McDonald v. Keystone Ins. Co.

• Decision Date: 06 May 1983
• Citation: 459 A.2d 1292,313 Pa.Super. 404
• Parties: Rosemarie DeTorro McDONALD, Appellant, v. KEYSTONE INSURANCE COMPANY.
• Court: Pennsylvania Superior Court

459 A.2d 1292

313 Pa.Super. 404

Rosemarie DeTorro McDONALD, Appellant, v. KEYSTONE INSURANCE COMPANY.

Superior Court of Pennsylvania.

May 6, 1983

Argued Feb. 11, 1983.

Eugene Spector, Philadelphia, for appellant.

Dennis Veneziale, Philadelphia, for appellee.

Before CERCONE, P.J., and CAVANAUGH, WIEAND, CIRILLO, POPOVICH MONTGOMERY and HOFFMAN, JJ.

HOFFMAN Judge:

Appellant contends that the lower court erred in vacating an arbitrators' award granting her $15,000 in uninsured motorist benefits. She argues that: (1) she was entitled to recover uninsured benefits because the driver's legal minimum policy limits were too low to fully compensate her and (2) appellee, her insurer, was estopped from denying her coverage because it had failed to comply with her request for "full and complete "coverage" or to adequately explain how the legal minimum coverage she purchased would fall short of being full and complete. Finding no merit in appellant's contentions, we affirm the order of the lower court.

When appellant applied for automobile insurance she requested "full and complete" coverage. Appellee's agent sold her a standard no-fault and uninsured motorist policy with legal minimum limits of $15,000 per person. The agent never explained the circumstances in which the insurer would not pay "uninsured" motorist benefits, nor did he explain that, if appellant wished to purchase insurance with higher policy limits, she could also obtain a form of excess or underinsured motorist, coverage that would pay her the difference between her policy limits and those of a liable third party with lower policy limits. ^[1]

On January 19, 1979, while appellant was a passenger, Frieda Larr drove her car into a utility pole, seriously injuring appellant. Appellant sought no-fault benefits from appellee and eventually received $7,500. ^[2] Appellant threatened a tort action against Ms. Larr, whose insurer settled, paying appellant Ms. Larr's policy limits of $15,000. Appellant then sought additional recovery from appellee under the "uninsured" motorist provision of her policy. After a hearing, the arbitrators awarded appellant $15,000 in uninsured motorist benefits. The lower court, however, reversed the award as being an error of law. This appeal followed, and we granted this en banc review. ^[3]

An arbitrators' award under the Act of 1927 is subject to judicial correction if it is "against the law, and is such that had it been the verdict of the jury the court would have entered different or other judgment notwithstanding the verdict." 5 P.S. 171(d); State Farm Mutual Ins. Co. v. Williams, 481 Pa. 130, 392 A.2d 281 (1978). See 42 Pa.C.S.A. § 7302(d)(2). ^[4]

Appellant contends that, because the driver of the car in which she was injured did not have enough insurance to fully compensate appellant's losses, that driver was underinsured, and therefore "uninsured" as to appellant's remaining losses, so as to entitle appellant to uninsured motorist benefits. Our courts have specifically rejected this contention on grounds that the legislature, by the Uninsured Motorist Act, 40 P.S. § 2000, intended only to create a means to provide minimum coverage to persons injured by financially irresponsibile motorists carrying less than the legal minimum or no insurance. Our legislature did not intend to provide additional insurance to those who although they suffered severe injury had recourse to at least the legal minimum of insurance through the other motorist. Davis v. Government Employees' Ins. Co., 500 Pa. 84, 454 A.2d 973 (1982). It is undisputed that the driver here carried the legal minimum of insurance, $15,000 per person, see 40 P.S. § 1009.104, and that the driver's insurer paid that amount to appellant. Thus, the driver was not "uninsured," and appellant is not entitled to recover from appellee under the uninsured motorist provision of her policy.

Appellant contends also that appellee is estopped from denying her uninsured motorist coverage because appellee's agent failed to comply with her request for "full and complete" coverage or to adequately explain how the minimum coverage she purchased would fall short of being full and complete. Our courts have held that if an insurance policy contains unusual provisions that might defeat the reasonable expectations of the insured the insurer has a duty at the time of application to volunteer information explaining the insured's rights. Failure to do so will prevent the insurer from enforcing those provisions against the insured. E.g., Collister v. Nationwide Life Ins. Co., 479 Pa. 579, 388 A.2d 1346 (1978); Kelmo Enterprises v. Commercial Union Ins. Co., 285 Pa.Superior Ct. 13, 426 A.2d 680 (1981); Klischer v. Nationwide Life Ins. Co., 281 Pa.Superior Ct. 292, 422 A.2d 175 (1980); Hionis v. Northern Mutual Ins. Co., 230 Pa.Superior Ct. 511, 327 A.2d 363 (1974). See generally Keeton, Insurance Rights at Variance with Policy Provisions, 83 Harv.L.Rev. 961 (1970). ^[5] This special rule is based on the adhesive nature of insurance transactions and the parties' disparity in bargaining power. Collister v. Nationwide Life Ins. Co., supra. Our courts also recognize traditional estoppel theories in the insurance context, as when the insured justifiably relies, to her detriment, upon the representations or promises of the insurer or its agent. E.g., DeRosa v. St. Paul Ins. Co., 222 Pa.Superior Ct. 424, 295 A.2d 157 (1972); Barth v. State Farm Fire and Casualty Co., 214 Pa.Superior Ct. 434, 257 A.2d 671 (1969). See Restatement (Second) of Contracts, § 90. No such unusual provisions existed here. Appellee's not paying "uninsured" motorist benefits when another motorist's insurer has already paid amounts equal to appellant's policy limits did not defeat appellee's reasonable expectations about "uninsured" motorist coverage. Nor is appellee estopped from denying coverage by its agent's failure to explain how appellant's coverage was less than "full and complete." Appellant, although unschooled in insurance, could understand that, because of the policy limits, she would not receive more than $15,000 from her insurer for a given accident. Collister v. Nationwide Life Ins. Co., supra (parties can bargain over amount of monetary coverage). However, appellant was probably unaware of the circumstances when another insurer rather than her own would pay for her losses. See, e.g., 40 P.S. § 1009.204 (priority scheme for sources of no-fault benefits). Likewise, she was probably unaware of the categories of damages--medical expenses, work loss, other personal injury damages, and property loss--that would be recoverable only under no-fault or only in third party actions. Nonetheless, she reasonably relied, even after the agent's...