Rourke v. Pennsylvania National Mutual Casualty Insurance ( 2015 )

J-A03006-15
2015 PA Super 100BETTY L. ROURKE, GUARDIAN OF THE IN THE SUPERIOR COURT OF
ESTATE AND PERSON OF FREDERICK PENNSYLVANIA
RICKARD, III, AN INCAPACITATED
PERSON
Appellant
v.
PENNSYLVANIA NATIONAL MUTUAL
CASUALTY INSURANCE CO., A/K/A PENN
NATIONAL
Appellee No. 1028 MDA 2014
Appeal from the Order Entered May 21, 2014
In the Court of Common Pleas of Franklin County
Civil Division at No(s): 2010-3694
BEFORE: MUNDY, J., STABILE, J., and FITZGERALD, J.*
OPINION BY MUNDY, J.: FILED APRIL 28, 2015
Appellant, Betty L. Rourke, appeals from the March 21, 2012 order
granting in part Appellee, Pennsylvania National Mutual Casualty Insurance
Company’s (Penn National), motion for judgment on the pleadings, and the
May 21, 2014 order granting Penn National’s motion for summary
judgment.1 After careful review, we reverse and remand for further
proceedings.
____________________________________________
*
Former Justice specially assigned to the Superior Court.
1
The trial court’s May 21, 2014 order granting Penn National’s motion for
summary judgment rendered the trial court’s March 21, 2012 order
(Footnote Continued Next Page)
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The trial court summarized the relevant factual history of this case as
follows.
This case involves a dispute over insurance
coverage. On January 28, 2010, Frederick Rickard,
III was severely injured in an auto accident while
riding as a passenger in a vehicle driven by his friend
Chad Odonel. Frederick, who was 19 years old at
the time, had been a foster child of James C. Rourke
and Betty L. Rourke. The Rourkes were insured by
[Penn National]. Mr. and Ms. Rourke were named
insureds under a [p]ersonal [a]uto [p]olicy. Mr.
Rourke reported the accident to Strickler Insurance
Company[and spoke to Miranda Lake] on or about
February 4, 2010. At that time, Mr. Rourke
requested that Frederick be added as an “insured
driver” under the policy. Subsequently, the Rourkes
made a claim for UIM coverage and [f]irst [p]arty
[b]enefits for Frederick. Penn National denied the
claim, stating that Frederick was not an “insured”
under the Rourke’s policy.
Trial Court Opinion, 8/5/14, at 1.
On August 27, 2010, Appellant filed a complaint, seeking a declaratory
judgment. Specifically, Appellant’s complaint sought coverage under the
subject policy because Frederick was a “family member” under the terms of
the policy. Appellant’s Complaint, 8/27/10, at ¶¶ 51-67. Appellant also
sought coverage on the theories that Frederick was an insured party on the
policy and that Appellant had a reasonable expectation of coverage for
_______________________
(Footnote Continued)
appealable. See Snizavich v. Rohm & Haas Co., 83 A.3d 191, 194 (Pa.
Super. 2013) (stating, “an appeal of a final order subsumes challenges to
previous interlocutory decisions[]”) (internal quotation marks and citation
omitted), appeal denied, 96 A.3d 1029 (Pa. 2014).
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Frederick. Id. at ¶¶ 67-81. On April 4, 2011, Penn National filed its answer,
along with a counterclaim for declaratory judgment. Penn National filed a
motion for judgment on the pleadings on September 2, 2011. Appellant
filed her response on September 15, 2011, along with a cross-motion for
judgment on the pleadings. On September 27, 2011, Penn National filed its
response to Appellant’s cross-motion. The trial court heard argument on the
motions on January 10, 2012. On March 21, 2012, the trial court entered an
order and opinion granting Penn National’s motion in part, denying it in part,
and denying Appellant’s cross-motion. The trial court concluded that
Frederick was not a family member, nor was he an insured party on
Appellant’s policy. However, the trial court denied Penn National’s motion
regarding Appellant’s reasonable expectation of coverage claim.
On January 23, 2013, Penn National filed a motion for summary
judgment as to Appellant’s reasonable expectation claim. Appellant filed her
response on February 18, 2013. According to the trial court, it took no
action on the motion “as neither party filed a [p]raecipe to [l]ist for
[a]rgument as required by local rule.” Trial Court Opinion, 8/5/14, at 2.
Penn National filed a second motion for summary judgment on August 29,
2013. Appellant filed a response on September 26, 2013. On May 21,
2014, the trial court entered an order granting Penn National’s motion for
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summary judgment. On June 18, 2014, Appellant filed a timely notice of
appeal.2
On appeal, Appellant raises the following issues for our review.
A. Whether the trial court erred in granting [Penn
National]’s motions for judgment on the pleadings
and holding that [Frederick] was not a family
member under the policy entitling him to first party
and UIM benefits[?]
1. Whether [Frederick] is entitled to first
party and UIM benefits as a “foster child” or
“ward” of the Rourkes, where [Penn National]
chose not to define these terms in the policy it
issued to the Rourkes and where the terms are
reasonably susceptible to more than one
meaning, rendering the policy language
ambiguous and requiring that the policy be
construed in favor of coverage?
2. Whether [Frederick] is a “foster child” of
the Rourkes entitling him to first party and UIM
benefits under the terms of the policy?
3. Whether [Frederick] is a “ward” of the
Rourkes, entitling him to first party and UIM
benefits under the terms of the policy where
[Frederick]’s mother is deceased and he had
little interaction with his biological father and
he lived with the Rourkes as a family member
both before and after his dependency was
terminated by Franklin County Children and
Youth Service?
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2
Appellant and the trial court have complied with Pennsylvania Rule of
Appellate Procedure 1925. Relevant to this appeal, we note the trial court’s
August 5, 2014 Rule 1925(a) opinion directs this Court to its March 21, 2012
opinion granting Penn National’s motion for judgment on the pleadings in
part. See Trial Court Opinion, 8/5/14, at 3.
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4. Whether an individual can be a “foster
child” or “ward” without a court order?
5. Whether a “foster child” or “ward” need
not be a minor?
B. Whether the trail [sic] court erred in granting
[Penn National]’s motion for summary judgment and
holding that the Rourkes did not have a reasonable
expectation that [Frederick] would be covered under
the policy for first party and UIM benefits?
1. Whether the Rourkes’ expectation of first
party and UIM benefits for [Frederick] is
reasonable where the record shows that [Penn
National]’s agent offered to add [Frederick]
retroactively to the policy as of the date of the
collision and where the Rourkes paid a
substantial increase in premiums related to the
policy change?
Appellant’s Brief at 5-6 (some capitalization removed).
We begin by noting our well-settled standard of review for judgment
on the pleadings.
Entry of judgment on the pleadings is
permitted under Pennsylvania Rule of Civil Procedure
1034, which provides that “after the pleadings are
closed, but within such time as not to unreasonably
delay trial, any party may move for judgment on the
pleadings.” Pa.R.C.P. 1034(a). A motion for
judgment on the pleadings is similar to a demurrer.
It may be entered when there are no disputed issues
of fact and the moving party is entitled to judgment
as a matter of law.
Appellate review of an order granting a motion
for judgment on the pleadings is plenary. The
appellate court will apply the same standard
employed by the trial court. A trial court must
confine its consideration to the pleadings and
relevant documents. The court must accept as true
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all well pleaded statements of fact, admissions, and
any documents properly attached to the pleadings
presented by the party against whom the motion is
filed, considering only those facts which were
specifically admitted.
We will affirm the grant of such a motion only
when the moving party’s right to succeed is certain
and the case is so free from doubt that the trial
would clearly be a fruitless exercise.
Sw. Energy Prod. Co. v. Forest Res., LLC, 83 A.3d 177, 185 (Pa. Super.
2013) (citation omitted), appeal denied, 96 A.3d 1029 (Pa. 2014).
Additionally, we note that interpretation of an insurance policy presents a
pure question of law, over which our standard of review is de novo. Peters
v. Nat’l Interstate Ins. Co., 108 A.3d 38, 42 (Pa. Super. 2014) (citation
omitted).
We elect to first address the portion of Appellant’s argument
concerning Frederick’s status as a ward. It is undisputed in this case that
the plain text of the subject policy provides coverage for family members. It
is also not in dispute that under the explicit terms of the policy, the term
“‘[f]amily 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.” Appellant’s Complaint, 8/27/10, Exhibit B, Form PP 00 01 06 98, at
1. The policy does not define the terms “foster child” or “ward.”
The goal in construing and applying the
language of an insurance contract is to effectuate the
intent of the parties as manifested by the language
of the specific policy. 401 Fourth St. Inc. v.
Investors Ins. Grp., 879 A.2d 166, 171 (Pa. 2005);
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Lititz Mut. Ins. Co. v. Steely, 785 A.2d 975, 978
(Pa. 2001). When the language of an insurance
policy is plain and unambiguous, a court is bound by
that language. 401 Fourth St. Inc., 879 A.2d at
171. Alternatively, if an insurance policy contains an
ambiguous term, “the policy is to be construed in
favor of the insured to further the contract’s prime
purpose of indemnification and against the insurer,
as the insurer drafts the policy, and controls
coverage.” Id. Contract language is ambiguous if it
is reasonably susceptible to more than one
construction and meaning. Lititz Mut. Ins., 785
A.2d at 978. Finally, the language of the policy must
be construed in its plain and ordinary sense, and the
policy must be read in its entirety. Riccio v. Am.
Republic Ins. Co., 705 A.2d 422, 426 (Pa. 1997).
Pa. Nat’l Mut. Cas. Ins. Co. v. St. John, 106 A.3d 1, 14 (Pa. 2014)
(parallel citations omitted).
Appellant argues that Frederick was a “ward” of her family within the
meaning of the policy so as to provide for coverage. Appellant’s Brief at 34.
Specifically, Appellant argues that Frederick was a ward because she and her
husband “were, at the least, [Frederick]’s quasi-guardians at the time of the
collision, providing him with clothing, shelter, money, food, and emotional
support.” Id. Appellant relies heavily on this Court’s decision in Donegal
Mutual Insurance Co. v. Raymond, 899 A.2d 357 (Pa. Super. 2006), in
support of her argument.
In Raymond, the plaintiff filed a declaratory judgment action seeking
insurance coverage for injuries sustained as a passenger in an automobile
accident, which occurred on September 28, 1998. Id. at 358. This Court
framed the issue as “whether [Raymond] was a ‘ward’ or ‘foster child’ such
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that the injuries sustained … are the obligation of [the insurance company]
to pay?” Id. This Court reviewed the terms of the subject policy, which
contained, verbatim, the same definition of “family member” as is found in
the policy subject to the instant appeal. Id. at 361.
In deciding whether Raymond was a “ward” within the meaning of the
policy, this Court rejected the insurance company’s argument that becoming
a ward “require[s] formal action by a Court for legal recognition.” Id. This
Court looked to “the public policy of this Commonwealth” and noted that
Raymond fit within the Motor Vehicle Financial Responsibility Law’s (MVFRL)
definition of an insured as he was “residing in the household of the named
insured as a minor in the custody of the named insured when the accident
occurred[.]” Id. at 364. This Court also looked to the circumstances
surrounding Raymond’s living situation with the insureds, the Decker family.
Additionally, the record discloses that
[Raymond] resided with and was cared for by the
Deckers between August 28, 1997, and June 12,
1998, which latter date he returned to live with his
biological parent. It was only when [Raymond]
phoned the Deckers on September 28, 1998, and
advised them of his [Mother being evicted from her
home] that the former foster parents agreed to
provide him with living arrangements. These
amenities included sleeping accommodations, a place
to keep all of [Raymond]’s clothes, and a family
physician to attend to the medical needs of the child
while under the Deckers’ roof. Deposition of
[Raymond], 3/11/02, at 10, 13. Furthermore,
[Raymond] remained with the Deckers for almost ten
(10) months after September 28, 1998, despite
[Children and Youth Services of Lackawanna
County’s] knowledge of his whereabouts. To
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interject into this family environment the lack of a
parental consent agreement or a court order as the
predicate to deny Appellee ward status on the day of
accident is pure sophistry. See Deposition of Donald
P. Nicastro, 11/11/02, at 22–23 ([Raymond]’s father
signed a voluntary agreement on September 30,
1998, and the court issued an order on October 9,
1998, naming [Raymond] “a ward of the
Deckers[.]”).
Id. Based on the above, the Raymond Court concluded that Raymond was
a ward of the Decker family.
Whether created by court order or not,
[Raymond] was under the protection of the Deckers
and had been for almost one year before the
vehicular accident. All of the elements of a
relationship of protector and ward were present
except for a formal designation of the relationship
from a court of competent jurisdiction or a parental
execution of a consent agreement. Nonetheless, the
relationship that existed was created by a history of
the Deckers providing [Raymond] with care and
protection, and his integration into the Deckers’
family continued as of the date of the accident on
September 28, 1998, and beyond until reunited with
his natural mother on June 10, 1999.
Id. Therefore, this Court affirmed the judgment entered in favor of
Raymond and against the insurance company. Id. at 365.
Turning to the case sub judice, we note, as the trial court did, that this
case is strikingly similar to Raymond. Specifically, Appellant’s complaint
alleged as follows.
24. [Frederick], was adjudicated dependent and
placed in the custody of Franklin County Children
and Youth on October 30, 2003.
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25. To date, [Frederick], had continuously lived
with and been dependent upon foster parents, Betty
L. Rourke and James C. Rourke since his placement
with the Rourkes in October 2003.
26. During more than six years of dependency
upon his foster parents, [Frederick] has maintained
his own bedroom and kept his clothing and all other
personal belongings at his foster parents’ home.
27. The Rourkes have supported [Frederick], both
financially and emotionally. They have provided all
of his necessities and most importantly have loved
and nurtured [Frederick] during the past six and a
half years he has lived in their home.
28. Other than having a different last name,
[Frederick] had been and continues to be treated in
all respects as the Rourkes’ natural child, and, for
the past six and a half years, he has maintained a
parent-son relationship with the Rourkes.
29. The Rourkes refer to [Frederick] as their son
and he often calls them “mom and dad”, [Frederick]
calls his foster sisters “sis”, and the Rourke’s
relatives treat [Frederick] the same as they treat the
Rourke’s [sic] biological children.
30. [Frederick]’s natural mother is deceased;
[Frederick]’s natural father has minimal contact with
his son. In fact, [Frederick]’s natural father has not
called or visited his son since [Frederick] was
released from the hospital following the collision.
31. After turning eighteen years of age on
September 14, 2008, [Frederick], remained in the
custody of the Franklin County Children and Youth
and remained dependent upon the Rourkes, in order
to complete secondary education.
…
43. Upon withdrawing from Allegheny College,
[Frederick] did not seek full-time employment, but
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remained financially dependant [sic] on the Rourke’s
[sic] while he pursued enrolling in Shippensburg
University.
44. Upon being terminated from Franklin County’s
foster care program, [Frederick] continued to be the
Rourke’s [sic] de facto foster child or ward.
45. Despite no longer receiving a stipend from the
County, the Rourkes continued to support
[Frederick] by providing food and shelter, paying his
bills, and continued to love and nurture him as
though he was their biological son.
46. After [Frederick] was terminated from the
foster care program, the Rourke’s [sic] continued
[to] act as [Frederick]’s de facto foster parents or
guardians as they provided financial and emotional
support to [Frederick] despite not being legally
obligated to do so.
47. After [Frederick] was terminated from the
foster care program, the Rourke’s [sic] continued to
look upon [Frederick] as their natural son and
intended to help provide for his college education.
Appellant’s Complaint, 8/27/10, at ¶¶ 24-31, 43-47.
Instantly, the trial court acknowledged that, as a factual matter, the
facts pled by Appellant in her complaint were very similar to those of
Raymond. Trial Court Opinion, 3/21/12, at 7. Appellant’s complaint
alleged that Frederick lived with her family continuously since October 2003,
had his own bedroom, and all of his personal possessions were in her home.
Appellant’s Complaint, 8/27/10, at ¶ 26. The complaint also alleged that
Appellant and her husband have financially supported Frederick since then.
Id. at ¶¶ 27, 43-47. Given our standard of review, accepting the allegations
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of fact set forth in the complaint as true, we see no distinction between
Raymond and the case sub judice. As in Raymond, the complaint
adequately pled that Frederick was a de facto ward and this relationship
“was created by a history of the [Rourkes] providing [Frederick] with care
and protection, and his integration into the [Rourkes]’ family[.]” Raymond,
supra. Frederick benefited from a former adjudicated foster child
relationship with the Rourkes but enjoyed a current ward status.
Despite this, Penn National argues, and the trial court concluded, that
Raymond is distinguishable from the instant case as Frederick was not a
minor at the time of the accident. Penn National’s Brief at 9; Trial Court
Opinion, 3/21/12, at 8. The complaint alleges that Frederick turned 18
years of age on September 14, 2008, his dependency was terminated on
January 19, 2010, and the collision occurred on January 28, 2010.
Appellant’s Complaint, 8/27/10, at ¶¶ 6-7, 31, 38-39. Therefore, from
September 14, 2008 until January 19, 2010, Frederick was still dependent
and was not a minor. Penn National appears to acknowledge that Frederick
would be eligible for coverage had his dependency not been terminated.
See Penn National’s Brief at 8 (stating, in relevant part, that Frederick was
not a ward because “he was a competent, nineteen-year-old man who did
not qualify as a foster child and indeed had already been formally
adjudicated as no longer a ‘dependent child[]’”). It therefore follows that
Frederick’s age does not factor into the calculus, as Frederick was covered
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under the policy, at a minimum, as a ward of the Rourkes past his 18th
birthday.
Moreover, we reject Penn National’s assertion that a ward relationship
cannot be established without a court order, as that argument was rejected
by this Court in Raymond. Raymond, supra at 364. Raymond also
stands in part for the proposition that the term “ward” in an insurance
contract that contains no further definition is an ambiguous term, as it is
susceptible to more than one definition.3 See id. at 361-363; St. John,
supra. Indeed, the trial court cited Black’s Law Dictionary for the definition
of “ward” as “a person usu. a minor, who is under a guardian’s charge or
protection.” Black’s Law Dictionary 1614 (8th ed. 2004) (emphasis added);
Trial Court Opinion, 3/21/12, at 5.4 As it is not specifically defined, there is
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3
In its opinion in this case, the trial court acknowledged that the terms
“foster child” and “ward” are susceptible to more than one dictionary
definition. See generally Trial Court Opinion, 3/21/12, at 3-5.
4
Curiously, Penn National, in its brief in support of its motion for judgment
on the pleadings gives Wikipedia’s definition as “someone placed under the
protection of a legal guardian[.]” Penn National’s Brief in Support of Motion
for Judgment on the Pleadings, 9/19/11, at 8.
Wikipedia describes itself as “a multilingual, web-based, free-content
encyclopedia project … [and] is written collaboratively by largely anonymous
volunteers who write without pay. Anyone with Internet access can write
and make changes to Wikipedia articles, except in limited cases where
editing is restricted to prevent disruption or vandalism.” Wikipedia,
http://en.wikipedia.org/wiki/Wikipedia:About (last visited Feb. 12, 2015).
We note that some federal courts have disapproved of citation to Wikipedia.
See generally United States v. Lawson, 677 F.3d 629, 650 (4th Cir.
(Footnote Continued Next Page)
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an ambiguity as to whether the term “ward” requires that the person be a
minor. Even accepting the trial court’s definition from Black’s Law
Dictionary, it only says that a ward is usually a minor. See Black’s Law
Dictionary 1614 (8th ed. 2004). Therefore, even the trial court’s preferred
definition does not foreclose the conclusion that a person may be a “ward”
and not be a minor.
Here, the insurance policy included the term “ward” within the broader
term “family member.” We recognize that the term “ward” may carry with it
potentially specialized legal meanings when defining legal duties among
parties. See generally In re Guardianship of Zorek, 475 A.2d 817, 818
(Pa. Super. 1984). However, these contexts, not being defined in the
insurance policy, are not likely to be readily understood by the average
insured, especially as the term is included expansively as part of the more
familiar term “family member.” Thus an insured, relying on a general
understanding of the relational nature of a ward, may not be alerted of a
need to take other legal action to extend coverage to a household member.
As noted above, our cases unequivocally state that “if an insurance
policy contains an ambiguous term, the policy is to be construed in favor of
_______________________
(Footnote Continued)
2012), cert. denied sub nom., Gilbert v. United States, 133 S. Ct. 393(2012); Li v. Holder, 400 F. App’x 854, 857-858 (5th Cir. 2010); Basada
v. Mukasey, 540 F.3d 909, 910-911 (8th Cir. 2008). Although our
Supreme Court has not commented on the subject, we generally look at
arguments involving citations to Wikipedia with skepticism.
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the insured to further the contract’s prime purpose of indemnification and
against the insurer, as the insurer drafts the policy, and controls coverage.”
Pa. Nat’l Mut. Cas. Ins. Co., supra. Penn National, as the drafter of the
policy, elected not to include a definition of “ward” in the policy. Nothing
prevents Penn National or any insurer from drafting its policies and
definitions more precisely or narrowly to avoid future litigation. However, it
did not do so in this case. This Court must examine and construe the policy
as it exists, not the way Penn National wishes it had drafted it with the
benefit of hindsight. The law does not permit Penn National to give a
definition in its policy and then post hoc, after a loss is reported, add an
additional textual limitation onto the same term. Stated another way, Penn
National cannot add an age restriction onto the term “ward” that is not
contained within the policy at the time of its issuance. Based on these
considerations, we hold that Appellant has sufficiently pled that Frederick
was a ward of the Rourkes at the time of the loss, within the meaning of the
policy.5 Accordingly, we conclude that the trial court erred in granting
judgment on the pleadings to Penn National based on its conclusion that
Frederick was not a ward of the Rourkes.
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5
In light of our conclusion, we need not address Appellant’s argument as to
whether Frederick qualifies as a “foster child” within the meaning of the
policy. See Raymond, supra at 365 n.6.
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We next address Appellant’s reasonable expectation of coverage issue,
which was the subject of the trial court’s May 21, 2014 order granting
summary judgment in favor of Penn National. Appellant argues that the trial
court erred when it granted summary judgment to Penn National on the
claim that she had a reasonable expectation of coverage for Frederick under
the subject policy. Appellant’s Brief at 50. We begin by noting our well-
settled standard of review.
“[O]ur standard of review of an order granting
summary judgment requires us to determine
whether the trial court abused its discretion or
committed an error of law[,] and our scope of review
is plenary.” Petrina v. Allied Glove Corp., 46 A.3d
795, 797–798 (Pa. Super. 2012) (citations omitted).
“We view the record in the light most favorable to
the nonmoving party, and all doubts as to the
existence of a genuine issue of material fact must be
resolved against the moving party.” Barnes v.
Keller, 62 A.3d 382, 385 (Pa. Super. 2012), citing
Erie Ins. Exch. v. Larrimore, 987 A.2d 732, 736
(Pa. Super. 2009) (citation omitted). “Only where
there is no genuine issue as to any material fact and
it is clear that the moving party is entitled to a
judgment as a matter of law will summary judgment
be entered.” Id. The rule governing summary
judgment has been codified at Pennsylvania Rule of
Civil Procedure 1035.2, which states as follows.
Rule 1035.2. Motion
After the relevant pleadings are closed, but
within such time as not to unreasonably delay
trial, any party may move for summary
judgment in whole or in part as a matter of law
(1) whenever there is no genuine issue
of any material fact as to a necessary
element of the cause of action or defense
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which could be established by additional
discovery or expert report, or
(2) if, after the completion of discovery
relevant to the motion, including the
production of expert reports, an adverse
party who will bear the burden of proof
at trial has failed to produce evidence of
facts essential to the cause of action or
defense which in a jury trial would
require the issues to be submitted to a
jury.
Pa.R.C.P. 1035.2.
“Where the non-moving party bears the
burden of proof on an issue, he may not merely rely
on his pleadings or answers in order to survive
summary judgment.” Babb v. Ctr. Cmty. Hosp.,
47 A.3d 1214, 1223 (Pa. Super. 2012) (citations
omitted), appeal denied, 65 A.3d 412 (Pa. 2013).
Further, “failure of a non-moving party to adduce
sufficient evidence on an issue essential to his case
and on which he bears the burden of proof
establishes the entitlement of the moving party to
judgment as a matter of law.” Id.Thus, our responsibility as an appellate
court is to determine whether the record either
establishes that the material facts are
undisputed or contains insufficient evidence of
facts to make out a prima facie cause of
action, such that there is no issue to be
decided by the fact-finder. If there is evidence
that would allow a fact-finder to render a
verdict in favor of the non-moving party, then
summary judgment should be denied.
Id., citing Reeser v. NGK N. Am., Inc., 14 A.3d
896, 898 (Pa. Super. 2011), quoting Jones v.
Levin, 940 A.2d 451, 452–454 (Pa. Super. 2007)
(internal citations omitted).
Cadena v. Latch, 78 A.3d 636, 638-639 (Pa. Super. 2013).
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This Court explained the reasonable expectation of coverage doctrine
in the following terms.
The reasonable expectation of the insured is
the focal point of the insurance transaction
involved here. Beckham v. Travelers
Insurance Co., 225 A.2d 532, 537 ([Pa.]
1967). Courts should be concerned with
assuring that the insurance purchasing public’s
reasonable expectations are fulfilled. Thus,
regardless of the ambiguity, or lack thereof,
inherent in a given set of insurance documents
(whether they be applications, conditional
receipts, riders, policies, or whatever), the
public has a right to expect that they will
receive something of comparable value in
return for the premium paid …. Through the
use of lengthy, complex, and cumbersomely
written applications, conditional receipts,
riders, and policies, to name just a few, the
insurance industry forces the insurance
consumer to rely upon the oral representations
of the insurance agent …. Courts must
examine the dynamics of the insurance
transaction to ascertain what are the
reasonable expectations of the consumer.
See, e.g., Rempel v. Nationwide Ins. Co.,
370 A.2d 366 ([Pa.] 1977).
Tonkovic[ v. State Farm Mut. Auto Ins. Co., 521
A.2d 920, 926 (Pa. 1987)].
“Consumers … view an insurance agent … as
one possessing expertise in a complicated subject.”
[Id. at 368.] “It is therefore not unreasonable for
consumers to rely on the representations of the
expert rather than on the contents of the insurance
policy itself.” Id.[].
Pressley v. Travelers Prop. Cas. Corp., 817 A.2d 1131, 1140-1141 (Pa.
Super. 2003) (parallel citations and footnote omitted). Our Supreme Court
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has also instructed that the reasonable expectations doctrine exists in part
to protect non-commercial insureds from both deception and non-apparent
terms. Madison Constr. Co. v. Harleysville Mut. Ins. Co., 735 A.2d 100,
109 n.8 (Pa. 1999); Tonkovic, supra at 925-926; see also Pressley,
supra at 1140 n.3.
In this case, Appellant argues that the totality of the circumstances
surrounding the reporting of the loss shows that her expectation that
Frederick would be covered as a “named insured” under the policy was
reasonable. Appellant’s Brief at 45. Specifically, Appellant avers that based
on her “affirmative allegations, Lake’s poor memory, and Strickler’s own
records, the only solid evidence suggests that the conversation occurred
according to [Appellant]’s version of events.” Id. at 49-50.
Lake testified at her deposition that she had no memory of any phone
calls between her and Mr. Rourke. N.T., 4/25/13, at 22. Specifically, Lake
had no recollection of what she would have discussed with either of the
Rourkes regarding their policy. Id. at 23. Utilizing the notes in her file,
Lake testified that a phone call between her and Mr. Rourke took place on
February 3, 2010. Id. at 27. Lake noted that there was a policy change to
add Frederick as a listed driver to a 2001 Ford Windstar, a vehicle on the
Rourkes’ policy, retroactive to January 28, 2010. Id. 28, 29. Lake testified
this would have been at Mr. Rourke’s request. Id. at 33. However, when
asked “[i]f [the Rourkes] asked [her] if there’s any way that [she knew] of
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that [Frederick] could be covered for [a] crash from a week ago[,]” Lake
answered “[n]o, and that’s insurance fraud.” Id. at 34. Lake explained
that, according to the records in the file, Penn National retroactively added
Frederick as a listed driver to one of the Rourkes’ vehicles as of January 28,
2010. Id. at 36. However, Lake stressed being a listed driver on a covered
vehicle is different than being a named insured on the policy. Id. Lake did
not provide any explanation for why Penn National applied the change
retroactively.
However, also contained within the record is the Rourkes’ auto policy
and a record of the premiums due before and after Frederick was added
retroactive to January 28, 2010. It is clear that the Rourkes incurred
additional premiums as a result of this change in the policy.6 See generally
Appellant’s Response to Penn National’s Motion for Summary Judgment,
2/20/13, Exhibit A, at 2, 4, 8, 10.7 Yet, under Penn National’s position, no
benefit was derived by the Rourkes from the requested retroactive
application of the change. Viewing the “dynamic” of the instant transaction,
it is the retroactive application of the changes to the policy together with the
admitted conversation between Mr. Rourke and Lake that creates a genuine
____________________________________________
6
The additional premium of $497.00, when parsed out, reflect only benefits
due an additional driver but that is only a factor to consider in evaluating the
Rourkes reasonable expectations.
7
We note the exhibit does not contain pagination. Therefore, we have
assigned each page a corresponding number for ease of reference.
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material question of fact as to the reasonable expectation of coverage the
Rourkes may have had. See Pressley, supra.As noted above, Lake testified that she could not recall the content of
her conversation with Mr. Rourke. N.T., 4/25/13, at 22. Additionally, the
parties agree that it was Frederick’s loss that was the entire purpose of Mr.
Rourke’s conversation with Penn National. Finally, there is no explanation in
the record for why any changes would be made retroactively if no benefit
could be derived as a result. Accordingly, the representations made by
Lake, the expectations held by the Rourkes, and the reasonableness of those
expectations become an issue for the jury. See Pressley, supra; Cadena,
supra. Therefore, under the unique circumstances of this case, we agree
with Appellant that there is a genuine issue of material fact as to whether
she reasonably believed that Frederick would be covered. This is for a jury
to resolve as a matter of fact. See Cadena, supra.Based on the foregoing, we conclude the trial court erred when it
granted Penn National’s motion for judgment on the pleadings, to the extent
it held that Frederick was not a ward of the Rourkes. We further conclude
that the trial court abused its discretion in granting Penn National’s motion
for summary judgment on Appellant’s reasonable expectation of coverage
issue. Accordingly, the trial court’s March 21, 2012 and May 21, 2014
orders are reversed, and the case is remanded for further proceedings,
consistent with this opinion.
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Orders reversed. Case remanded. Jurisdiction relinquished.
Judge Stabile joins the opinion.
Justice Fitzgerald concurs in the result.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 4/28/2015
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