Allstate Ins. Co. v. Heffner
| Decision Date | 22 September 1980 |
| Citation | 421 A.2d 629,491 Pa. 447 |
| Parties | ALLSTATE INSURANCE COMPANY, Appellant, v. Delores HEFFNER, Appellee. Homer S. PONTIUS, Administrator of the Estate of Janet A. Pontius, deceased, Appellee, v. UNITED STATES FIDELITY AND GUARANTY COMPANY, Appellant. |
| Court | Pennsylvania Supreme Court |
Both of these appeals present the question of the extent of benefits available under the Pennsylvania No-Fault Motor Vehicle Insurance Act 1 to the survivors of persons fatally injured in automobile accidents. For the reasons that follow, we will sustain the orders of the Superior Court.
The husband of appellee, Delores Heffner, was killed when the car he was driving struck a utility pole. No other vehicles or persons were involved in this accident. The deceased was the holder of an Allstate Motor Vehicle Insurance Policy which provided him with coverage in accordance with the No-Fault Act. Appellee Heffner applied for benefits under the decedent's Allstate insurance policy, seeking to recover funeral expenses, "survivor's loss" benefits, and "work loss" benefits. These latter two categories are statutorily defined benefits under the Act, and will be discussed below. Appellant, Allstate Insurance Company, agreed to pay both the funeral expenses and the survivor's loss benefits, but denied recovery on the work loss benefits claim. Appellee Heffner subsequently filed a complaint in assumpsit against Allstate seeking to recover the work loss benefits. The Court of Common Pleas of Philadelphia County entered an order granting judgment on the pleadings in favor of Allstate, thereby denying appellee Heffner's claim. The Superior Court reversed the Court of Common Pleas, --- Pa.Super. ---, 401 A.2d 1160 (1979), holding that work loss benefits were available to Mrs. Heffner. 2 We granted Allstate's petition for allowance of appeal pursuant to 42 Pa.C.S.A. § 724.
Appellee Homer Pontius is the administrator of the estate of Janet A. Pontius, who was killed in an automobile accident. The decedent was insured under an automobile policy issued by appellant, United States Fidelity and Guaranty Company (USF&G), in accordance with the No-Fault Act. USF&G paid the statutory "survivor's loss" benefits to the qualifying survivors, but rejected the estate's claim for "work loss" benefits under the Act. The estate brought suit in the Court of Common Pleas of Dauphin County seeking work loss benefits. That court sustained USF&G's preliminary objections in the nature of a demurrer to the complaint. 100 Dauphin 133 (1978). The Superior Court reversed in an unreported opinion, based solely upon its opinion in the Heffner case. We granted USF&G's petition for allowance of appeal and consolidated argument on this case with that on Heffner. 3
This Court must start from the position that its duty "is to ascertain and effectuate the intention of the General Assembly," so that full effect is given to every provision of a statute, if possible. 1 Pa.C.S.A. § 1921(a) (1980-81 pamphlet).
In enacting the No-Fault Act, the General Assembly expressly declared that "the maximum feasible restoration of all individuals injured and compensation of the economic losses of the survivors of all individuals killed in motor vehicle accidents on Commonwealth highways, ... is essential to the humane and purposeful functioning of commerce." 40 P.S. § 1009.102(a)(3) (emphasis added). Furthermore, "it is hereby declared to be the policy of the General Assembly to establish ... a statewide system of prompt and adequate basic loss benefits for motor vehicle accident victims and the survivors of deceased victims," 40 P.S. § 1009.102(b) (emphasis added). The legislature has provided definitions for the terms with which we must interpret the No-Fault Act. 4 The following definitions contained in Article I are required in order to resolve the issue presently before us:
"Allowable expenses" means reasonable charges incurred for, or the reasonable value of (where no charges are incurred), reasonably needed and used products, services, and accommodations for:
(A) professional medical treatment and care;
(B) emergency health services;
(C) medical and vocational rehabilitation services;
(D) expenses directly related to the funeral, burial, cremation, or other form of disposition of the remains of a deceased victim, not to exceed one thousand five hundred dollars ($1,500); and
The term does not include that portion of a charge for a room in a hospital, clinic, convalescent, or nursing home, or any other institution engaged in providing nursing care, and related services, in excess of a reasonable and customary charge for semiprivate accommodations, unless more intensive care is medically required; or any amount includable in work loss, replacement services loss, or survivor's loss.
"Basic loss benefits" means benefits provided in accordance with this act for the net loss sustained by a victim, subject to any applicable limitations, exclusions, deductibles, waiting periods, disqualifications, or other terms and conditions provided or authorized in accordance with this act. Basic loss benefits do not include benefits for damage to property. Nor do basic loss benefits include benefits for net loss sustained by an operator or passenger of a motorcycle.
"Injury" means accidentally sustained bodily harm to an individual and that individual's illness, disease, or death resulting therefrom.
"Loss" means accrued economic detriment resulting from injury arising out of the maintenance or use of a motor vehicle consisting of, and limited to, allowable expense, work loss, replacement services loss, and survivor's loss.
"Replacement services loss" means expenses reasonably incurred in obtaining ordinary and necessary services in lieu of those the victim would have performed, not for income, but for the benefit of himself or his family, if he had not been injured.
"Survivor" means:
(A) spouse; or
(B) child, parent, brother, sister or relative dependent upon the deceased for support.
"Survivor's loss" means the:
(A) loss of income of a deceased victim which would probably have been contributed to a survivor or survivors, if such victim had not sustained the fatal injury; and
(B) expenses reasonably incurred by a survivor or survivors, after a victim's death resulting from injury, in obtaining ordinary and necessary services in lieu of those which the victim would have performed, not for income, but for their benefit, if he had not sustained the fatal injury, reduced by expenses which the survivor or survivors would probably have incurred but avoided by reason of the victim's death resulting from injury.
"Victim" means an individual who suffers injury arising out of the maintenance or use of a motor vehicle; "deceased victim" means a victim suffering death resulting from injury.
"Work loss" means:
(A) loss of gross income of a victim, as calculated pursuant to the provisions of section 205 of this act; and
(B) reasonable expenses of a victim for hiring a substitute to perform self-employment services, thereby mitigating loss of income, or for hiring special help, thereby enabling a victim to work and mitigate loss of income.
40 P.S. § 1009.103. (Emphasis added.)
Article II of the Act establishes the right to benefits and imposes monetary ceilings on the amount of benefits recoverable. Specifically, Section 201, in pertinent part, confers the right to receive basic loss benefits to "any victim or any survivor of a deceased victim," if the accident resulting in injury occurs within the Commonwealth. 5 Section 202 enumerates the four types of basic loss benefits as well as their monetary limits: a) allowable expense limits, including reasonable professional medical treatment and care, emergency health services, medical and vocational rehabilitation services; and funeral expenses; 6 b) work loss benefits ($15,000 maximum); 7 c) replacement services losses ($25 per day for one year); 8 and d) survivors losses ($5,000 maximum). 9 Section 205, in turn, establishes the method for determining the amount of work loss benefits. 10 The Act requires that benefits be paid monthly as loss accrues. "Loss accrues not when injury occurs, but as allowable expenses, work loss, replacement services loss, or survivor's loss is sustained." 11
The crux of the issue presented to us is whether the legislature intended "victims" of motor vehicle accidents to be accorded differing basic loss benefits from those accorded survivors of "deceased victims." Appellants, Allstate and USF&G, contend that the legislature did intend such a distinction. On the one hand, appellants assert that "victims" are entitled to the following basic loss benefits: allowable expense, work loss, and replacement services loss. On the other hand, appellants maintain survivors of "deceased victims" are only entitled to: allowable expense (funeral expenses) and survivor's loss. This view has been adopted by four different courts of common pleas 12 but was rejected by the Superior Court in the two cases presently before us.
Appellants support their position by referring to the definition of "victim" contained in section 103. Appellants assert that section 103 differentiates between "victims" and "deceased victims." These terms are defined in the same paragraph which states:
"Victim" means an individual who suffers injury arising out of the maintenance or use of a motor vehicle; "deceased victim" means a victim suffering death resulting from injury.
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