Lead Opinion
Arlyn W. Ploen commenced two actions for declaratory judgment in the district court for Dodge County, one against Union Insurance Company (Union) and the other against Union and Shelter Mutual Insurance Company (Shelter). On April 23, 1996, the district
SCOPE OF REVIEW
Whether a statute is constitutional is a question of law; accordingly, the Nebraska Supreme Court is obligated to reach a conclusion independent of the decision reached by the court below. State v. Severin,
The interpretation and construction of an insurance contract or policy involve questions of law, in connection with which an appellate court has an obligation to reach its conclusions independent of the determinations made by the court below. Kast v. American-Amicable Life Ins. Co.,
In reviewing a summary judgment, an appellate court views the evidence in a light most favorable to the party against whom judgment is granted and gives such party the benefit of all reasonable inferences deducible from the evidence. Kramer v. Kramer,
FACTS
On December 24, 1991, Ploen was a passenger in a car owned and operated by his father. The car was hit from behind by a car driven by Karen Keller, and Ploen allegedly suffered back injuries as a result of the accident. Ploen sued Keller, who admitted liability, and the parties eventually settled for $54,000 of Keller’s policy liability limit of $100,000. However, Ploen alleges that his damages total at least $250,000.
Ploen was covered by his father’s policy with Union for $5,000 in medical payments and $25,000 in underinsured motorist benefits. He was also covered by his own policy with Shelter for $25,000 in medical payments and $100,000 in underinsured motorist benefits. Ploen alleges that as a result of the accident, he incurred medical expenses in the amount of at least $50,364. Union paid to or on behalf of Ploen $5,000 in medical payments, and Shelter paid $25,000 to Ploen for medical payments.
Prior to his settlement with Keller, Ploen requested that Union and Shelter give their consent to the proposed settlement agreement and requested that Union and Shelter waive their subrogation interests. Both companies denied such requests on the basis that Ploen should not settle for less than Keller’s policy limit if his damages were indeed $250,000.
Thereafter, Ploen filed petitions for declaratory judgment against Union and Shelter. In its answer denying liability for underinsured coverage and asserting subrogation rights, Union relied on its contractual provision stating that recovery will be had only after “the limits of liability under any applicable bodily injury liability bonds or policies have been exhausted by payment of judgments or settlements.” Shelter relied on its contractual provision stating that it was obligated to pay only such damages as “are in excess of the total limits of all bodily injury liability insurance policies and bonds applicable to the person or persons legally responsible for such damages and available to cover the insured’s damages.” Union and Shelter also asserted that Ploen had breached the insurance contracts by settling without their written consent.
Union and Shelter each moved for summary judgment, and Ploen filed cross-motions for summary judgment. The district court sustained Union’s and Shelter’s motions for summary judgment, overruled Ploen’s cross-motions for summary judgment, and dismissed the lawsuits. In so doing, the court specifically found that Neb. Rev. Stat. § 44-3,128.01 (Reissue 1993), a statute providing for subrogation of medical payments, is constitutional. Ploen timely appealed the orders granting summary judgments to Union and Shelter and overruling his cross-motions for summary judgment.
Ploen makes the following assignments of error: (1) The district court erred in finding that Ploen’s settlement with Keller adversely affected Union and Shelter, (2) the court erred in finding that § 44-3,128.01 is constitutional, and (3) the court erred in sustaining Union’s and Shelter’s motions for summary judgment and overruling Ploen’s cross-motions for summary judgment.
ANALYSIS
Subrogation for Medical Payments
We first address whether Union and Shelter are able to subrogate for the medical payments made to or on behalf of Ploen. In support of their right to subrogate, Union and Shelter rely on § 44-3,128.01, which provides:
A provision in an automobile liability policy or endorsement which is effective in this state and which grants the insurer the right of subrogation for payment of benefits under the medical payments coverage portion of the policy shall be valid and enforceable, except that if the claimant receives less than actual economic loss from all parties liable for the bodily injuries, subrogation of medical payments shall be allowed in the same proportion that the medical expenses bear to the total economic loss. For purposes of this section, it shall be conclusively presumed that any settlement or judgment which is less than the policy limits of any applicable liability insurance coverage constitutes complete recovery of actual economic loss.
In Shelter Ins. Cos. v. Frohlich,
Ploen argues that § 44-3,128.01 violates due process by creating an irrebuttable presumption that settlement for less than the tort-feasor’s coverage equals full recovery. In Elliott v. Ehrlich,
In contrast to Elliott, in Haven Home, Inc. v. Department of Pub. Welfare,
Classifications are upheld where no constitutionally protected right of status is significantly impaired, and where the classification bears a rational relationship to a legitimate legislative goal. In such cases classifications to avoid administrative difficulty of individual determinations in every case are proper, even though the classifications adopted are neither necessary nor universally true.
In Weinberger, the Court upheld an irrebuttable presumption for purposes of Social Security benefits that any marriage not preceding a wage earner’s death by at least 9 months was a sham. Weinberger illustrates the distinction between Haven Home, Inc. and Elliott. In Weinberger, the Court distinguished cases regarding legislative decisions regulating the private sector of the economy and public treasury from cases involving constitutionally protected rights such as the right to conceive and raise one’s children, residency, or the freedom of personal choice in matters of marriage and family life.
In cases involving constitutionally protected rights, a challenged irrebuttable presumption under the 5th Amendment Due Process Clause must meet the applicable 14th Amendment standard. In contrast, other irrebuttable classifications need meet only the standard of legislative reasonableness. See Weinberger v. Salfi, supra. Under the standard of legislative reasonableness, the Legislature’s action is sufficient if it is rationally based and free from invidious discrimination. See, State v. Garber,
The right to settle with a tort-feasor for less than the tortfeasor’s policy limit without one’s insurer’s consent does not approach a constitutionally recognizable right, and Ploen does not make such a contention. Therefore, we consider whether the irrebuttable presumption found in § 44-3,128.01 is rationally based and free from invidious discrimination. See Dandridge v. Williams,
Whether a statute is constitutional is a question of law; accordingly, the Nebraska Supreme Court is obligated to reach a conclusion independent of the decision reached by the court below. State v. Severin,
Liability for Underinsured Benefits
Next, we address whether Ploen is entitled to underinsured benefits from either Union or Shelter. Ploen argues that since he seeks only the difference between the policy limit and his damages, his settlement with the tort-feasor for less than the policy limit did not adversely affect Union’s or Shelter’s rights. In Horace Mann Cos. v. Pinaire,
We first consider Ploen’s policy with Shelter. Shelter failed to file a brief in this court. The only indication that Shelter may have been adversely affected by Ploen’s settlement was Union’s assertion at oral argument, allegedly on Shelter’s behalf, that the policy with Shelter contained a clause prohibiting the insured from settling with a tort-feasor for less than the tortfeasor’s policy liability limit. Shelter’s policy contained a provision which stated:
[T]he limits of liability of this coverage shall be reduced by the total limits of all bodily injury liability insurance policies and bonds applicable to the person or persons legally responsible for such damages. Our obligation hereunder shall apply only to such damages as are in excess of thetotal limits of all bodily injury liability insurance policies and bonds applicable to the person or persons legally responsible for such damages and available to cover the insured’s damages.
Interpretation and construction of an insurance contract or policy involve questions of law, in connection with which an appellate court has an obligation to reach its conclusions independent of the determinations made by the court below. Kast v. American-Amicable Life Ins. Co.,
We conclude that Shelter’s policy does not require that the insured must exhaust the tort-feasor’s liability policy in order to assert a claim for underinsured motorist benefits. We do not address whether Shelter may have been adversely affected by Ploen’s settlement with the tort-feasor.
Having determined that the policy does not preclude Ploen from settling for less than the tort-feasor’s policy limit, we conclude that a material question of fact exists as to whether Ploen can recover under the provisions of Shelter’s underinsured motorist policy and that the district court erred in granting summary judgment to Shelter.
We next address Ploen’s contention that he is entitled to summary judgment on his cross-motion because the amount of his damages is undisputed. In arguing that his damages are undisputed, Ploen relies on Union’s and Shelter’s failure to controvert his affidavit which stated that his damages were in excess of $250,000. Ploen’s affidavit sets forth an opinion as to the amount of damages, but it does not establish damages as a matter of law. Statements in affidavits as to opinion, belief, or conclusions of law are of no effect. Whalen v. U S West Communications, ante p. 334,
We next address Ploen’s policy with Union, which stated: “We will pay under this coverage only after the limits of liability under any applicable bodily injury liability bonds or policies have been exhausted by payment of judgments or settlements.” Ploen argues that despite this clear language, the provision in question is void as against public policy.
Some courts have held similar provisions to be against public policy. In Schmidt v. Clothier,
The purposes of the no-fault act . . . include those of easing the burden of litigation and encouraging prompt payment of claims. Enforcement of policy exhaustion clauses would produce results contrary to those purposes. It could serve to force an insured to litigate the claim to final judgment in order to exhaust the policy limits. Litigation expenses would lessen the insured’s net recovery, the time involved in litigation would serve to delay payment to the insured, and the litigation itself would unnecessarily burden our court system. Where the best settlement available is less than the defendant’s liability limits, the insured should not be forced to forego [sic] settlement and go to trial in order to determine the issue of damages. The insured has the right to accept what he or she considers the best settlement available and to proceed to arbitrate the underinsurance claim for a determination of whether the damages do indeed exceed the tortfeasor’s liability limits.
Id. at 260-61. See, also, Shaw v. Continental Ins. Co.,
In contrast, at least one court has held under a provision similar to the one found in
The parties to an insurance contract may make the contract in any legal form they desire, and in the absence of statutory provisions to the contrary, insurance companies have the same right as individuals to limit their liability and to impose whatever restrictions and conditions they please upon their obligations, not inconsistent with public policy. Safeco Ins. Co. of America v. Husker Aviation, Inc.,
Public policy is that principle of the law which holds that no subject can lawfully do that which has a tendency to be injurious to the public or against the public good, the principles under which the freedom of contract or private dealings are restricted by law for the good of the community. Southern Neb. Rural P.P. Dist. v. Nebraska Electric,
Uninsured motorist coverage laws were enacted for the benefit of innocent victims of financially irresponsible motorists. See Lane v. State Farm Mut. Automobile Ins. Co.,
While noting the concern that a provision such as Union’s might encourage an insured to litigate against the tort-feasor rather than settle, we also note the insurer’s concern that the insured settle with the tort-feasor for the maximum amount possible before the insured is allowed to seek underinsured benefits. We believe that such a determination with regard to public policy is better left to the wisdom of the Legislature. Since Union’s policy is valid and enforceable as to its underinsured motorist coverage, we do not consider whether Ploen’s settlement with the tort-feasor adversely affected Union’s rights under the policy. We therefore affirm the judgment of the district court granting summary judgment to Union.
CONCLUSION
The summary judgment in favor of Shelter is reversed on the issue of underinsured benefits, and the cause is remanded for further proceedings. The summary judgment in favor of Union is affirmed.
Affirmed in part, and in part reversed and REMANDED FOR FURTHER PROCEEDINGS.
Concurrence Opinion
concurring in part, and in part dissenting.
The majority determined Shelter’s provision was not an exhaustion clause and Union’s exhaustion clause was consistent with public policy. I concur because the majority correctly determined Shelter’s policy was not an exhaustion clause, but it failed to address the ambiguity of the provision. However, I also dissent because the majority failed to identify the ambiguity in Union’s exhaustion clause, failed to construe the provision against Union, and failed to determine
Shelter’s underinsured motorist policy provides:
[T]he limits of liability of this coverage shall be reduced by the total limits of all bodily injury liability insurance policies and bonds applicable to the person or persons legally responsible for such damages. Our obligation hereunder shall apply only to such damages as are in excess of the total limits of all bodily injury liability insurance policies and bonds applicable to the person or persons legally responsible for such damages and available to cover the insured’s damages.
The majority concluded that Shelter’s policy did not require Ploen to exhaust the tort-feasor’s liability policy to assert a claim for underinsured motorist benefits. The majority reached the correct conclusion, yet failed to determine exactly how the provision operates or to identify the ambiguity in the provision.
For example, in Gust v. Otto,
“The company will pay all sums . . . because of bodily injury . . . provided
“(1) that the limits of liability for Underinsured Motorists coverage shall be reduced by the total limits of all Bodily Injury Liability insurance policies applicable to the person or persons legally responsible for such damages;
“(2) that the company’s obligation hereunder shall apply only to such damages that are in excess of the total limits of all Bodily Injury Liability insurance policies applicable to the person or persons legally responsible for such damages and available to cover the insured’s damages . . . .”
Gust,
The issue on appeal was whether the underinsured motorist coverage began at the level of the insured’s underlying recovery or at the level of the major liability carrier’s policy limit. The court initially stated that, when read together, subparagraphs (1) and (2) create an ambiguity which must be construed against the insurer. Subparagraph (1) reduces the insurer’s underinsured motorist coverage by the total limits of all bodily injury insurance policies. Subparagraph (2), however, reduces the insurer’s underinsured motorist coverage by the total limits of all bodily injury insurance policies and the damages available to cover the insured’s damages. Thus, the court determined that subparagraph (2) qualified subparagraph (1) by limiting the reduction to the insured’s damages, be it the policy limit or an amount available to cover the insured’s damages.
In Gust, Verlyn Otto, while driving with a passenger, struck an oncoming car containing Harold Gust, Gust’s wife, and the Newmier family. Otto, who was found 100 percent negligent, had a $300,000 liability insurance policy. All claims for the Gusts and Newmiers totaled $479,000. Their total recovery from Otto’s insurer was $248,184, the remaining portion of Otto’s $300,000 liability coverage being paid to Otto’s passenger. The insurer contended that coverage began at Otto’s policy limit, of $300,000. The Gusts contended that coverage began with the underlying recovery of $248,184. The court determined the amount available for the insured’s damages did not amount to Otto’s policy limit of $300,000, but, rather, the underlying recovery of $248,184. The court found that the insurer was entitled to reduce the underinsured motorist coverage only by the portion of the total bodily injury limit specifically available to cover the insured’s damages. The court reasoned that the insurer’s interpretation would allow insurance companies to benefit from a credit not received by the insured. As such, the court held that subparagraph (2) established the scope of the insurer’s reducing clause, and thus, the insurer could reduce its coverage by the amount of the insured’s underlying recovery, $248,184.
Union’s provision stated, “We will pay under this coverage only after the limits of liability under any applicable bodily injury liability bonds or policies have been exhausted by payment of judgments or settlements.” (Emphasis supplied.) The majority determined the exhaustion clause was consistent with public policy and, thus, valid and enforceable. In turn, the majority affirmed the district court’s grant of summary judgment and did not consider whether Ploen’s settlement with the tort-feasor adversely affected Union’s rights under the policy. However, I dissent because Union’s exhaustion clause (1) contains an ambiguity and (2) is inconsistent with public policy.
The phrase “any applicable” in Union’s policy is ambiguous. For example, in Tate v. Secura Ins.,
In interpreting a contract, a court must first determine, as a matter of law, whether the contract is ambiguous. Moller v. State Farm Mut. Auto. Ins. Co.,
Insurance companies in drafting their policies formulate language which may either prevent or create ambiguity. In such draftsmanship, precision provides certainty, while the absence of articulation accounts for ambiguity. As expressed in Peony Park v. Security Ins. Co.,137 Neb. 504 , 508,289 N.W. 848 , 851 (1940): “It is consistent with both reason and justice that any fair doubt as to the meaning of the words of a policy should be resolved against the one who prepares it, for if the terms of a policy are capable of two meanings, that is, where the true meaning is doubtful, the law favors such construction as will protect the insured, and not avoid the policy.” See Farm Bureau Ins. Co. v. Pedlow,3 Mich. App. 478 ,142 N.W.2d 877 (1966).
Denis v. Woodmen Acc. & Life Co.,
Union’s exhaustion clause is also void as against public policy. Those states that have held exhaustion provisions to be valid and
There are of course a number of considerations which militate in favor of settlement between the underinsured tortfeasor’s insurer and the injured party. Obviously, settlement avoids litigation with its attendant expenses and resultant burden upon the legal system. Where the amount of settlement is less than the policy limits, the unpaid amount may well represent the savings in litigation costs for both sides. More importantly, settlement hastens the payment to the injured party who obviously needs compensation soon after the injuries when the medical expenses begin to amass and when the anxiety level is probably quite high. Additionally, there are many situations where litigation would not be a preferred course of action because, while the injuries are certain, there may remain other problems of proof. Thus, the public policy considerations, apart from the contract of the parties, generally favor settlements.
Bogan,
they unnecessarily promote litigation costs, increase the number of trials, and unreasonably delay the recovery of underinsured motorist benefits. Specifically, these cases point out that an insured may have valid reasons for accepting less than the tortfeasor’s policy limit, that an “underinsured motorist carrier” can compute its payments to the insured as if the insured had exhausted the tortfeasor’s policy limit, and that if an “exhaustion clause” is in effect, the tortfeasor’s carrier can force the plaintiff to go to trial by offering less than the tortfeasor’s policy limit, thereby greatly increasing litigation costs and expenses and promoting delay.
(Emphasis in original.) Mann,
In Augustine v. Simonson,
On appeal, the Montana Supreme Court initially determined the exhaustion clause required the insured to entirely exhaust the limits of all existing bodily injury liability bonds or policies before proceeding against the underinsured motorist carrier. The Montana Supreme Court overruled the district court’s judgment, noting the general purpose of underinsurance and specifically the aforementioned passages from Bogan, supra, and Mann, supra. The court stated that the holding in Bogan was consistent with Montana public policy; the purpose of underinsurance, to provide indemnification for accident victims when the tort-feasor does not provide adequate indemnification; and the declared public policy of encouraging settlement and avoiding unnecessary litigation. Therefore, the court concluded the exhaustion provision was contrary to public policy and unenforceable to the extent the provision violates public policy.
This court has stated that the purpose of underinsured motorist insurance is to “provide a means to make the victims of less than adequately insured motorists whole, or as nearly so as reasonably possible . . . .” Muller v. Tri-State Ins. Co., 252 Neb. 1, 8,
concurring in part, and in part dissenting.
I join that portion of Chief Justice White’s dissent concluding that the exhaustion clause in the underinsured motorist section of Union’s insurance contract is void as against public policy. Such a clause that requires entire exhaustion of a tort-feasor’s liability insurance as a prerequisite to asserting an underinsured motorist claim is contrary to sound public policy for the reasons set forth in the Chief Justice’s dissent. This is particularly true when, as here, the injured party seeks only the difference between the tort-feasor’s liability policy limit and the damages sustained by the injured party.
