Lead Opinion
¶1. American Family Mutual Insurance Company appeals a judgment of the circuit court determining that Trisha Taylor can recover under the underinsured motorist (UIM) coverage provisions of two of its auto policies. Taylor argues, and the circuit court agreed, that the reducing clauses of both policies created illusory coverage; and therefore, her reasonable expectations mandate coverage. Because we conclude that Ross Hermanson's vehicle was not an underinsured motor vehicle as defined in the policies, each of which provides underinsured motorist benefits in an amount greater than the statutory minimum for the purchase of automobile liability
¶ 2. American Family also claims that it was error for the circuit court to award Taylor accidental death benefits under both policies because accidental death coverage is an investment contract and Wis. Stat. § 631.43(1) (1993-94)
BACKGROUND
¶ 3. Paul Taylor was killed when his vehicle was struck by a vehicle driven by Ross Hermanson. Hermanson had $50,000 of liability coverage under a policy issued by Greatway Insurance Company. The damages incurred by the Taylors were stipulated to exceed $160,000. Trisha Taylor, Paul's wife, settled her claims against Hermanson and Greatway for the policy limits, and then she sued American Family under the UIM provisions of the American Family policies the Taylors had purchased.
¶ 4. The Taylors owned two auto policies issued by American Family. Both policies included UIM coverage, each with limits of $50,000. Both policies defined an underinsured motor vehicle by comparing the amount of liability coverage which had been purchased by the tortfeasor with the amount of UIM coverage
¶ 5. In denying UIM benefits, American Family contended that Hermanson was not driving an under-insured motor vehicle according to the American Family policies' definition because the limits of Hermanson's liability policy ($50,000) were not less than the limits of each American Family policy ($50,000). Taylor argued that the circuit court could look beyond the policy definition of underinsured motor vehicle, if that definition, in combination with other provisions of the policy, created illusory coverage. The circuit court agreed with Taylor and concluded that the reducing clause in the policies created illusory coverage. Therefore, it allowed Taylor to recover the policy limits of $50,000 under each policy.
¶ 6. Taylor also made a claim for accidental death benefits under both policies, each of which had a face amount of $5,000 coverage. American Family paid the $5,000 limit from one policy. However, it refused to pay the limit under the other policy, contending that coverage for accidental death benefits could not be stacked because of an "other insurance" clause in both
DISCUSSION
Standard of Review.
¶ 7. The resolution of whether Hermanson's vehicle was an underinsured motor vehicle under the policies requires us to interpret the language of the policies. The interpretation of an insurance policy is a question of law which we decide de novo. See Filing v. Commercial Union Midwest Ins. Co.,
¶ 8. We interpret an insurance policy's ambiguities in favor of coverage, while coverage exclusion clauses are narrowly construed against the insurer. See Guenther v. City of Onalaska,
¶ 9. American Family contends that Taylor may not recover based on the holdings of Smith and Krech v. Hanson,
¶ 10. In Wood, the supreme court construed UIM coverage under a policy that attempted to reduce its payout by amounts payable by the tortfeasor. In concluding that there was UIM coverage, the court reasoned, "we believe that a reasonable insured expects to be protected against a loss caused by another that is not covered by the underinsured driver's liability coverage." Wood,
¶ 12. Therefore, under Smith, we must first decide that Hermanson did drive an underinsured motor vehicle, before we may address whether the reducing clause results in illusory coverage. In reviewing the policies, we note that the language used to define "underinsured motor vehicle" in Smith is virtually identical to the language in the American Family policies and that Smith held this language was unambiguous. See Smith,
¶ 13. We recently addressed stacking issues in Krech and in Engstrom. In Krech, the tortfeasor's policy contained a liability limit of $100,000 and Krech was insured under two policies, each having UIM coverage of $100,000. In Engstrom, the tortfeasor had two policies, one of $25,000 and one of $100,000. Engstrom had UIM coverage, defined as in Smith, of $50,000. In both cases, we declined to stack policies, either of the insured or of the tortfeasor, before deciding whether the tortfeasor met the definition of an underinsured motorist on the coverage issue. See Krech,
¶ 14. In Hoglund, we made a further refinement of UIM jurisprudence when we considered whether a definition of an underinsured motor vehicle, which was on all fours with the Smith definition, controlled the UIM coverage question when the policy limits of UIM coverage were $25,000, an amount identical to the minimum amount of liability insurance one could purchase in Wisconsin. The insurer in Hoglund, argued that Krech and Smith dictated that we determine whether a tortfeasor drove an underinsured motor vehicle by examining only the policy definition, and if that definition led us to conclude that the tortfeasor did not, we were precluded from deciding whether coverage was illusory due to some other circumstance. We disagreed. Because the statutes required that one who chose .to purchase liability insurance in Wisconsin must purchase at least $25,000 of coverage and the policy at issue had a limit of $25,000 for UIM coverage, Hoglund would never have been entitled to recover any amount of UIM benefits for policies written in Wisconsin. We held that this result did not comport with the reasonable expectations for UIM coverage, which coverage should have been provided in at least some conceivable circumstance.
¶ 15. In harmonizing Wood, Smith, Krech, Hoglund, and Gifford, we conclude that where a policy provides a definition of an underinsured motor vehicle that compares an insured's UIM policy limits to a tortfeasor's policy limits and the insured's policy limit is more than the statutory minimum found in Wis. Stat. § 344.33(2), then we will not review whether a reducing clause within the policy makes recovery of those UIM benefits illusory. However, we will examine whether a reducing clause makes recovery of those UIM benefits illusory when the insured's policy provides the same UIM benefits as the statutory minimum amount of liability insurance a driver may purchase in Wisconsin. In statutory minimum cases, a definition of underinsured motor vehicle which compares the insured's UIM limits with the tortfeasor's liability limits is against public policy because under those circumstances, the insured will have paid a premium for a type of coverage.that will never be available, if the tortfeasor purchased insurance in Wisconsin. As a matter of law, that is a result contrary to the reasonable expectations of an insured.
¶ 16. Therefore, because each American Family policy in question contained a higher amount of UIM coverage than the amount which was the statutory minimum amount of liability insurance one may
¶ 17. We note that effective October 1, 1995, notice that UIM coverage is available must be given when liability insurance is sold or renewed, and if the insured chooses to purchase it, the statutory minimum is $50,000 per person and $100,000 per accident. See Wis. Stat. § 632.32(4m)(d) (1995-96). However, the statutes do not define "underinsured motorist," so insurance companies remain free to establish that definition by comparing the coverage of the tortfeasor with the UIM coverage of the insured, rather than defining an underinsured motorist through a comparison of the coverage of the tortfeasor with the damages sustained by the insured, which latter definition is the reasonable expectation of an insured. As the supreme court said in Wood and Kaun:
Accidental Death Benefits.
¶ 18. Taylor also made a claim for accidental death benefits under both policies; American Family responded by paying the $5,000 limit from one policy. However, it refused to pay the limit under the other policy contending that coverage for accidental death benefits could not be stacked because of an "other insurance" clause in both policies. Taylor argues that the other insurance clause was not enforceable because Wis. Stat. §631.43(1) prohibits such clauses from reducing the aggregate protection of an insured when two or more policies promise to indemnify the insured against the same loss. American Family argues that accidental death benefits are investment contracts, not indemnity policies, and therefore, § 631.43(1)
¶ 20. However, neither Cunningham nor Rixmann interprets Wis. Stat. § 631.43(1), nor do they have any application to the issue before us. Additionally, in examining those cases, we do not find their reasoning helpful in determining whether § 631.43(1) applies to the promises to pay upon the accidental death of the insured, which are contained in the two policies at issue here. Those provisions state: "death BENEFIT: We will pay maximum benefit shown in the declarations, if the insured person dies within 90 days of the accident."
¶ 21. In interpreting Wis. Stat. § 631.43(1) previously, the supreme court has noted that the statute does not make reference to "indemnity policies," as American Family contends it must before it can be applied to the Taylors' policies. Instead of focusing on the type of policy, the supreme court focused on the type of loss and who was to receive compensation.
*719 [T]he statute makes reference to policies which "promise to indemnify." As a consequence, the applicability of sec. 631.43(1) cannot be simply ascertained by resorting to historical definitions of indemnity and liability insurance. Rather, an analysis must be made on a case-by-case basis as to whether the particular liability policy at issue promises to indemnify the insured against the same loss as the other insurance policies involved.
Wood,
¶ 22. Here, both policies promise first-party payment for the same loss (accidental death) caused by an automobile accident. Therefore, we conclude that the accidental death benefits in both policies are promises to indemnify the insured against the same loss, the accidental death of an insured as the result of an auto accident. Furthermore, it appears that the legislative intent underlying WlS. Stat. § 631.43(1) supports our conclusion. In Welch v. State Farm Mutual Automobile Insurance Co.,
¶ 23. Therefore, we conclude that the accidental death benefits found in the two American Family policies owned by the Taylors promise to indemnify the insured against the same loss and accordingly, we affirm that portion of the judgment allowing recovery under both policies.
CONCLUSION
¶ 24. Because we conclude that Hermanson's vehicle was not an underinsured motor vehicle as defined in the policies, each of which provides UIM benefits in an amount greater than the statutory minimum for the purchase of liability insurance in Wisconsin, we reverse that portion of the judgment of the circuit court awarding UIM benefits. We further conclude that accidental death provisions found in both policies are promises to indemnity the insured against the same loss, the accidental death of the insured in an auto accident. Therefore, we affirm that portion of the judgment allowing payment of accidental death benefits under both policies.
By the Court. — Judgment affirmed in part; reversed in part.
Notes
A11 references to the Wisconsin Statutes are to the 1993-94 version unless otherwise noted.
The other insurance clause in the policies provided, "If any insured person under this endorsement is also covered under another endorsement of the same kind, issued by us, any payment for loss under the other endorsement shall reduce to the extent of that payment, our obligation under this endorsement."
The policy definition of an underinsured motor vehicle was not discussed in Wood v. American Family Mutual Insurance Co.,
If the tortfeasor had insurance issued in another state where less than $25,000 of liability insurance could be purchased, collection would have been possible.
In Allstate Insurance Co. v. Gifford,
In 1993, when the accident occurred, the statutory minimum amount of liability insurance required was $25,000 per person, per accident, as it remains today.
We note that in Kaun v. Industrial Fire & Casualty Insurance Co.,
Wisconsin Stat. § 631.43(1) provides in relevant part:
When 2 or more policies promise to indemnify an insured against the same loss, no "other insurance" provisions of the policy may reduce the aggregate protection of the insured below the lesser of the actual insured loss suffered by the insured or the total indemni*718 fication promised by the policies if there were no "other insurance" provisions.
Concurrence Opinion
¶ 25. (concurring). The majority makes a formidable attempt to reconcile: Smith v. Atlantic Mut. Ins. Co.,
¶ 26. Though it is not the oldest case, I conclude that the starting place for underinsured motorist (UIM) issues is Smith. Smith has two virtues. It was decided by the supreme court, and therefore must be followed in any conflict with a court of appeals opinion. See State v. Lossman,
¶ 27. Smith is important because it holds that UIM issues are, first of all, a matter of contract. Smith,
¶ 28. Smith involved an accident in which the driver at fault carried liability limits of $50,000 and the injured person carried UIM coverage with policy limits of $50,000. Id. at 809-10. Thus, Smith did not consider
¶ 29. But the injured person in Hoglund argued that the policy's definition of underinsured motor vehicle, read in conjunction with WlS. Stat. § 344.33, the statute which requires auto policies issued in Wisconsin to have at least $25,000 liability coverage, resulted in illusory UIM coverage. Id. We agreed with that argument and concluded that the trial court should reform the policy to provide for whatever coverage the injured person reasonably expected. See id. at 272. That is where the trouble started.
¶ 30. First, contractual language is ambiguous if it is susceptible to more than one reasonable interpretation. See id. at 268. By concluding that a UIM provision in an auto policy is unambiguous, we acknowledge that reasonable persons would not differ as to its meaning, and if that meaning excludes UIM coverage, no-one could have a reasonable expectation that coverage existed. Thus, our conclusion in Hoglund that the auto policy unambiguously precluded UIM coverage but the injured person had a reasonable expectation of coverage is illogical. It is an unreachable conclusion. It is the equivalent of an injured person asserting: "Had I read the policy, I would have known that coverage for underinsured motorists is often excluded, but I didn't read the policy, I expected more, and therefore I am entitled to more."
¶ 32. The Hoglund court was faced with this problem. Its solution was to examine the injured party's insurance policy and conclude that it defined an uninsured motor vehicle by comparing the liability limits of the tortfeasor's vehicle with the minimum required under Wisconsin law. See Hoglund,
¶ 33. Our conclusion in Hoglund is logically flawed. A particular policy can define both underin-sured and «reinsured motor vehicles in a myriad of ways. Because a policy defines an uninsured motor vehicle in a way that includes motor vehicles with some liability coverage does not mean that the UIM coverage must follow suit. It makes no sense to look to the definition of an «reinsured motor vehicle when looking at the coverage for rere&erinsured motor vehicles. The UIM coverage in the policy under consideration in Hoglund defined an underinsured motor vehicle as a vehicle "to which a bodily injury bond or policy applies at the time of the accident; however, its limit for bodily injury is less than the limit of liability for this coverage." That definition fits hand-in-glove the situation where an out-of-state tortfeasor with a liability policy limit of $10,000 injures a Wisconsin motorist with $25,000 of UIM coverage.
¶ 34. We could have concluded in Hoglund that the definitions of «reinsured and rere&erinsured vehicles in the policy led to a conclusion that the tortfeasor was
¶ 35. Thus, when we concluded in Hoglund that the injured party's UIM coverage was illusory, what we were really holding was that the motorist was not getting much for his premium dollar, and that we would remedy that problem. We refused, however, to consider that despite UIM coverage's usual inapplicability, there was no premium for the coverage. See Hoglund,
¶ 36. Gifford concluded that Hoglund governed its decision. Gifford,
¶ 37. Wood is of lesser significance here because it involved reducing clauses in auto policies, an area we do not reach here. Wood,
¶ 38. I therefore conclude, as does the majority, that because each of the Taylors’ American Family pol
¶ 39. Because I agree with the majority's conclusion, but disagree with some of its reasoning, I concur.
This is true if, as usual in UIM policies, the policy defines an underinsured motorist as a motorist whose liability limit is less than the limit of the UIM coverage.
