Liberty Mutual Insurance v. Ditillo
Liberty Mutual Insurance v. Ditillo
Concurring in Part
concurring in part and dissenting in part:
I agree with the majority that the workers’ compensation carrier (Reliance) has a lien (subject to section 97-10.2(j)) on uninsured
Policy Provisions
I also agree that neither the “limitation of liability” or “exclusionary” provisions of the State Farm and Liberty Mutual policies are effective to preclude payment of uninsured benefits. This Court has consistently held that a “limitation of liability” clause contained in a personal automobile policy is inconsistent with the Act and not enforceable, e.g., McMillian v. N.C. Farm Bureau Mut. Ins. Co., 125 N.C. App. 247, —, 480 S.E.2d 437, — (1997), to the extent of the mandatory minimum coverage required by the Act. See Government Employees Ins. Co. v. Herndon, 79 N.C. App. 365, 367, 339 S.E.2d 472, 473 (1986) (coverage above mandatory minimum is voluntary and governed by terms of policy). Although our courts have not addressed the validity of an “exclusionary” clause of the type contained in these policies, the rationale for rejecting the viability of the “limitation of liability” clause applies equally well to the “exclusionary” clause. In both instances the effect is to eliminate uninsured coverage if there is workers’ compensation coverage for the injuries.
In this case at the time the policies were issued the insurance companies had no obligation to provide uninsured coverage in excess of the minimum limits of $25,000. N.C.G.S. § 20-279.21(b)(3) (1961)
Section 97-10.2(j)
I also do not agree that the trial court did not have the discretion to determine the amount of the workers’ compensation lien on the uninsured benefits. Section 97-10.2(j) grants the trial court the authority to exercise its discretion in determining the amount of the workers’ compensation lien if the “judgment” against the negligent party is “insufficient to compensate the subrogation claim” of the workers’ compensation carrier. N.C.G.S. § 97-10.2Q) (1991). The amount of the “judgment” is determined by reducing the verdict by “the amount of the workers’ compensation benefits received” by the injured party. Hieb v. Lowery, 344 N.C. 403, 410, 474 S.E.2d 323, 327 (1996). In this case, there is no jury verdict and the parties stipulated that the trial court was to “treat” the case as though a judgment had been entered against the uninsured driver in an amount in excess of the combination of all uninsured and workers’ compensation benefits. In the Clark case the uninsured benefits (under the State Farm policy) are $25,000 and the workers’ compensation benefits (paid through the date of the trial) are $130,997.62 for a total of $155,997.62. In other words, in the Clark case the parties have stipulated to a verdict of $156,000 (an amount reasonably in excess of $155,997.62). The “judgment” (within the meaning of section 97-10.2(j) and Hieb) in the Clark case is therefore $25,002.38, determined by subtracting the amount of the workers’ compensation benefits ($130,997.62) from the amount of the verdict ($156,000). The judgment (in the Clark case) thus is “insufficient to compensate the subrogation claim” of the workers’ compensation carrier (Reliance) and the trial court had discretion to determine the amount of the workers’ compensation lien. In the Stilwell case, the record does not reveal the amount of workers’ compensation benefits received by the estate prior to the date of the trial. It is thus impossible to determine whether the “judgment” is sufficient or insufficient to compensate the workers’ compensation carrier. I would therefore remand the Stilwell case for a determination of the amount of workers’ compensation benefits received by the Stilwell estate as of the date of the declaratory judgment hearing before Judge Helms. After that amount is determined the trial court shall then apply the same formula utilized above (in the Clark case) to determine if the “judgment” is sufficient to compensate the subrogation claim of the workers’ compensation carrier.
In summary, I would affirm the trial court’s order denying Ditillo and Clark’s claims under the Liberty Mutual policy. I would affirm the order of the trial court that Stilwell and Clark are entitled to uninsured benefits under their respective policies (Liberty Mutual and State Farm) in the amounts of $25,000.1 would reverse the finding of the trial court that it did not have discretion to apportion the uninsured proceeds pursuant to section 97-10.2(j) and would remand for the exercise of that discretion.
. This statute was amended in 1992 and now provides that if the insured named in the policy “does not reject uninsured motorist coverage and does not select different coverage limits, the amount of uninsured motorist coverage shall be equal to the highest limit of bodily injury and property damage liability coverage for any one vehicle in the policy.” N.C.G.S. § 21-279.21(b)(3) (1993). Under this statute the uninsured coverage is mandatory, at least to the extent the insured does not reject uninsured coverage and does not select an amount of uninsured coverage in excess of “the highest limit of bodily injury and property damage liability coverage for any one vehicle in the policy,” Id.; see Bray v. N.C. Farm Bureau Mut. Ins. Co., 341.N.C. 678, 685, 462 S.E.2d 650, 654 (1995).
Opinion of the Court
We note that Reliance failed to file their notice of appeal within thirty days from the judgment as required by N.C.R. App. P. 3. However, in our discretion and pursuant to N.C.R. App. P. 2, 21, we treat Reliance’s appeal as a petition for writ of certiorari and allow the petition in the interest of justice.
We first consider whether the trial court erred in its conclusion that defendant-employees’ potential uninsured motorist benefits were subject to a lien in favor of the workers’ compensation carrier, Reliance, pursuant to G.S. 97-10.2. While applying G.S. 97-10.2, decisions in North Carolina have consistently upheld the workers’ compensation carrier’s right to a lien on uninsured motorist benefits paid to the employee by or on behalf of a third party as a result of the employee’s injury. Creed v. R.G. Swain & Son, 123 N.C. App. 124, 472 S.E.2d 213 (1996); Martinez v. Lovette, 121 N.C. App. 712, 468 S.E.2d 251 (1996); Bailey v. Nationwide Mutual Ins. Co., 112 N.C. App. 47, 434 S.E.2d 625 (1993); Ohio Casualty Group v. Owens, 99 N.C. App. 131, 392 S.E.2d 647, disc. review denied, 327 N.C. 484, 396 S.E.2d 614 (1990). Defendant-employees here have advanced no new arguments or authorities. Accordingly, we respectfully decline to address this issue again here and conclude that the workers’ compensation car
We next consider whether the trial court correctly concluded that the limitations and exclusions of the Liberty Mutual and State Farm policies denying uninsured motorist coverage are enforceable against employee-defendants. The estates of Stilwell, Ditillo and Clark contest the enforceability of the limitations and exclusions of the Liberty Mutual policy, only the Clark estate contests the enforceability of the limitations and exclusions of the State Farm policy. However, because the provisions at issue of the State Farm and Liberty Mutual policies are identical, we will discuss them together.
The uninsured motorist limitation of liability provision provides,
Any amount otherwise payable for damages under this coverage shall be reduced by all sums:
2. Paid or payable because of the bodily injury under any of the following or similar law:
a. workers’ compensation law; ....
Similarly, the exclusionary provision provides:
C. This coverage shall not apply directly or indirectly to benefit any insurer or self-insurer under any of the following or similar law:
1. workers’ compensation law; ....
In essence, both of these provisions deny coverage to the extent that coverage may benefit a workers’ compensation carrier. Plaintiffs attempt to distinguish the application of appellate decisions on the grounds that one provision is a limitation of liability and the other is an exclusion; however, we treat them the same because they have the same practical effect. Moreover, even though the exclusionary language above has not previously been brought to the attention of this court, the exclusionary language did exist in policies where this Court previously has addressed the enforceability of identical limitation of liability provisions. See Bailey v. Nationwide Mutual Ins. Co., 112 N.C. App. 47, 54-55, 434 S.E.2d 625, 630 (1993); Hieb v. St. Paul Fire & Marine Ins. Co., 112 N.C. App. 502, 506, 435 S.E.2d 826, 828 (1993).
The estates of Ditillo and Clark argue that the trial court erred in concluding that Ditillo and Clark did not meet the definition of a person for whom the Motor Vehicle Safety and Financial Responsibility Act would require coverage beyond the terms of the policy. The Ditillo and Clark estates contend that the Financial Responsibility Act does apply to them, and therefore, because the provisions of the Financial Responsibility Act conflict with the limitations and exclusions of the Liberty Mutual policy, they are entitled to recover. See Ohio Casualty Group, 99 N.C. App. at 133, 392 S.E.2d at 649.
In order for the Financial Responsibility Act to apply to the Ditillo and Clark estates under the Liberty Mutual policy they must be “persons insured” for purposes of the act. G.S. 20-279.21 (b)(3) (1993) provides:
*707 For purposes of this section “persons insured” means the named insured and, while resident of the same household, the spouse of any such named insured and relatives of either, while in a motor vehicle or otherwise, and any person who uses with the consent, expressed or implied of the named insured, the motor vehicle to which the policy applies and a guest in such motor vehicle to which the policy applies or the personal representative of any of the above or any other person or persons in lawful possession of such motor vehicle.
As the North Carolina Supreme Court explained in Smith v. Nationwide, 328 N.C. 139, 143, 400 S.E.2d 44, 47 (1991) a “person insured” pursuant to G.S. 20-279.21(b)(3) is divided into two classes:
“In essence, N.C. Gen. Stat. 20-279.21(b)(3) establishes two ‘classes’ of ‘persons insured’: (1) the named insured and, while resident of the same household, the spouse of the named insured and relatives of either and (2) any person who uses with the consent, express or implied, of the named insured, the insured vehicle, and a guest in such vehicle.” Members of the second class are “persons insured” for the purposes of UM and UIM coverage only when the insured vehicle is involved in the insured’s injuries. Members of the first class are “persons insured” even where the insured vehicle is not involved in the insured’s injuries.
328 N.C. at 143, 400 S.E.2d at 47 (quoting Crowder v. N.C. Farm Bureau Mut. Ins. Co., 79 N.C. App. 551, 554, 340 S.E.2d 127, 130, disc. rev. denied, 316 N.C. 731, 345 S.E.2d 387 (1986)) (citations omitted). While Stilwell and Clark fit into the first class of persons insured with regard to their respective policies, Ditillo and Clark do not fit into either class of “persons insured” with regard to the Liberty Mutual policy pursuant to G.S. 20-279.21(b)(3). Ditillo and Clark were neither named insureds on the Liberty Mutual policy, residents of the Stilwell household, nor passengers in any vehicle insured by the Liberty Mutual policy. The vehicle in which Stilwell, Ditillo and Clark were riding at the time of the accident was a rental car provided by Day & Zimmerman for a company business trip and was not listed as an insured vehicle on the declarations page of the Liberty Mutual policy. Accordingly, we hold the trial court correctly concluded that the Financial Responsibility Act did not apply to Ditillo and Clark under the Liberty Mutual policy, and therefore, the provisions of the Liberty Mutual policy limiting and excluding coverage to the extent a workers’ compensation carrier would benefit were enforceable.
We next consider whether the trial court erred in its determination that it did not have discretion to apportion the uninsured motorist coverage between the workers’ compensation carrier, Reliance, and the estate of the first class insureds, Stilwell and Clark, pursuant to G.S. 97-10.2Q), because there was not a judgment insufficient to satisfy the workers’ compensation lien. The trial court based its holding on the parties’ stipulation that “[i]n determining the extent of insurance coverage liability, the court may treat each case as though a judgment was entered against the uninsured driver in an amount in excess of the combination of all applicable insurance coverages under these policies plus the amount of any applicable work
In conclusion, as to employee-defendants’ assignments of error that the trial court erred in concluding that there was a workers’ compensation lien, we overrule these assignments of error. As to Ditillo and Clark’s assignments of error that the trial court erred in holding that they were not entitled to uninsured motorist coverage under the Liberty Mutual policy, we overrule these assignments of error. As to Stilwell and Clark’s assignments of error that the trial court erred in holding that the exclusions and limitations of the Liberty Mutual and State Farm policies reduced the uninsured motorist coverage to $25,000.00, we sustain these assignments of error. As to Stilwell and Clark’s assignments of error that the trial court erred in holding that it did not have discretion to apportion the uninsured motorist coverage between their estates and the workers’ compensation carrier, Reliance, pursuant to G.S. 97-10.2(j), we overrule these assignments of error.
Affirmed in part, reversed in part.
Reference
- Full Case Name
- LIBERTY MUTUAL INSURANCE COMPANY and STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiffs v. PATRICIA E. DITILLO, Executrix of the Estate of JOHN JOSEPH DITILLO; PAULA C. BURGOON, Administratrix of the Estate of RALPH JEAN CLARK; DONNA T. STILWELL, Administratrix of the Estate of CHARLES BRUCE STILWELL; RELIANCE INSURANCE COMPANY; And DAY & ZIMMERMAN, INC., Defendants
- Cited By
- 3 cases
- Status
- Published