, I respectfully dissent.
¶ 71. I am authorized to state that Chief Justice SHIRLEY S. ABRAHAMSON and Justice LOUIS B. BUTLER, JR. join this dissent.
For example, a policy could not reduce UIM coverage limits by amounts donated by others to aid one's recovery or given gratuitously by a benefactor.