Piersa v. Phoenix Ins. Co.

• Decision Date: 10 May 2005
• Docket Number: No. 17206.,17206.
• Citation: 871 A.2d 992,273 Conn. 519
• Court: Connecticut Supreme Court
• Parties: Stephen PIERSA v. PHOENIX INSURANCE COMPANY et al.

871 A.2d 992

273 Conn. 519

Stephen PIERSA v. PHOENIX INSURANCE COMPANY et al.

No. 17206.

Supreme Court of Connecticut.

Argued January 3, 2005.

Decided May 10, 2005.

Jon Berk, Hartford, for the appellant (plaintiff).

William J. Melley III, Hartford, for the appellee (defendant city of Hartford).

SULLIVAN, C.J., and BORDEN, NORCOTT, KATZ and ZARELLA, Js.

BORDEN, J.

The sole issue in this certified appeal is whether a self-insured municipal employer may reduce the limits of its uninsured motorist coverage by the amount of workers' compensation benefits paid, without having created a writing effectuating such a reduction. The Appellate Court concluded that it could do so. Piersa v. Phoenix Ins. Co., 82 Conn.App. 752, 753, 848 A.2d 485 (2004). We disagree with that conclusion and, accordingly, we reverse the judgment of the Appellate Court.¹

The plaintiff, Stephen Piersa, brought this action against the defendant city of Hartford² for uninsured motorist benefits. The defendant moved for summary judgment, which the trial court granted. The court then rendered judgment for the defendant. The plaintiff appealed to the Appellate Court, which affirmed the trial court's judgment. This certified appeal followed.

The facts and procedural history are undisputed, as stated by the Appellate Court. "On January 15, 1997, the plaintiff was employed by the defendant as a police officer. On that date, while responding to a call for assistance, the plaintiff sustained personal injuries when an uninsured motor vehicle collided with his police cruiser. As a result of the injuries he sustained, the plaintiff incurred medical expenses and lost time from his employment. The defendant paid him $42,261.69 in compensation benefits due to his injuries and financial loss. At the time of the accident, the defendant was a self-insured municipality with uninsured motorist coverage limits of $20,000 per person and $40,000 per occurrence.

"The plaintiff commenced this action, seeking uninsured motorist benefits from his own insurance carrier, Phoenix Insurance Company, and the defendant. Only his claim against the defendant is at issue in this appeal. In his amended complaint, the plaintiff alleged the facts concerning his employment and the subject collision. He also alleged that the police cruiser was a self-insured motor vehicle and that the defendant had breached its statutory duty to provide him with uninsured motorist benefits. In response, the defendant denied that it was in breach and alleged four special defenses, including one that `[t]he insurance coverage on the police vehicle is offset by [w]orkers' [c]ompensation benefits received by [the] plaintiff.' After the plaintiff filed a single general denial of the defendant's several special defenses, the defendant filed a motion for summary judgment." Id., at 753-54, 848 A.2d 485.

It is also undisputed that the only writing created by the defendant regarding the limits of its self-insured motorist coverage was its letter to the state insurance department, dated August 21, 1996, stating in relevant part as follows: "The City of Hartford will continue to be self insured for Automobile Liability, up to $500,000 per occurrence. The required Uninsured and Underinsured Motorist coverages will be self insured with limits of 20/40...." Thus, this writing did not specifically invoke any reductions in limits on the uninsured motorist coverage permitted by statute and regulation, such as the one involved in this case, namely, the reduction for workers' compensation benefits paid. The Appellate Court concluded that "the defendant was not required to create a writing to reduce its uninsured motorist coverage by the amount of the compensation benefits that were paid to the plaintiff." Piersa v. Phoenix Ins. Co., supra, 82 Conn.App. at 768, 848 A.2d 485. Accordingly, the Appellate Court affirmed the judgment of the trial court. Id. The plaintiff claims that the Appellate Court improperly so concluded. We agree with the plaintiff.

We begin with the common ground between the parties and certain undisputed legal propositions. Because the defendant was the owner of the police cruiser in question, a private passenger motor vehicle, it was obligated to provide insurance with respect to that vehicle in accordance with the applicable statutes: General Statutes § 38a-363 (d) (definition of "`[o]wner'") and (e) (definition of "`[p]rivate passenger motor vehicle'"); and General Statutes § 38a-371 (a) (requirement that owner of private passenger motor vehicle provide security in accordance with General Statutes §§ 38a-334 through 38a-343). That obligation required the defendant, as a self-insured municipality, "to provide uninsured motorist coverage on its vehicles" pursuant to General Statutes § 38a-336. Conzo v. Aetna Ins. Co., 243 Conn. 677, 683 n. 9, 705 A.2d 1020 (1998). Although that obligation may be discharged by virtue of an insurance policy or through self-insurance; General Statutes § 38a-371 (b) and (c); the funding mechanism for meeting that requirement is irrelevant to the defendant's obligation to comply with its obligation, because "self-insurance is the functional equivalent of commercial insurance." Hertz Corp. v. Federal Ins. Co., 245 Conn. 374, 378 n. 4, 713 A.2d 820 (1998); see also General Statutes § 38a-363 (b) (terms "`[i]nsurer'" and "`insurance company'" include self-insurer). There is no bar on an insurer, and therefore a self-insurer, from providing broader coverage than the minimum required by law. General Statutes § 38a-334 (b); Willoughby v. New Haven, 254 Conn. 404, 437 n. 27, 757 A.2d 1083 (2000).

Moreover, the defendant explicitly agrees with the plaintiff that "[t]he rules, exclusions and reductions that may be applicable to uninsured motorist protection are applicable whether [the] uninsured motorist protection is provided by commercial insurance or self-insurance." Those rules, exclusions and reductions are governed, not specifically by statute, but by the regulations of the insurance commissioner (commissioner) promulgated pursuant to § 38a-334 (a), which requires the commissioner to adopt such regulations "with respect to minimum provisions to be included in automobile liability insurance policies," and which provides that such regulations "shall relate to the insuring agreements, exclusions, conditions and other terms applicable to ... the uninsured motorists coverages under such policies...."³ The regulation of the commissioner that is applicable to this case and the meaning of which is at issue is § 38a-334-6 of the Regulations of Connecticut State Agencies,⁴ entitled "Minimum provisions for protection against uninsured or underinsured motorists," and more specifically, subsection (d)(1)(B) thereof, which provides as follows: "Limits of liability. (1) The limit of the insurer's liability may not be less than the applicable limits for bodily injury liability specified in subsection (a) of section 14-112 of the general statutes, except that the policy may provide for the reduction of limits to the extent that damages have been ... (B) paid or are payable under any workers' compensation law...." See footnote 4 of this opinion.

There is no dispute that the minimum applicable limits specified in General Statutes § 14-112 are $20,000 per person and $40,000 per accident, and that the defendant's letter to the commissioner specified those minimum amounts. Thus, the defendant, in its notice of self-insurance to the commissioner, specifically stated that it was opting for the minimum coverage. The letter was silent, however, regarding whether that minimum coverage would be further reduced by the reductions in limits specifically permitted by the regulation, including the reduction in limits at issue in the present case.

Consequently, the dispute centers around the meaning and effect of the following language of § 38a-334-6 (d)(1)(B) of the Regulations of Connecticut State Agencies: "except that the policy may provide for the reduction of limits" to the extent of workers' compensation payments. (Emphasis added.) The dispute arises because the word "policy" is specifically defined by statute in such a way that it does not comfortably fit within a scheme of self-insurance.

General Statutes § 38a-1 (15) provides as follows: "`Policy' means any document, including attached endorsements and riders, purporting to be an enforceable contract, which memorializes in writing some or all of the terms of an insurance contract." This definition applies to this case, and to § 38a-334-6 of the regulations, because the opening clause of § 38a-1 provides: "Terms used in this title, unless it appears from the context to the contrary, shall have a scope and meaning as set forth in this section." This definition invokes the traditionally understood insurance policy, with the characteristics of an enforceable written contract between insurer and insured, memorializing the terms of that contract. That definition does not fit comfortably within a self-insurance context because in such a context the insurer and insured are one and the same, and there is no enforceable contract between them.

The question presented by this case, therefore, becomes: how should we interpret the language of § 38a-334-6 (d)(1) of the Regulations of Connecticut State Agencies, "except that the policy may provide for the reduction of limits," when there is no such policy within the statutory definition because the insured has chosen to be self-insured? (Emphasis added.) The parties differ on how to answer this conundrum. The plaintiff contends that the self-insured defendant must create some written document specifying, either in specific terms or by reference to the regulation, the reduction of limits that it wishes to invoke. The defendant contends that there is no statutory obligation to do so and that, by electing to be self-insured and notifying the commissioner of that election, it necessarily and as a...