Peters, M. v. National Interstate Insurance Compan ( 2014 )

J-A24044-14
2014 PA Super 276MICHAEL PETERS AND MALINDA IN THE SUPERIOR COURT OF
PETERS, H/W AND ROBERT WESTON, AS PENNSYLVANIA
GUARDIAN OF JADEN PETERS,
Appellees
v.
NATIONAL INTERSTATE INSURANCE
COMPANY AND EVANS DELIVERY
COMPANY, INC.,
Appellants No. 445 EDA 2014
Appeal from the Order Entered September 10, 2013
in the Court of Common Pleas of Philadelphia County
Civil Division at No.: August Term, 2011, No. 3268
BEFORE: GANTMAN, P.J., BENDER, P.J.E., and PLATT, J.*
OPINION BY PLATT, J.: FILED DECEMBER 16, 2014
Appellants, National Interstate Insurance Company, and Evans
Delivery Company, Inc., appeal from the order declaring that Appellees,
Michael Peters and Melinda Peters, husband and wife, and Robert Weston,
guardian of Jaden Peters (the Peters’ minor daughter), Ohio residents, could
make a claim against National Interstate for under-insured motorist benefits
(UIM) pursuant to the Pennsylvania Motor Vehicle Financial Responsibility
____________________________________________
*
Retired Senior Judge assigned to the Superior Court.
J-A24044-14
Law (MVFRL)1 for an accident in Ohio.2 Appellees have no legally
enforceable claim for UIM under Pennsylvania law. Accordingly, we vacate
the order, reverse the trial court’s determination of coverage, and remand.
There is no significant dispute about the underlying history of the case.
The parties entered into a joint stipulation of facts. (See Joint Stipulations
at Certified Docket Entry No. 47; Memorandum Opinion, 9/10/13, at 2-7;
R.R. at R-148a-R-158a). We summarize the facts most relevant to our
analysis.
The accident occurred in Kent County, Ohio, on August 21, 2009.
(See Joint Stipulation of Facts [Stipulation], ¶ 3). Both Michael Peters, the
driver, and his minor daughter, Jaden, who was traveling with him as a
passenger, were seriously injured in the accident.3 At the time of the
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1
75 Pa.C.S.A. §§ 1701─ 1799.7.
2
Appellants purport to appeal from the order of December 23, 2013,
denying their post-trial motion. A party must file post-trial motions to
preserve claims the party wishes to raise on appeal. See Motorists Mut.
Ins. Co. v. Pinkerton, 830 A.2d 958, 964 (Pa. 2003) (citing, inter alia,
Chalkey v. Roush, 805 A.2d 491 (Pa. 2002), and Pa.R.C.P. 227.1).
However, an appeal after disposition of the required post-trial motion is
properly taken from the order of declaratory judgment, which is the final
order. See 42 Pa.C.S.A. § 7532 (“[S]uch declarations shall have the force
and effect of a final judgment or decree.”). We have amended the caption
accordingly.
3
Their underlying complaint alleges that Michael Peters suffered multiple
fractures (foot, leg, hip, ribs) and paralysis of his left leg, incurring medical/
hospital expenses of approximately $700,000.00. Daughter Jaden, then six
years old, (d/o/b 10/13/02), suffered facial fractures and blindness in her
(Footnote Continued Next Page)
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accident Michael Peters, an Ohio resident, was employed as a truck driver by
Evans Delivery, a Pennsylvania corporation. National Interstate issued a
commercial vehicle policy to Evans Delivery in Pennsylvania.
The truck Michael Peters was driving was registered in Ohio and not
principally garaged in Pennsylvania. (See id. at ¶ 5). The other driver,
Matthew Knecht, hit the Peters’ vehicle head-on. Knecht had insufficient
insurance coverage to satisfy the Peters’ entire damages claim. Knecht’s
insurer paid the policy limits of $200,000.00. The parties here stipulated
that the Peters’ damages substantially exceed $200,000.00. (See id. at
¶ 18, ¶ 19).
Appellees made a UIM claim pursuant to the Pennsylvania Motor
Vehicle Financial Responsibility Law (MVFRL)4 against National Interstate
under the Evans Delivery commercial vehicle policy.5 (See First Amended
Action for Declaratory Judgment, ¶ 33, ¶ 40). National Interstate refused
coverage. (See Stipulation ¶ 21; First Amended Action for Declaratory
Judgment, ¶ 34). Appellees brought the underlying complaint, seeking a
declaratory judgment of coverage. They alleged that the form signed by
_______________________
(Footnote Continued)
right eye, incurring medical/ hospital expenses of $68,000.00. (See
Complaint, at 7-8, §§ 28-29, at R.R. 103a-104a; see also id. at 4 §6, at
R.R. 100a).
4
75 Pa.C.S.A. §§ 1701─ 1799.7.
5
Appellees later added Evans Delivery as an additional defendant.
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Evans Delivery, rejecting UIM, was “invalid, illegal and void[.]” (First
Amended Action for Declaratory Judgment, ¶ 51).
The trial court held a non-jury trial on June 17, 2013. The trial
consisted of argument only. Neither of the parties called any witnesses, or
offered additional evidence, relying on the Joint Stipulation and the Joint
Trial Exhibits, plus the amended complaint for declaratory judgment and the
answer. (See N.T. Trial, 6/17/13, at 4-5; see also Trial Court Opinion,
9/10/13, at 1). The trial court filed an opinion and order on September 10,
2013. In essence, the trial court reasoned that because the policy offered
“no information on how the premium for UM/UIM was calculated . . . its
terms are ambiguous and therefore must be construed in favor of the
[Appellees].” (Trial Ct. Op., 9/10/13, at 12; Trial Ct. Op., 2/18/14, at 13).
Appellants filed a motion for post trial relief, which the court denied, after
oral argument, on December 23, 2013. This timely appeal followed.6
Appellants present one over-arching generic question and seven
subsidiary questions for our review:7
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6
Appellants timely filed a concise statement of errors on January 31, 2014.
See Pa.R.A.P. 1925(b). The trial court filed an opinion on February 18,
2014. See Pa.R.A.P. 1925(a).
7
We have re-numbered Appellants’ questions. In addition to mis-numbering
their questions, we note that Appellants fail to comply with Pennsylvania
Rule of Appellate Procedure 2119(a), which directs in pertinent part that “the
argument shall be divided into as many parts as there are questions to be
argued; and shall have at the head of each part--in distinctive type or in
(Footnote Continued Next Page)
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Did the trial court abuse its discretion and commit an error
of law by:
1. Holding that an alleged ambiguity in the calculation
of the premium charged for uninsured and underinsured
motorist coverage in states that required a mandatory
minimum amount of coverage was equivalent to an
ambiguity in the terms of the contract and scope of
coverage offered under the policy that must be resolved
against the [A]ppellants-insurer and named insured[?]
2. Holding that the intent of the Appellants was not
clear[?]
3. Declaring that blanket underinsured motorist
coverage existed under the commercial motor vehicle
insurance policy number EDC 81600000 00 issued by
[A]ppellant National Interstate Insurance Company to
[A]ppellant Evans Delivery Company, Inc.[?]
4. Declaring that underinsured motorist benefits under
the subject policy equaled the liability limits of
$1,000,000[?]
5. Misconstruing the issue of whether [A]ppellees had
standing to challenge [A]ppellant Evans Delivery’s waiver of
UIM coverage under the policy[?]
[6]. Failing to address whether the Pennsylvania
Motor Vehicle Financial Responsibility law applied to
[A]ppellees[’] vehicle registered in Ohio[?]
7. Failing to declare that the rejection of UIM
coverage form for Pennsylvania was valid and
enforceable[?]
_______________________
(Footnote Continued)
type distinctively displayed--the particular point treated therein[.]”
Pa.R.A.P. 2119(a). Nevertheless, because Appellants’ inconsistent
numbering does not impede our review, and their issues are otherwise
apparent, we will address their claims on their merits.
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(Appellants’ Brief, at 3-4).
We note our standard of review, and related legal principles applicable
to that review:
Our standard of review in a declaratory judgment action is
limited to determining whether the trial court clearly abused its
discretion or committed an error of law. We may not substitute
our judgment for that of the trial court if the court’s
determination is supported by the evidence.
Additionally,
[w]e will review the decision of the lower court as we
would a decree in equity and set aside the factual
conclusions of that court only where they are not supported
by adequate evidence. The application of the law, however,
is always subject to our review.
As noted above, this case involves a dispute regarding
insurance coverage. In actions arising under an insurance
policy, our courts have established a general rule that it is a
necessary prerequisite for the insured to establish that his claim
falls within the coverage provided by the insurance policy.
However, when the insurer relies on a policy exclusion as the
basis for its denial of coverage, the insurer has asserted an
affirmative defense and bears the burden of proving the
exclusion.
Erie Ins. Group v. Catania, 95 A.3d 320, 322-23 (Pa. Super. 2014)
(citations and quotation marks omitted).
Herein, the Declaratory Judgment Act has been invoked to
interpret the obligations of the parties under an insurance
contract. The proper construction of an insurance policy is
resolved as a matter of law to be decided by the court in a
declaratory judgment action. Hence, as with all issues of law,
our review is de novo. Our standard of review in a declaratory
judgment action is narrow. We review the decision of the trial
court as we would a decree in equity and set aside factual
conclusions only where they are not supported by adequate
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evidence. We give plenary review, however, to the trial court’s
legal conclusions. . . .
Insurance policies are contracts, and in reviewing the trial
court’s determination, we are mindful of the following principles.
In interpreting a contract, the court must ascertain the intent of
the parties. Such intent is to be inferred from the written
provisions of the contract. Where the contract language is clear
and unambiguous, we are required to give effect to that
language unless it violates a clearly expressed public policy. We
have been reluctant to invalidate a contractual provision due to
public policy concerns.
Where a provision of a policy is ambiguous, the policy
provision is to be construed in favor of the insured and against
the insurer, the drafter of the agreement. . . .
Policy provisions are ambiguous only when they are
reasonably susceptible of different constructions and
capable of being understood in more than one sense. A
court cannot torture the policy language to create
ambiguities where none exist. This is not a question to be
resolved in a vacuum. Rather, contractual terms are ambiguous
if they are subject to more than one reasonable interpretation
when applied to a particular set of facts. [C]ourts must construe
the terms of an insurance policy as written and may not modify
the plain meaning of the words under the guise of “interpreting”
the policy. If the terms of a policy are clear, this Court cannot
rewrite it or give it a construction in conflict with the accepted
and plain meaning of the language used.
Where, as here, a defense is based on an exception or
exclusion in a policy, the burden is on the insurer to establish its
application. Exclusionary clauses generally are strictly construed
against the insurer and in favor of the insured.
Swarner v. Mutual Ben. Group, 72 A.3d 641, 644-45 (Pa. Super. 2013),
appeal denied, 85 A.3d 484 (Pa. 2014) (citations, some punctuation and
internal quotation marks omitted) (emphases added).
Mandatory offering.─No motor vehicle liability insurance
policy shall be delivered or issued for delivery in this
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Commonwealth, with respect to any motor vehicle
registered or principally garaged in this Commonwealth,
unless uninsured motorist and underinsured motorist coverages
are offered therein or supplemental thereto in amounts as
provided in section 1734 (relating to request for lower limits of
coverage). Purchase of uninsured motorist and underinsured
motorist coverages is optional.
75 Pa.C.S.A. § 1731(a) (emphasis added).
“[T]his Commonwealth does not require UIM coverage. See 75
Pa.C.S. § 1731(a) (requiring the offer of UM and UIM motorist coverage, but
declaring that such coverage is optional).” Burstein v. Prudential
Property and Cas. Ins. Co., 809 A.2d 204, 210 (Pa. 2002).
Underinsured motorist coverage provides “protection for
persons who suffer injury arising out of the maintenance or use
of a motor vehicle and are legally entitled to recover damages
therefor from owners or operators of underinsured motor
vehicles.” 75 Pa.C.S. § 1731(c). While all motor vehicle liability
insurance policies issued for vehicles registered in the
Commonwealth must offer underinsured and/or uninsured
motorist coverage, the 1990 amendments to the Motor Vehicle
Financial Responsibility Law made the purchase of underinsured
and/or uninsured motorist coverage optional. 75 Pa.C.S.
§ 1731(a).
Eichelman v. Nationwide Ins. Co., 711 A.2d 1006, 1007 n.2 (Pa. 1998).
[U]nderinsured motorist coverage serves the purpose of
protecting innocent victims from underinsured motorists who
cannot adequately compensate the victims for their injuries.
That purpose, however, does not rise to the level of public policy
overriding every other consideration of contract construction. As
this Court has stated, there is a correlation between premiums
paid by the insured and the coverage the claimant should
reasonably expect to receive.
Adamitis v. Erie Ins. Exchange, 54 A.3d 371, 376 (Pa. Super. 2012)
(citations and internal quotation marks omitted).
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Moreover, in his Concurring and Dissenting Opinion in
[Prudential Property and Cas. Ins. Co. v.] Colbert[, 813
A.2d 747, 754-55 (Pa. 2002)], then-Justice, now-Mr. Chief
Justice Castille noted:
The overriding concern powering the decisions in
Burstein, Eichelman, and the earlier cases is to ensure
that both insurer and insured receive the benefit of what is
statutorily required and contractually agreed-upon
(consistently with statutory requirements) and nothing
more. As this Court recognized in Eichelman, an insured
should not be permitted to demand coverage for a
risk for which coverage was not elected or premiums
paid.
Id. (some citations omitted) (emphasis added).
In Pennsylvania, an insured is statutorily defined as follows:
“Insured.” 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.
75 Pa.C.S.A. § 1702 (emphases added). “An ‘insured’ is defined at 75
Pa.C.S. § 1702, inter alia, as ‘[a]n individual identified by name as an
insured in a policy of motor vehicle liability insurance.’” Blakney v. Gay,
657 A.2d 1302, 1304 (Pa. Super. 1995) (emphasis added).
“By its terms, the MVFRL applies only to policies delivered or issued for
delivery in Pennsylvania, with respect to any motor vehicle registered
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or principally garaged in Pennsylvania.” Nationwide Mut. Ins. Co. v.
West, 807 A.2d 916, 920-21 (Pa. Super. 2002) (citation omitted; emphasis
added).
Here, we first address Appellants’ sixth question (applicability of
Pennsylvania MVFRL to vehicle registered and principally garaged in Ohio).8
(See Appellants’ Brief, at 54-55). On review, we are constrained to
conclude that the trial court erred in deciding that Appellees had a legal right
to pursue UIM coverage in Pennsylvania under the Evans Delivery policy,
pursuant to the MVFRL.
First, and foremost, the plain language of the MVFRL, under which
Appellees claim, applies to vehicles “registered or principally garaged in this
Commonwealth.” 75 Pa.C.S.A. § 1731(a). There is no dispute that the
vehicle at issue was registered in Ohio and not principally garaged in
Pennsylvania. (See Stipulation ¶ 5). Therefore, the Pennsylvania MVFRL
does not apply to Appellees. See West, supra at 920-21. The trial court
erred on the law in ignoring the plain meaning of these statutory limitations,
as confirmed by controlling caselaw. We lack jurisdiction to consider a claim
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8
Appellees argue that this issue was not preserved for appeal and is waived.
(See Appellees’ Brief, at 32). However, subject matter jurisdiction is always
at issue, and we may raise it sua sponte. See Dougherty v. Heller, 97
A.3d 1257, 1261 (Pa. Super. 2014). “The appealability of an order is a
question of jurisdiction and may be raised sua sponte.” Bolmgren v. State
Farm Fire and Cas. Co., 758 A.2d 689, 690 (Pa. Super. 2000) (citation
omitted).
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which would require us to apply a Pennsylvania statute, in disregard of its
plain meaning, to Ohio residents, in an Ohio accident, involving a truck
registered and garaged in Ohio.9 Appellants are entitled to relief on this
sixth issue alone.10
Moreover, even if we were to assume for the sake of argument that
the Pennsylvania MVFRL did apply, the evidence of record established the
fact that Evans Delivery intentionally rejected UIM coverage in Pennsylvania.
In fact, the parties stipulated that it was the intention of Evans Delivery to
reject UIM (and UM) coverage in the policy at issue. (See Stipulation ¶ 29).
The trial court abused its discretion in ignoring this stipulation along
with companion evidence that Evans Delivery consistently rejected UIM
coverage in virtually every state where it was legally permitted to do so and,
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9
Indeed, the attempt to apply purported Pennsylvania requirements to Ohio
residents, for events which occurred in Ohio, raises choice of law questions
and problems of constitutional dimensions, neither addressed by the trial
court. The trial court concedes that Pennsylvania law does not mandate
coverage in Ohio (“nor could it”). (Trial Ct. Op. 2/18/14, at 14).
Nevertheless, it claims that it is not applying its ruling to Ohio, only
construing Pennsylvania law as to coverage the policy already provides.
(See id.). The bald assertion is counter-intuitive, contradicted by the
evidence of UIM rejection, and, importantly, unsupported by any reference
to controlling authority. We are not persuaded.
10
Because this issue (the non-applicability of Pennsylvania’s MVFRL) is
dispositive, we need not reach the additional issues raised. However, to
avoid any confusion, especially in light of the reasoning of the trial court,
and in the interests of clarity and completeness, we will address Appellants’
other issues on the merits as well.
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where UIM was required, selected the statutory minimum.11 (See Trial Ct.
Op., 2/18/14, at 13; see also Joint Trial Exhibits A-E). Pennsylvania does
not require UIM coverage. See Burstein, supra at 210 (citing 75 Pa.C.S.A.
§ 1731(a)).
The trial court further erred in ruling that Evans Delivery was legally
obligated to provide Appellees the benefit of UIM coverage, even though the
purchase of UIM coverage is optional under Pennsylvania law, and Evans
expressly rejected it. (See Trial Ct. Op., 2/18/14, at 13-14).
Appellees, who are indisputably not named insureds, are not
“insureds” within the statutory meaning of the term. 75 Pa.C.S.A. § 1702.
Therefore, the trial court’s categorical insistence that Appellees were
“indisputably . . . insureds[,]” (Trial Court Opinion, 2/18/14, at 9; see also
id. at 10; Memorandum Opinion, 9/09/13, at 9), is misleading, and at best,
over-simplified.
For purposes of our review of the trial court’s legal conclusions, it is
more appropriate to recognize that, under Pennsylvania law, Appellees
would be, at most, third-party beneficiaries. “An injured person who makes
a claim for uninsured motorist benefits under a policy to which he is not a
signatory is in the category of a third party beneficiary.” Egan v. USI
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11
The only exception is that Appellants could not produce evidence of a
rejection in South Carolina.
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Mid-Atlantic, Inc., 92 A.3d 1, 20 (Pa. Super. 2014) (citation omitted)
(emphasis added).
Because Appellees were not named insureds, they did not elect UIM
coverage under the Evans Delivery policy at issue, indeed, could not, and
indisputably paid no premium for it. Thus, they had no reasonable
expectation, or legally cognizable claim, of UIM coverage. See Been v.
Empire Fire and Marine Ins. Co. 751 A.2d 238 (Pa. Super. 2000), appeal
denied, 764 A.2d 1063 (Pa. 2000):
This Court concludes that the language of the policy
afforded Budget [car rental agency], as the “named insured”,
with the statutory right to reject UM/UIM coverage. Blakney v.
Gay, 441 Pa.Super. 547, 657 A.2d 1302, 1303 (1995), alloc.
den. 542 Pa. 655, 668 A.2d 1119 (1995). Also, there is no
statutory requirement that uninsured motorist benefits be
provided by a liability carrier for third persons who may
be injured by an insured vehicle. Id. at 1304. Lastly, one
may not create UM/UIM coverage where none exists. Id.
Id. at 241 (emphasis added).
Nevertheless, Appellees argue that Evans Delivery’s rejection form was
void, citing Jones v. Unitrin Auto and Home Ins. Co., 40 A.3d 125 (Pa.
Super. 2012). (See Appellees’ Brief, at 33-38). However, we need not
reach the question of the legal adequacy of the rejection form, because, as
we have already decided, the Pennsylvania MVFRL does not apply to
Appellees. Secondly, as third party beneficiaries, Appellees had no
cognizable claim for UIM benefits. See Egan, supra at 20; Been, supra at
241.
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Thirdly, Appellees’ reliance on Jones is misplaced, because Ms. Jones
was a named insured. See Jones, supra at 126. This is not a case in
which the first named insured contests the statutory sufficiency of the notice
on the rejection form, as occurred in Jones. To the contrary, in this appeal
the insurer and the named insured agree that Evans Delivery intentionally
rejected UIM coverage in Pennsylvania, as well as other states where it was
legally permitted to do so. (See Appellants’ Brief, at 16).12
Finally, on this issue, Appellees failed to establish that their claim falls
within the coverage provided by the insurance policy. See Catania, supra
at 322-23. Therefore, Appellants are entitled to relief on their seventh
question (validity of UIM rejection).
Because Appellants intentionally and validly rejected UIM coverage,
they are also entitled to relief on their third question (whether the trial court
erred in its declaration of UIM coverage). Furthermore, because the record
supports the finding that the intent (to reject UIM coverage in Pennsylvania)
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12
Moreover, to the extent that the issue of rejection is not precluded for the
reasons already noted, we would conclude that the rejection form was valid
and binding. See Winslow-Quattlebaum v. Maryland Ins. Group, 752
A.2d 878, 881 (Pa. 2000) (concluding, inter alia, that to give effect to entire
instruction regarding basic UIM waiver, other UIM information on the same
page cannot operate to void rejection form). We further note that “[i]t is
not the prerogative of an intermediate appellate court to enunciate new
precepts of law or to expand existing legal doctrines. Such is a province
reserved to the Supreme Court.” Vosk v. Encompass Ins. Co., 851 A.2d
162, 165 (Pa. Super. 2004) (citation omitted).
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was clear, and the parties stipulated to the intent to reject, (see Stipulation
¶ 29), Appellants are entitled to relief under their second claim as well (trial
court finding intent not clear).
It bears repeating for emphasis and clarification that Appellees are not
named insureds. They had no cognizable legal right to request, did not
request, and did not pay a premium for UIM coverage in Pennsylvania. At
best, they were third party beneficiaries of the policy. Therefore, they had
no reasonable expectation of UIM coverage in Pennsylvania, particularly as
an adjunct for supplementary recovery beyond what was recoverable─and
recovered─under Ohio law. Appellees are not entitled to such relief.
Our conclusion is not altered by the trial court’s assertion of ambiguity.
In their first question, Appellants challenge the trial court’s conclusion, that
an alleged ambiguity in the calculation of the premium entitled the court to
find that the terms of the policy were ambiguous (without limitation), and
must be construed in favor the Appellees. (See Appellants’ Brief, at 3).
Appellants argue that the trial court found an ambiguity where none existed
to provide UIM coverage even though no such coverage existed. (See id. at
25-29). We agree.
We perceive two major difficulties with the reasoning of the trial court.
First, there is no demonstrable ambiguity in the calculation of the premium.
Second, even if there were, it does not justify a reinterpretation of the UIM
provisions of the policy.
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This Court has long recognized that “[i]n this State, we do not ‘create’
a doubt in insurance cases, ‘which would not be tolerated in any other kind
of contract’, in order to resolve it in favor of the insured[.]” McCowley v.
N. Am. Acc. Ins. Co., 29 A.2d 215, 215 (Pa. Super. 1942) (citation
omitted) (collecting cases); see also Huffman v. Aetna Life and Cas. Co.,
486 A.2d 1330, 1334 (Pa. Super. 1984) (recognizing that “this Court cannot
create a doubt for the purpose of resolving it in favor of the insured . . .
where language in an insurance contract is clear and unambiguous,
Pennsylvania courts must give effect to that language.”) (citations omitted)
As we have already noted, “[p]olicy provisions are ambiguous only
when they are ‘reasonably susceptible of different constructions and capable
of being understood in more than one sense.’” Swarner, supra at 645
(citation omitted). Absence of information, even if assumed for the sake of
argument, is not the equivalent of ambiguity, especially when the
information is not relevant to the claims at issue.
Furthermore, an ambiguity once asserted, however tortuously, cannot
be applied ad libitum to any other term in the policy, however clear and
unambiguous in itself. A declaration of ambiguity does not justify a
wholesale reformation of independent, unrelated provisions in a policy. The
trial court offers no supporting authority to the contrary. Moreover, here,
there is no ambiguity, especially none that affect the disposition of this case.
This is a coverage dispute, not a premium pricing dispute.
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While the trial court’s explanation is rather elliptical, it appears to
reason that because the premiums for various items of coverage were
concededly “rolled up” the allocation of premiums was “ambiguous.” (See
Trial Ct. Op., 2/18/14, at 13). The court offers no supporting authority for
this conclusion. (See id.)
Instead, selecting items from various parts of the policy, the trial court
identifies $3,241,960 as the “coverage part” of the premium, (id. at 8; see
also Joint Trial Exhibit E), compares this charge to the premium for liability
coverage ($3,052,243), and finds that the difference ($189,717) constitutes
the premium paid for UM/UIM coverage. (See Trial Ct. Op., 2/18/14, at 8 ¶
41). The court appears to conclude that some of the premium could
therefore be attributable to an allocation for UIM coverage in Ohio for
Appellees. (See Trial Ct. Op. 2/18/14, at 8, ¶¶ 41, 42). Again, this entire
line of reasoning is unsupported by any reference to controlling authority, or
to the facts of record.
To the contrary, the court’s computations and conclusions ignore the
reality that the policy pages from which it derives its basic amounts allocate
nothing for uninsured motorist coverage or underinsured motorist
coverage. (See, e.g., Joint Trial Exhibit E, at 1004; 1007). Rather, the
spaces provided to identify premiums for these coverages are left blank.
Furthermore, the nominal attribution of one and two dollar premiums
for four categories of coverage, including personal injury protection (PIP),
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while the basic premium exceeds three million dollars, lends further support
to the conclusion that the premiums on this policy actually were “rolled up”
rather than itemized.
Therefore, the trial court’s assumptions and mathematical
computations are purely speculative, and contradicted by the express
declarations of the policy. We are constrained to conclude that the trial
court’s findings of fact are not supported by the evidence of record, and it
has abused its discretion.
In any event, Appellees’ claims depend on the applicability of the
Pennsylvania MVFRL, and, alternatively, the validity and enforceability of the
rejection of UIM coverage, not the actuarial apportionment of premiums for
coverage requested. There is no dispute or ambiguity that in this case, the
coverage claimed was not requested by the named insured. It was rejected.
The trial court cannot manufacture an ambiguity in one specific provision of
the policy, and then use it to reform entirely unrelated provisions of the
policy.
It is beyond dispute that Appellees paid no premiums for the additional
UIM coverage now demanded, and, because they are not named insureds,
could not have, even if they tried. Premiums are relevant in this case, or
others like it, only to the extent that a named insured is denied coverage for
which he, she, or it, has paid a corresponding premium. “[T]here is a
correlation between premiums paid by the insured and the coverage the
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claimant should reasonably expect to receive.” Adamitis, supra at 376(citation omitted).
“As this Court recognized in Eichelman, an insured should not be
permitted to demand coverage for a risk for which coverage was not elected
or premiums paid.” Id. (citation omitted). Appellants’ first question would
also merit relief.
In their fourth question, Appellants challenge the trial court’s
determination that UIM benefits are available up to the general policy limits
of one million dollars per accident. (See Appellants’ Brief, at 3). Appellants
argue that the trial court concluded that the only limit to UIM coverage was
the maximum liability limit in the policy, $1,000,000.00.13 (See id., at 46-
51). They cite the trial court’s holding that the lack of a rejection form for
UIM in Ohio (which apparently does not require a formal rejection form),
coupled with the trial court’s determination that UIM coverage was available
under the policy, resulted in the conclusion that there was “no statement
limiting [UIM] coverage for insureds in Ohio.” (Trial Ct. Op., 2/18/14, at
13).14
____________________________________________
13
The trial court never explicitly says this. Nevertheless, on review,
Appellants’ claim is the most reasonable, if not the only, inference to draw
from the trial court’s generalized but sweeping language. (See Trial Ct. Op.,
4/18/14, at 13)
14
The trial court’s Rule 1925(a) opinion discussion of this issue tracks
virtually identical language in its preceding opinion.
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Because we have already determined that Appellees are not entitled to
claim UIM under Pennsylvania law at all, we need not address the trial
court’s determination that they are eligible for UIM benefits up to a million
dollars. Appellees have no legal right to UIM benefits under this policy.
Appellants’ fourth question is moot.
Similarly, we need not address Appellants’ argument in support of its
fifth question, on standing. (See Appellants’ Brief, at 51-53). Appellants’
reliance on Been, supra at 241, is misplaced. (See id., at 52). Been
addresses entitlement to UIM benefits, not standing. It appears that
Appellants may have confused standing to make a claim with entitlement to
relief on the merits. In any event, here, Appellees have had a full and fair
opportunity to present their claims. This issue is also moot.
Finally, we express our sincere concern for the misfortunes visited on
Appellees. However, compassion does not relieve us of our responsibility to
review the issues raised on appeal under our standard of review, and the
related principles of law previously noted. An insurance policy is a contract.
See Swarner, supra at 644. “The overriding concern . . . is to ensure that
both insurer and insured receive the benefit of what is statutorily required
and contractually agreed-upon (consistently with statutory requirements)
and nothing more.” Adamitis, supra at 376 (citations omitted). The
named insured has the statutory right to reject UIM coverage. See Been,
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J-A24044-14
supra at 241. Here, the named insured rejected it. “[O]ne may not create
UM/UIM coverage where none exists.” Id.
Order vacated. Declaration of coverage reversed. Case remanded for
disposition in accordance with this opinion. Jurisdiction relinquished.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 12/16/2014
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