DocketNumber: C.A. Nos. PB 02-6524, PB 02-4764, PB 02-6983
Judges: SILVERSTEIN, J.
Filed Date: 11/21/2006
Status: Precedential
Modified Date: 7/6/2016
The pertinent facts in this case appear to be undisputed. An automobile accident occurred in Rhode Island between Claimant and Tortfeasor. Claimant allegedly suffered personal injuries as a result of Tortfeasor's negligence. Claimant's damages are unclear on the record, but in all cases the damages allegedly exceed the amount of Claimant's UM policy limits. At the time of the accident, Tortfeasor was a resident of Massachusetts and was insured under an automobile liability policy issued by Trust Insurance Company (Trust). Under that policy, Trust agreed to insure Tortfeasor for damages for which he was legally responsible up to the limits of coverage stated in the insurance policy.2
On August 2, 2000, Trust was found to be insolvent by a court of competent jurisdiction in Massachusetts. As a result of Trust's insolvency, the Mass. Fund became obligated to pay "covered claims" arising out of certain Trust policies as provided by Mass. Gen. Laws c. 175D, §§ 1-16. Rhode Island has a similar statute, the Rhode Island Insurers' Insolvency Fund Act, G.L. 1956 §§
Claimant was a resident of Rhode Island at the time of the accident, and was insured under an UM policy issued by UMCo. That policy provided Claimant with coverage for damages caused by uninsured motorists, including those motorists whose insurer becomes insolvent,3 up to limits stated in the policy.4 UMCo has paid to Claimant an amount equal to her UM policy limit as a result of the automobile accident and Trust's insolvency.
The Mass. Fund seeks a declaration that any liability to Claimant on a covered claim resulting from Trust's insolvency should be offset by amounts that Claimant recovers from her UM policy. It also seeks a declaration that Claimant may not recover from Tortfeasor except to the extent that her claims exceed amounts already recovered from her UM policy. Claimant and Tortfeasor have both objected to the motion for summary judgment.
Background of Insurers Insolvency Funds
In 1969, the National Association of Insurance Commissioners drafted a model act — adopted in different forms by both Massachusetts and Rhode Island — which governs insurers' insolvency funds. See Post-Assessment Property and Liability Insurance Guaranty Association Model Act at www.lexis.com, 3 NAIC Model Laws, Regulations and Guidelines 540-1, Legislative History (Nat'l Ass'n of Ins. Comm'rs, April, 2006) (hereinafter NAIC Model Act). The purpose of the act is to
"provide a mechanism for the payment of covered claims under certain insurance policies, to avoid excessive delay in payment and to the extent provided in this Act minimize financial loss to claimants or policyholders because of the insolvency of an insurer, and to provide an association to assess the cost of such protection among insurers." Id. § 2; see G.L. 1956 §
27-34-2 (containing a similar provision, but stating that the purpose is to "avoid financial loss" as opposed to merely minimizing loss to the extent provided in the act).5
These purposes are achieved by assessments on liability carriers which do business in states which have enacted the NAIC Model Act. NAIC Model Act § 8(3). The insurers, in turn, pass the costs of the insolvency fund onto their insureds through higher premiums. See id. § 16.
When an insurer becomes insolvent, the Act provides that a state's insolvency fund is only obligated to pay "covered claims." Id. § 8(A)(1)(a). A covered claim is defined as
"an unpaid claim, including one for unearned premiums, submitted by a claimant, which arises out of and is within the coverage and is subject to the applicable limits of an insurance policy to which this Act applies issued by an insurer, if the insurer becomes an insolvent insurer after the effective date of this Act." Id. § 5(F).6
Therefore, a covered claim is one which is within the coverage of a policy issued by an insurer if the insurer becomes insolvent. A covered claim does not include, however, any "amount due any reinsurer, insurer, insurance pool or underwriting association as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise." Id. § 5(F)(3)(c). In this way, some protection is provided to claimants and policyholders from an insurer's insolvency, but other members of the insurance industry do not benefit from the insolvency fund.
The provision of the Act that is central to the dispute at bar is titled "Exhaustion of Other Coverage" in the NAIC Model Act.Id. § 12. Prior to 1996, this section was called "Nonduplication of recovery," but the NAIC Model Act changed the name "to better reflect the intent of the section." Id., Legislative History.7 For convenience, the Court will refer to provisions of this type as "exhaustion provisions." The Model Act's exhaustion provision has been modified over the years, but now states that
"[a]ny person having a claim against an insurer whether or not the insurer is a member insurer under any provision in an insurance policy other than a policy of an insolvent insurer which is also a covered claim, shall be required to exhaust first his or her right under the policy. An amount payable on a covered claim under this Act shall be reduced by the amount of recovery under the insurance policy. Id. § 12.
Therefore, when an insured or claimant asserts a claim against an insolvency fund, the claim is offset by recoveries obtained from other sources. While both the Massachusetts and Rhode Island exhaustion provisions derive from the same source, Plaintiff and Defendants have contrasting views — which correspond to the contrasting views expressed by the high courts in Massachusetts and Rhode Island, respectively — over how the exhaustion provision applies.
The Exhaustion Provisions in Rhode Island and Massachusetts
The leading case interpreting Rhode Island's exhaustion provision is Rhode Island Insurers Insolvency Fund v. Benoit,
The victim brought two claims: one against his own insurer for the $50,000 UM coverage,8 and one claim against the R.I. Fund for $25,000 as a covered claim resulting from the insolvency of the tortfeasor's liability insurer. Id. at 306. Consequently, the R.I. Fund brought a declaratory judgment action, similar to the cases at bar, arguing that it had no liability to the victim's estate because the estate had recovered under her UM policy, and that the UM recovery must be offset against the R.I. Fund's liability. See id. at 305.9 Because the $50,000 UM policy exceeded the limits of the $25,000 liability policy, the R.I. Fund argued that it had no liability.Id. at 306.
The Court looked to the Rhode Island Act's exhaustion provision, which states that
"[a]ny person having a claim against an insurer under any provision in an insurance policy other than a policy of an insolvent insurer which is also a covered claim, shall be required to exhaust first his or her right under that policy. Any amount payable on a covered claim under this chapter shall be reduced by the amount of any recovery under the insurance policy." §
27-34-12 (a) (emphasis added).
The Court found that since the victim's UM claim was asserted against its own insurer, and not the insolvent insurer, it fell outside the definition of covered claim. Id. at 307; see G.L. 1956 §
As a result, the victim's estate received the following amounts towards her damages, which exceeded $100,000: a $50,000 recovery from her own UM policy; and $25,000 as a covered claim from the R.I. Fund. Id. at 308. The Court noted that this result furthered the policy of the provision — to avoid duplicate recoveries — because the victim's estate did not receive more than she would have received if the liability insurer had not become insolvent. Id.10 Therefore, the R.I. Fund could not "offset an amount due from an insolvent insurer in the event a claimant has not received full compensation for damages." Id. Therefore, the rule in Rhode Island is that the R.I. Fund's liability to pay covered claims will be offset by amounts received from UM policies only to the extent that it would result in a victim receiving more than the amount of her damages.11 Otherwise, the R.I. Fund is not entitled to an offset, and must pay as much as is necessary to make the victim whole, after accounting for UM recoveries, up to the stated limits of the liability policy.
In a case similar to Benoit, the Supreme Judicial Court of Massachusetts has expressed a different view on its own exhaustion provision. See Vokey v. Massachusetts InsurersInsolvency Fund,
The Supreme Judicial Court denied the victim's claims even though he still had unpaid damages. The Massachusetts provision states that:
"[a]ny person having a claim against his insurer under any insolvency provision in his insurance policy which is also a covered claim shall be required to exhaust first his right under such policy. Any amount payable on a covered claim under this chapter shall be reduced by the amount of such recovery under the claimant's insurance policy." Mass. Gen. Laws, c.
175D, § 9 (emphasis added).
The court found that "the purpose of the exhaustion requirement of the first sentence of § 9 is to render the [Mass.] Fund a source of last resort in the event of insolvency." Vokey,
The court held that the exhaustion provision required that UM recoveries be offset against the Mass. Fund's liability on covered claims. See id. at 785-86. Therefore, the Massachusetts rule is that the insolvency fund will pay only so much as is necessary for the victim to receive — from all insurance sources — the amount that he or she would have received under the tortfeasor's liability insurance policy.14 If the UM coverage is greater than or equal to the tortfeasor's liability coverage, the Mass. Fund has no liability, and the only way for a victim to obtain a recovery greater than the tortfeasor's liability policy is to have UM coverage that exceeds those liability limits.15
That two similar enactments of the same model provision can be interpreted in such contrasting ways demonstrates that the provision was "neither a model of clarity nor an exemplar of the draftsman's craft." Benoit,
Under the Rhode Island interpretation, claimants and policyholders will bear less of the harm from automobile accidents when an insurer becomes insolvent because there will be a greater pool of funds from which to recover. To cover his or her damages, the claimant can recover the limit of his UM policy from his own insurer, and, if necessary, the limit of the tortfeasor's liability policy from the insolvency fund. Conversely, under the Massachusetts rule, there will be less insurance available — between UM coverage and the insolvency fund — to compensate claimants. The claimant's total recovery from insurance sources is limited to the tortfeasor's liability policy limit, or his own UM limit if it happens to be higher, but not the sum of both as in Rhode Island. Therefore, a greater part of the losses will fall either to the tortfeasor — who will be liable on the amounts in excess of his liability policy — or if he is judgment-proof, the claimant will bear the loss. So if the purpose of an insolvency fund is to "minimize" or "avoid financial loss to claimants and policyholders," the Rhode Island rule better accomplishes that goal. See G.L. 1956 §
That protection has a cost, however. Under the Rhode Island rule, the insolvency fund will pay more claims, and therefore, charge higher assessments to its member insurers whose customers will pay higher premiums for liability insurance. Conversely, under the Massachusetts rule, the fund will pay fewer claims, charge less to its member insurers, and their customers should pay less in insurance premiums. The Massachusetts legislature is entitled to decide the extent of losses it will insure and which it will leave for tortfeasors and their victims to bear because it was never required to create an insolvency fund in the first place. See Vokey,
Choice of Law Issues as to the Mass. Fund's Liability
It is clear that the law in Rhode Island and in Massachusetts is well-settled in opposite directions. The high courts in the respective states have concluded that their legislatures intended different results when they enacted slightly different versions of the exhaustion provisions. Therefore, this Court must decide which jurisdiction's law to apply to the cases at bar.
Rhode Island choice of law rules seek to apply the law of the forum with the most significant interest in having its law applied. See, e.g., Blais v. Aetna Casualty Sur. Co.,
It would be an absurd result if the Mass. Fund, an association created by Massachusetts statute, which is funded by Massachusetts insurers who write policies covering Massachusetts motorists and whose obligation to pay arises from a Massachusetts statute, should have that statute interpreted according to Rhode Island case law. As our Supreme Court noted, it would be improper to try to interpret Massachusetts law using the precedents of Rhode Island:
"When we are presented with an issue to be governed by foreign law, we . . . should have for our purpose the giving of just effectuation to the rights and obligations created by the laws of the appropriate locus. . . . Our aim should be to incorporate the law of the locus into our decision so as to homologize fairly any and all claims and defenses which each party would enjoy under the laws of the governing jurisdiction. In short, we should examine the laws of the locus and, using them as a model, seek to achieve the same result as would likely be reached by its courts. . . . In so doing, we are recognizing and satisfying, whenever possible, the expectancies of the parties as well as protecting innocent litigants from having their legal rights and claims, valid under the laws of one forum, from being disfranchised. . . ." Clougherty v. Royal Ins. Co.,
102 R.I. 636 ,649-50 ,232 A.2d 610 ,617 (1967) (Kelleher, J., concurring) (emphasis added).
The Mass. Fund is an association which relied on the fact that its obligations were governed by Massachusetts law, as interpreted by Vokey, in order to determine the extent of its potential liabilities, and therefore, how much to assess its member insurers. If the Court adopted the Rhode Island interpretation of the exhaustion provision, it would dramatically increase the Mass. Fund's potential liability beyond that which it expected or for which it is prepared to bear.16 TheBenoit decision was a decision of the Rhode Island Supreme Court, which interpreted a Rhode Island statute. Therefore, even if the statutes are in many ways similar, Benoit cannot control the obligations of the Mass. Fund. Accordingly, the Court finds that Massachusetts law applies to the obligations of the Mass. Fund to pay claims, and the principles of Vokey, described above, are controlling. See
Application of Massachusetts Law as to the Liability of theMassachusetts Fund
As noted above, the law in Massachusetts after Vokey is that UM recoveries must be offset against the Mass. fund's liability to pay covered claims.
It is true that Claimant will be worse off as a result of any offset because, unlike the Plaintiff in Vokey, her Rhode Islanduninsured motorist polices also include underinsured motorist coverage, while in Massachusetts underinsured coverage is optional.17 See
While the Court acknowledges that Claimant is worse off as a result of the insolvency, Massachusetts has not made this the determining factor as to whether other recoveries are offset against the Mass. Fund's liability. The determining factor is whether she has obtained "any recovery to which a claimant is contractually entitled under [his or her] own insurance policy."19 Vokey,
Defendants also argue that a UM claim against Claimant's insurer is not a "covered claim" within the meaning of the Massachusetts exhaustion provision. This was the argument that prevailed in Benoit: that only covered claims could offset the insolvency fund's liability, and since UM claims were not asserted against insolvent insurers, such claims should not be offset. See
Massachusetts seems to have written the phrase, "which is a covered claim," out of its exhaustion provision, instead focusing on the phrase "any insolvency provision in his insurance policy" to conclude that the provision requires the offset of UM recoveries. Id. § 9.20 As so interpreted, the statute could be read as follows: any person having a claim against his insurer under any insolvency provision in his insurance policy which arises out of the same incident as a covered claim shall be required to exhaust first his right under such policy. Therefore, Massachusetts rejected this argument in Vokey,
albeit implicitly, that claims under UM policies are not covered claims when it held that UM claims should be offset against the Mass. Fund's liability. See Vokey,
The Vokey decision appears unsatisfactory because it applies a strained interpretation to the exhaustion provision. However, with regards to statutory interpretation, the Benoit approach is also imperfect as well. It is rare, if not impossible, for a person to have a claim against his own UM insurer which is also a claim against the insolvent liability insurer — even if they arise from the same incident, they are separate claims against separate parties. Therefore, by holding that only claims which are also covered claims offset the insolvency fund's liability, our Court seems effectively to have written the entire exhaustion provision out of the statute.
The Court gives effect to the exhaustion provision by saying that it applies only to prevent a duplicative recovery. Benoit,
Extent of Tortfeasor's Liability Following the Insolvency of HisInsurer
In addition to limiting its own liability, the Mass. Fund seeks a declaration that Tortfeasor has no liability to Claimant except to the extent that Claimant's damages exceed the amounts recovered through Claimant's UM policy. It argues that since the Massachusetts Act was designed to protect insured persons whose insurers become insolvent, Claimant should not be able to recover against Tortfeasor except to the extent that her damages exceed Tortfeasor's policy limit. In support of this proposition, the Mass. Fund cites a Superior Court case from Pennsylvania. SeePanea v. Isdaner,
Under the Massachusetts rule, Claimant's UM insurer has taken the place of Tortfeasor's insolvent liability insurer up to the extent of the UM policy limits. See Panea,
Claimant argues, however, that UMCo has waived its right to seek subrogation and has assigned its claim against Tortfeasor to Claimant.25 Claimant now seeks to assert that claim against Tortfeasor. The Mass. Fund argues here that the Claimant should not be able to seek recourse against Tortfeasor on this subrogation claim because Tortfeasor's liability only resulted from his own insurer's insolvency; without the insolvency, the Tortfeasor would have been protected up to the limit of his liability policy. See Panea,
While the Court sympathizes with the Claimant, whose damages allegedly exceed the amount of insurance available, the Court finds that the Mass. Fund has the better argument. Any claim that Claimant has up to the amount of Tortfeasor's liability policy is actually the subrogation claim of UMCo against Tortfeasor, gratuitously assigned to Claimant, because Claimant has already been paid on the UM policy. The legislatures of both Rhode Island and Massachusetts have expressed the intent that members of the insurance industry must bear some of the loss arising from insolvency, and may not recover from the insured. See G.L. 1956 § 37-34-8(ii)(C); Mass. Gen. Laws c.
This result makes sense because even though the automobile accident was allegedly Tortfeasor's fault, the insolvency of his liability insurer was not his fault, and he should be able to enjoy the benefit that he purchased with his insurance premiums. Claimant has been compensated by her UM policy at least to the amount of Tortfeasor's liability policy, if not more. Further, Claimant has a remaining claim against Tortfeasor for the excess damages above the liability policy amount. If any injustice can be said to result from this rule, it is that Rhode Island UM insurers, who would normally have subrogation claims against the tortfeasors, are barred from asserting those claims. SeePanea,
Based upon the above principles, the Court finds that in Mass.Fund v. Lambert, Mulrath, and Metropolitan Property and CasualtyInsurance Co., C.A. No. PB 02-6524, Defendant Mulrath has recovered $100,000 from her UM policy. Defendant Lambert's liability policy with the insolvent Trust Company was limited to $100,000 per person. Therefore, Mulrath's UM recovery is offset against the Mass. Fund's $100,000 covered claim liability, and the Mass. Fund has no further liability to Mulrath. Mulrath has a claim against Lambert for excess damages to the extent that her damages exceed $100,000. However, Lambert is not subject to any subrogation claim that Metropolitan or Mulrath may have for the $100,000 paid by Metropolitan.
In Mass. Fund v. Weremay and Martins, C.A. No. PB 02-4764, Defendant Martins has received $100,000 from her UM policy. Defendant Weremay's liability policy with the insolvent Trust Company had limits of either $20,000 or $25,000 per person.27 For the reasons described above, the Mass. Fund's covered claim liability of at most $25,000 is offset by Martins' recovery from her UM policy. Therefore, the Mass. Fund has no further liability to Martins. For the reasons described above, Weremay is not subject to any claim for subrogation for the first $20,000 or $25,000 of the amount paid by Allstate to Martins. However, Weremay remains subject to any subrogation claim that Martins or Allstate may have for the remaining $75,000 or $80,000 paid by Allstate. Martins also has a claim against Weremay to the extent that her damages exceed the $100,000 that she has recovered from her UM policy.
In Mass. Fund v. Teixeira and Burke, C.A. No. PB 02-6983, Defendant Burke has $25,000 of UM coverage. Defendant Teixeira's liability policy with the insolvent Trust Company had limits of $100,000 per person. For the reasons described above, the Mass. Fund's covered claim liability, which is at most $100,000, is offset by Burke's $25,000 UM policy. Therefore, the Mass. Fund's liability is equal to the amount of damages incurred by Burke, up to $100,000, less $25,000. Teixeira is not subject to any subrogation claim that Burke or Allstate may have against Teixeira for $25,000. Because Teixeira had liability coverage of $100,000 per person, Burke may recover from Teixeira to the extent that Burke's damages exceed $100,000.
Prevailing counsel may present an order and judgment consistent herewith which shall enter upon notice to all other counsel of record.
Clougherty v. Royal Insurance Company , 102 R.I. 636 ( 1967 )
Indiana Insurance Guaranty Ass'n v. Blickensderfer , 2002 Ind. App. LEXIS 1893 ( 2002 )
Billeaudeau v. Lemoine , 386 So. 2d 1359 ( 1980 )
Arizona Property & Casualty Insurance Guaranty Fund v. ... , 156 Ariz. 203 ( 1988 )
Blais v. Aetna Casualty & Surety Co. , 1987 R.I. LEXIS 509 ( 1987 )
Panea v. Isdaner , 2001 Pa. Super. 108 ( 2001 )
Richard v. Blue Cross & Blue Shield , 1992 R.I. LEXIS 62 ( 1992 )
Rhode Island Insurers' Insolvency Fund v. Benoit , 1999 R.I. LEXIS 41 ( 1999 )
Sands v. Pa. Ins. Guaranty Ass'n , 283 Pa. Super. 217 ( 1980 )