Valley Forge Insurance v. Katz
Valley Forge Insurance v. Katz
Opinion of the Court
At the time of the alleged tort — an automobile
Katz, through her mother and next friend, brought a negligence action against Spicer and against Alternative and the driver of its van, Maria Bililies. Prior to trial of the negligence case, Katz settled her claims against Spicer for $70,000. A Superior Court jury returned a verdict of no negligence against Bililies and Alternative. Next, on Katz’s behalf, her mother made a demand upon Valley Forge for underinsured motorist benefits in excess of $100,000. In its initial response, Valley Forge denied payment under its underinsured motorist provision stating that “it is our evaluation that Gabrielle Katz’s injuries do not exceed the $100,000 available under [the tortfeasor] Richard Spicer’s policy.” This initial response did not raise the issue whether Katz was in fact covered by the policy. Katz then demanded that they arbitrate her claim. Valley Forge initially agreed to do so, but it subsequently elected not to arbitrate the matter and instead filed this action.
Valley Forge brought this declaratory judgment action (G. L.
1. There is a threshold matter: Katz argues that disposition on summary judgment was error because she introduced evidence raising a factual issue as to whether Alternative reasonably expected that the underinsured motorist coverage it had purchased extended to all passengers, not just to those who were not covered under a household member’s standard automobile policy with underinsurance benefits.
We conclude that this evidence, considered in the light most favorable to Katz, does not create a genuine issue of material fact. As we shall discuss, the policy language on its face does not provide coverage for Katz; Alternative’s intent in purchasing the underinsured motorist coverage is relevant, if at all, only on the question of Alternative’s reasonable expectation that passengers such as Katz would be covered in a situation such as this. Without engaging in a prolonged discussion of whether or to what extent Massachusetts appellate courts have actually
2. Underinsurance coverage. The underinsured motorist coverage provisions of Valley Forge’s standard Massachusetts commercial automobile policy, in effect in 1996, the year Katz’s claim arose, in pertinent part, obligated it to “pay all sums an insured is legally entitled to recover as damages from the owner or operator of an ‘underinsured motor vehicle.’ ” The named insured under Valley Forge’s policy is Alternative. An “insured person” for underinsurance purposes is defined in a standard form endorsement, as follows:
“a. You [the named insured], while ‘occupying’ a covered ‘auto,’ while ‘occupying’ an ‘auto’ you do not own, or if injured as a ‘pedestrian.’
“b. If the form of your business under Item one of the Declarations is shown as an individual, any ‘household member,’ while ‘occupying’ ... an ‘auto’ not owned by you, or if injured as a ‘pedestrian.’ . . .
“c. Anyone else while ‘occupying’ a covered ‘auto.’ We will not pay damages to or for anyone else who has a Massachusetts auto policy of his or her own, or who is covered by a Massachusetts auto policy of any*763 ‘household, member’ providing underinsured auto coverage.
“d. Anyone else for damages he or she is entitled to recover because of injury to a person under this coverage.” (Emphasis supplied.)
This standard policy language, in most material respects, tracks the language of G. L. c. 175, § 113L(5), which discusses uninsured motorist coverage but also encompasses by its terms underinsured motorist benefits.
Given these impediments, Katz posits a novel set of arguments for how and why this court should deem her covered by the policy/statutory provisions. First, she claims that, because the insured Alternative was in a special relationship to its passengers, who included children and adults with disabilities, the courts should treat these passengers as “named insureds” of the
(a) Special relationship. Relying on Thattil v. Dominican Sisters of Charity of the Presentation of the Blessed Virgin, Inc., 415 Mass. 381 (1993), Katz proposes that she should be considered a “named insured” eligible for benefits under the Valley Forge policy. In Thattil, the Supreme Judicial Court ruled that the underinsured motorist coverage in a policy issued to the Dominican Sisters of Charity of the Presentation of the Blessed Virgin (Dominican Sisters) as a nonprofit corporation was available to Sister Thattil, a member of the Dominican Sisters, as a “named insured” because
“Sister Thattil has merged her identity with that of the Order. In these unusual circumstances we conclude that identity exists between the Order and its individual members. This identity should not be ignored because the policy described the insured in its corporate form.”
Id. at 388. The court found such an “identity” between Thattil and the Dominican Sisters only because of the unique circumstances in which Sister Thattil lived: her vows precluded her from owning a car or other possessions apart from the Order; thus, it was impossible for her to purchase any form of underinsured motorist coverage to protect herself from the event which befell her. Only a policy issued to the Dominican Sisters as the named insured could provide her coverage. Ibid.
Katz asks us to follow Thattil here, arguing that, because
(b) Lack of coverage from Katz’s mother’s automobile policy. Katz argues that she is entitled to benefits under the Valley Forge policy as a passenger of the van, despite policy language that specifically excludes passengers “covered by a Massachusetts auto policy of any ‘household member’ providing underinsured auto coverage.” Katz argues that she is not in fact “covered” by a household member’s policy providing underinsured motorist benefits since the limits on her mother’s policy mean she will not recover any money. Our court recently considered and rejected this argument in Mercadante v. Worcester Ins. Co., 62 Mass. App. Ct. 293 (2004).
The facts of Mercadante are very similar to those in this case. Mercadante was injured in an accident caused by another driver while she was driving a vehicle owned by a funeral home. She was not the named insured on any automobile policy, nor could she collect any benefits from her husband’s underinsurance policy, because its limits matched those of the underinsured tortfeasor’s liability limits. Mercadante tried to collect
(c) The public policy argument. Katz also suggests that public policy considerations should lead us to interpret G. L. c. 175, § 113L(5), as requiring coverage in a case such as this where she was a passenger of a professional transportation company with a high duty of care to its passengers, and she will be left without any recourse to insurance for her damages beyond $100,000, a worse position than she would be in if her mother had not responsibly purchased underinsured motorist coverage on her own automobile policy. A pure public policy approach is unnecessary and inappropriate for an intermediate appellate court where there is legislation controlling the issue. However, we consider the public policy points here since this discussion also helps explain why we rejected Katz’s arguments that she is a “named insured” and is not “covered” by her mother’s policy.
In revising the uninsured and underinsured motorist coverage statute in 1988, the Legislature “undertook to state the policy to which a person injured in a motor vehicle accident should look for underinsured motorist coverage.” Smart v. Safety Ins. Co., 419 Mass. 144, 149 (1994). Our courts have consistently recognized the legislative design by applying G. L. c. 175, § 113L, in a mechanical manner that holds claimants strictly to the sources of coverage dictated by the statute, even in cases where equitable factors such as those Katz points to were present, and where a claimant is thereby prevented from reaching the only policy with benefit limits beyond an underinsured tortfeasor’s inadequate liability limits.
A brief summary of some prior cases demonstrates that the
The approach our courts have taken, then, is to apply G. L. c. 175, § 113L, mechanically even in the face of equitable considerations similar to those Katz points to in this
Finally, Katz’s repeated references to the nature of Alternative’s business and the high duty of care the company has for its passengers does not affect our analysis of underinsured motorist benefits. This argument reduces to a request to hold Alternative strictly hable for anything that happens to its passengers, or to impose a requirement that all professional transportation companies provide underinsurance to all passengers. We decline to do either. It is not for an intermediate appellate court to change the common-law rule of liability, especially in a case where Alternative is not even a party. Likewise, it is not our role to write additional paragraphs into G. L. c. 175. Cf. Jacobs v. United States Fid. & Guar. Co., 417 Mass. at 77-78 (declining to write additional paragraph into standard insurance policy).
Judgment affirmed.
Although the judge took note that the parties were on the verge of arbitration prior to the instant action, the arbitration had not commenced and thus he proceeded to the merits. Citing Lumbermens Mut. Cas. Co. v. Malacaria, 40 Mass. App. Ct. 184 (1996), Katz argues that the steps Valley Forge took toward arbitration now bar it from seeking review of the coverage issue in court. We do not follow Lumbermens in this case because, in contrast to what
Katz counterclaimed, alleging a violation of G. L. c. 93A and G. L. c. 176D, which prohibit insurers from engaging in so-called “unfair or deceptive practices” in the settlement of claims. The parties settled these counterclaims and they are not before us on appeal.
In relevant part, G. L. c. 175, § 113L(5), inserted by St. 1988, c. 273, § 47, provides:
“Uninsured motorists coverage shall provide that regardless of the number of vehicles involved, whether insured or not, persons covered, claims made, premiums paid or the number of premiums shown on the policy, in no event shall the limit of liability for two or more vehicles or two or more policies be added together combined or stacked to determine the limits of insurance coverage available to injured persons. An insured who is not a named insured on any policy providing uninsured motorist coverage may recover only from the policy of a resident relative providing the highest limits of such coverage whether or not such vehicle was involved in the accident.... Any injured occupants who are not named insureds on a policy and who are not insured on a resident relative’s policy may obtain uninsured motorist coverage from the named insured’s policy covering the vehicle they occupy when injured.” (Emphasis supplied.)
The court also pointed out that the insurance company that sold the policy to the Dominican Sisters was aware of these unique circumstances and that the agent who sold the policy testified that it was reasonable for the Dominican
The Supreme Judicial Court departed from the statute’s mechanism for determining which policy an injured person must look to for underinsured motorist benefits in Hanover Ins. Co. v. Shedd, 424 Mass. 399 (1997), where a named insured elected “zero” coverage. This decision, however, was based on the household member’s policy, which indicated that it would pay in such a circumstance. The court declined to interpret the unambiguous policy language against the insured, even though the policy was inconsistent with the authorizing statutory framework. Id. at 402-403.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.