Serefeas v. Nationwide Ins. Co.
| Decision Date | 30 January 1985 |
| Citation | 338 Pa.Super. 587,488 A.2d 48 |
| Parties | Kassiani SEREFEAS v. NATIONWIDE INSURANCE COMPANY, Appellant. |
| Court | Pennsylvania Superior Court |
James M. Marsh, Philadelphia, for appellant.
George Wm. Georges, Philadelphia, for appellee.
Before CIRILLO, MONTEMURO and CERCONE, JJ.
This is an appeal by Nationwide Insurance Company from a judgment entered in the trial court in favor of Kassiani Serefeas in the amount of $14,309.40, plus interest, in her claim for benefits under the Pennsylvania No-Fault Motor Vehicle Insurance Act (Act). 1 Nationwide denied her claim on the basis of an exclusion clause in her policy which limited coverage to accidents occurring only in the United States, its territories or possessions, and Canada. The trial court found this clause to be violative of the language and intent of the No-fault Act. We affirm.
Plaintiff-appellee Serefeas (appellee) is a citizen of the United States and a Pennsylvania resident. While riding as a passenger with her brother, a resident of Greece, through Yugoslavia on November 10, 1978, his uninsured vehicle struck another in the rear. As a result of this motor vehicle accident, appellee sustained various bodily injuries. She was hospitalized in Yugoslavia, Greece, and Pennsylvania for her injuries.
Appellee was insured under a policy issued to her husband which provided basic personal injury protection (no-fault benefits) to appellee as spouse of an insured residing in his household. Nationwide refused payment of appellee's no-fault benefits on the basis of the territorial exclusion clause of the policy:
All coverages apply in Canada, the United States of America and its territories and possessions, or between their ports. All coverages except Uninsured Motorist coverage apply to occurrences in Mexico if within 50 miles of the United States boundary.
This policy exclusion is authorized by various regulations promulgated by the Insurance Commissioner, which address the relevant issue of "basic loss benefits," and provide:
Basic loss benefits shall apply to accidents which occur within the United States of America, its territories or possessions or Canada. 31 Pa.Code § 66.1-201.
This endorsement is designed to modify a private passenger automobile liability policy so that it will meet the minimum requirements for provisions of basic loss benefits coverage ... This coverage applies only to accidents which occur during the policy period and within the United States of America, its territories and possessions or Canada. 31 Pa.Code § 66.2(A).
Appellee filed an action in assumpsit on October 15, 1980, seeking recovery of no-fault benefits under the policy. Appellant filed Preliminary Objections to her Complaint in the nature of a demurrer, based on the territorial exclusion clause. In her Answer to the Preliminary Objections, appellee alleged that the policy's territorial exclusion clause was void as contrary to the spirit and letter of the Act. Appellant's Preliminary Objections were denied, an arbitration hearing was held at which appellee, waiving expenses incurred in Yugoslavia and Greece, presented a claim for expenses incurred only in Pennsylvania. The Board of Arbitrators ruled in appellee's favor and awarded her $14,309.40, including her U.S. medical expenses, net work loss, replacement service expenses, and interest.
The issue for our determination is whether the territorial exclusion clause and the relevant regulations of the Insurance Commissioner are contrary to the intent of the Legislature as it appears in the No-fault Act.
Our starting point is the Act itself. Under § 1009.102(b), Purposes, is this pronouncement:
Therefore, it is hereby declared to be the policy of the General Assembly to establish at reasonable cost to the purchaser of insurance, a Statewide system of prompt and adequate basic loss benefits for motor vehicle accident victims and the survivors of deceased victims.
Then, § 1009.201, Right to basic loss benefits; limitations on benefits, provides:
(a) Accident within this State.--If the accident resulting in injury occurs in this Commonwealth, any victim or any survivor of a deceased victim is entitled to receive basic loss benefits in accordance with the provisions of this act.
(b) Accident outside this State.--If the accident resulting in injury occurs outside of this Commonwealth, a victim or a survivor of a deceased victim is entitled to receive basic loss benefits if such victim was or is:
(1) an insured, or
(2) the driver or other occupant of a secured vehicle.
Thus, eligible victims who are injured outside of this state are intended to be compensated.
Appellant reasons that the Act pertains only to accidents occurring in any state of the United States, in the District of Columbia, in Guam or in the Virgin Islands, by citing §§ 102, 103, and 110 of the Act. § 102 speaks in terms of "intrastate," "Commonwealth highways," and, "Statwide" system, under "Findings and Purposes". § 103, Definitions, defines "state" as above. § 110 refers to the applicability of insurance of a motor vehicle by an owner in this Commonwealth to compliance with another state's requirements for such when the vehicle is operated there. Thus, appellant contends, the territorial exclusionary clause of its policy and the regulations of the insurance commissioner are authorized by the Act.
This piecemeal approach indicates the contrary to this court. It is not clear that what the Legislature meant in § 201 by "outside of this Commonwealth" was limited to any state in this country, the District of Columbia, Guam or the Virgin Islands. Especially is this true when § 1009.208, Ineligible claimant, is considered. That section excludes converters of motor vehicles and those who intentionally injure themselves or others from the benefits of the Act. As this court said in Gerardi v. Harleysville Insurance Co., 293 Pa.Superior Ct. 375, 378, 439 A.2d 160, 161 (1981): 2
No mention in the No-fault Act is made of an intent to exclude those injured outside a certain distance of the territorial boundaries of Pennsylvania. In fact, without qualification, as quoted above, § 1009.201 of the Act provides for coverage for those injured "outside of this Commonwealth" if the eligible victim or survivor of a deceased victim was or is (1) an insured; or (2) the driver or other occupant of a secured vehicle. The plaintiff in this case qualifies as an insured; appellant concedes this, but denies her benefits because she was injured too far from Pennsylvania.
It is helpful to refer to the Uniform Motor Vehicle Reparations Act (UMVARA), 3 Section 2(b),...
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