Heffner v. Allstate Ins. Co.

• Decision Date: 12 April 1979
• Citation: 401 A.2d 1160,265 Pa.Super. 181
• Parties: Delores HEFFNER, Appellant, v. ALLSTATE INSURANCE COMPANY.
• Court: Pennsylvania Superior Court

401 A.2d 1160

265 Pa.Super. 181

Delores HEFFNER, Appellant, v. ALLSTATE INSURANCE COMPANY.

Superior Court of Pennsylvania.

April 12, 1979

Argued June 16, 1978.

Ira Silverstein, Philadelphia, for appellant.

James M. Marsh, Philadelphia, for appellee.

Before JACOBS, President Judge, and HOFFMAN, CERCONE, PRICE, VAN der VOORT, SPAETH and HESTER, JJ.

CERCONE President Judge:

The instant appeal arises from the lower court's granting a motion for summary judgment in favor of the defendant Allstate Insurance Company. In granting the motion the lower court determined that Mrs. Heffner, whose husband was fatally injured when the automobile he was driving flipped over and collided with a utility pole, was entitled to recover from Allstate Only the survivor's loss benefit of $5,000 and the funeral expense benefits provided according to Pennsylvania's No-Fault Motor Vehicle Insurance Act, 40 P.S. § 1009.101 et seq. (Supp. 1978). Mrs. Heffner contended that she was additionally entitled to receive the work loss benefits her husband indisputably would have received had he been permanently injured, rather than killed in the accident. Having thoroughly considered both sides of this novel argument, ^[1] we conclude that the lower court's decision was in error. Consequently, we will reverse and remand for further proceedings consistent with this opinion.

At the outset we caution anyone who embarks on the high seas of Pennsylvania's No-Fault Motor Vehicle Insurance Act not to do so without a good compass, a knowledge of reefs and storms and plenty of food and water. Any attempt to choose an alternate route by land in an effort to unlock the secrets of the Act will encounter mazes of paths, pitfalls, underbrush and dead ends. In attempting to explain what should be the rudimentary "work loss" compensatory scheme, no less an experienced guide than the Pennsylvania Bar Institute was forced to conclude that the Act is impenetrable. In its book, Pennsylvania No-Fault Motor Vehicle Insurance Act Practice Under the Act (Pub. # 61, 1975), PBI unequivocally asserts:

"It is not possible to determine with any degree of certainty the amount of work loss benefits required to be paid under the act. . . . The act is essentially incapable of execution since there are at least four possible interpretations of how 'basic loss benefits' for 'work loss' are calculated. None of the interpretations properly use all of the act and the provisions are apparently totally irreconcilable." Id at 22.

With these difficulties in mind, we turn to the resolution of the instant controversy.

In essence appellant's argument is a simple syllogism: The No-Fault Motor Vehicle Insurance Act provides that survivors of deceased victims are entitled to receive basic loss benefits; ^[2] "Work loss" is adumbrated under the Act as a particular kind of basic loss; ^[3] Therefore, as a survivor of a deceased victim, Mrs. Heffner contends she is entitled to receive work loss benefits. Mrs. Heffner argues this conclusion is fortified by the preamble to the Act which declares 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 . . . is essential to the humane and purposeful functioning of commerce . . . ." ^[4] Thus, Mrs. Heffner urges us to construe liberally the No-Fault Motor Vehicle Insurance Act to achieve its broad, remedial purposes ^[5] and conclude that work loss benefits are available to survivors of deceased victims of motor vehicle accidents.

Allstate maintains, and the hearing court below agreed, that the scheme of the Act, insofar as is relevant to the instant litigation, was to devise two separate classes of accident victims. On the one hand, had Mr. Heffner survived the accident he would have been entitled to particular basic loss benefits including: professional medical treatment and care, emergency health services, and medical and vocational rehabilitation services; ^[6] work loss benefits; ^[7] as well as replacement services loss. ^[8] However, Allstate argues, because Mr. Heffner died immediately as a result of the accident, appellant was only entitled to recover survivor's loss ^[9] and funeral expenses. ^[10] Allstate supports its position by referring us to two features of the Act. First, Section 103 differentiates between victims and deceased victims; the former "means an individual who suffers injury arising out of the maintenance or use of (an automobile)," while the latter "means a victim suffering death resulting from injury." Thus, Allstate contends that there was no reason for creating a "victim-deceased victim" dichotomy unless the legislature intended to differentiate benefits for surviving victims and survivors of deceased victims. Second, Allstate contends, appellant's argument requires this court to construe the Act to provide overlapping coverage, a kind of double recovery. For example, since work loss is generally defined in part as the gross income of the victim, it includes so much of a victim's income as he would have naturally contributed to support his dependents, in this case Mrs. Heffner. However, survivor's loss is designed to estimate the amount of this contribution and provide it to Mrs. Heffner as a survivor's loss benefit under the Act. Thus, if Mrs. Heffner is entitled to recover both survivor's loss and work loss, she is, in effect, recovering twice the amount of money Mr. Heffner would have contributed to her support. Furthermore, Allstate points out, if Section 201 of the Act is to be read so that the survivor of a deceased victim is to receive All basic loss benefits, the position which Mrs. Heffner espouses herein, ^[11] she will receive a double recovery for "Replacement services loss" when Sections 202(c)-(d) and 103 are read together. Allstate concludes that the statutory scheme of reparations will be thrown into disarray if the Act may be read to provide benefits in excess of the economic losses which survivors of deceased victims actually sustain as the result of an accident. This, Allstate submits, contradicts the clear legislative intent to compute with as much precision as possible the precise monetary costs of a motor vehicle accident as exemplified by the net loss provisions of the Act. ^[12] See The Statutory Construction Act, 1 Pa.C.S. § 1921 (Supp. 1978).

Of course, recalling the sentiment with which we began our discussion of the No-Fault Motor Vehicle Insurance Act, it is not surprising to learn that Allstate's argument is cogent so long as one ignores contrary signs of guidance in the Act. For example, as we stated above, in its preamble the Act exclaims its purpose to be, Inter alia, "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 . . . ." ^[13] Historically, the courts of this Commonwealth have routinely followed this spirit and found coverage for the insured in close or doubtful insurance cases. ^[14] The tendency has been that if we should err in ascertaining the intent of the legislature or the intendment of an insurance policy, we should err in favor of coverage for the insured. ^[15] Obviously, to adopt Allstate's interpretation of the Act in the instant case is to give less than generous application to that principle. In addition, although Allstate directed our attention to the definitional dichotomy of "victim-deceased victim" which the Act creates, it has overlooked the impact of the Act's definition of "injury." Section 103 provides: " 'Injury' means accidentally sustained bodily harm to an individual and that individual's illness, disease, or Death resulting therefrom." (Emphasis added.) Because the Act specifically defines the term "injury," for the purposes of construing the Act, "injury" is a term of art to which we should ascribe precisely the meaning the Act gives it. ^[16] As one might expect when he analyzes the No-Fault Act, this interpretational truism creates another paradox, a nettlesome impediment for Allstate's position. True, the Act has differentiated victims from deceased victims, but it has not differentiated injuries from fatal injuries. ^[17] The result is that some sections of the Act which Allstate insists apply only to non-fatal injuries are not so limited by their terms. For example, Section 103 of the Act defines "Loss" as the "accrued economic detriment resulting from Injury . . . consisting of, and limited to, allowable expense, Work loss, replacement services loss, And survivor's loss." (Emphasis added.) Since injury means death, as well as non-fatal injury, Section 103 can be read to mean that work loss is an accrued economic detriment resulting from death. ^[18] This implication is fortified by Section 206 of the Act which, in attempting to define "net loss," provides that life insurance proceeds are not to be subtracted from loss in calculating the net loss available to an individual because of injury. Certainly, if the legislature intended to establish benefits for two different classes of individuals, "victims" and "deceased victims" it did not do so in very lucid fashion. Indeed, Mrs. Heffner points out that if the legislature had intended to deny work loss benefits to the survivors of deceased victims, it could have done so clearly as have numerous other jurisdictions which have enacted no-fault legislation. ^[19]

Thus, the Act leaves us in a quandary. To adopt appellant's argument is to create the likelihood of overlapping or double recoveries for survivors of deceased victims, as well as to compensate them for expenses which were not incurred (e. g., support for a victim who did not survive an...