Mejia v. Heimsch, Unpublished Decision (6-25-2001)
Mejia v. Heimsch, Unpublished Decision (6-25-2001)
Opinion of the Court
On July 1, 1998, Charles Heimsch ("Heimsch") lost control of his automobile and went off the roadway. Heimsch's automobile struck and killed Melissa Mejia as she was riding her bicycle on the berm. The survivors of Melissa Mejia, her parents, Kathryn and Calixto, her two brothers, Matthew and Michael, and her sister, Andrea, are the appellants in this appeal. Appellants filed a complaint against West American, State Farm, Progressive Preferred Insurance Company ("Progressive"), and Heimsch. The complaint sought wrongful death, survivorship, property and punitive damages against Heimsch and UIM benefits from Progressive, West American, and State Farm.
Appellants reached a settlement with Heimsch and he was dismissed with prejudice on December 22, 1999. Appellants reached a settlement with Progressive, Heimsch's insurer. Progressive was dismissed with prejudice on May 30, 2000. West American, State Farm and appellants all moved for summary judgment on the issue of whether appellants were entitled to collect underinsured motorist benefits under the State Farm and West American insurance policies. Andrea Mejia had a policy with State Farm which provided UIM coverage in the amount of $50,000 per person/$100,000 per accident. The remainder of appellants were insured under the West American policy which also had UIM limits of $50,000 per person/$100,000 per accident.
The trial court determined that appellants were not entitled to UIM benefits under the terms of the policies and granted summary judgment in favor of State Farm and West American. Appellants appeal the trial court's decision and raise two assignments of error. In their first assignment of error, appellants contend that the trial court erred in the manner in which it calculated the set-off for amounts paid to appellants by third parties. In their second assignment of error, appellants contend that the trial court erred in applying California law instead of Ohio law to determine what coverage was available under the State Farm policy. Each assignment of error will be discussed individually.
Choice of Law: Andrea Mejia's State Farm Policy
We begin with the issue of whether appellant Andrea Mejia ("Andrea") is entitled to UIM benefits under a policy she has with State Farm. The trial court found that California law applied to the issue of whether Andrea was entitled to UIM benefits under the State Farm policy. The parties agree that if California law applies, Andrea is not entitled to UIM benefits.
Andrea lives in the State of California and the State Farm policy was issued in California. The State Farm agent who issued the policy was registered in the State of California and the vehicle insured by the policy was registered in California. Appellants contend that Ohio law should apply to this issue because the choice of law provisions applicable to torts should apply since the claim ultimately arises in tort. Appellees contend that the choice of law for contracts should apply because the insurance policy is a contract between the parties.
After the parties briefed this case and after oral arguments were heard, the Supreme Court of Ohio addressed this exact issue. The court held that "[a]n action by an insured against his or her insurance carrier for payment of underinsured motorist benefits is a cause of action sounding in contract, rather than tort, even though it is tortious conduct that triggers applicable contractual provisions." Ohayon v.Safeco Ins. Co. of Illinois (2001),
In the case at bar, the State Farm contract was negotiated in California between a California resident and a California licensed insurance agent. The insured vehicle was licensed in California. Accordingly, California law should apply to the determination of UIM benefits. California allows an insurer to limit damages for bodily injury to injuries that occur to the insured. See Calif. Insurance Code Section
Appellants also argue that the State Farm policy is ambiguous regarding what law should be used to determine coverage issues and that the ambiguity should be construed in favor of coverage. As support for this argument, appellants cite Csulik v. Nationwide Mut. Ins. Co. (2000),
Again, this issue was addressed by the court in Ohayon. The insurance policy in that case provided that the insurer would pay UIM benefits which an insured was "legally entitled to recover." Although the plaintiffs argued that the phrase was ambiguous, the court stated that it had previously found the phrase "legally entitled to recover" meant that the insured must be able to prove the elements of his or her claim against the tortfeasor. Id. at 484; Kurent v. Farmers Ins. Of Columbus (1990),
The language in the instant case is strikingly similar to the language of the contract in Ohayon. We find no discernable difference between "legally entitled to recover" and "legally entitled to collect" as it relates to the insurance contract at issue. Accordingly, we find appellant Andrea Mejia is not entitled to UIM benefits under the State Farm policy. Appellants' second assignment of error is overruled.
Amount of Set-Off: West American Policy
Appellants argue that the trial court erred in the method of calculating the set-off for amounts paid to appellants by third parties. Heimsch was insured by Progressive with policy limits of $100,000 per person and up to $300,000 per occurrence. Progressive paid the $100,000 per person limit to appellants in settlement of the claim. Heimsch personally contributed an additional $25,000 in settlement of his individual claim. After attorney's fees and expenses were deducted from the $125,000 settlement, the remainder was divided equally among the five survivors. Individually, each survivor received $15,988.89 out of the proceeds of the settlement.
Appellants agree that pursuant to R.C.
However, the case relied on by the trial court has recently been reversed by the Ohio Supreme Court. Littrell v. Wigglesworth (Mar. 13, 2000), Butler App. Nos. CA99-05-092, CA99-08-141, unreported, reversed (2001),
Although appellants argue that this court should separately set-off the amount each individual appellant received from the $50,000 UIM limit of the policies, the Ohio Supreme Court has recently discussed the method of set-off calculation in cases where the insurance policy limits recovery to a single per-person limit. In Clark v. Scarpelli (2001),
In Clark, four wrongful death beneficiaries attempted to recover UIM benefits from their insurance company. The policy limited all wrongful death claims to the single per-person limit of $100,000. Id. at 284. Because of this consolidation language, all claims for wrongful death were included in the single per-person policy limit. Id. Thus, the amount available to all the wrongful death beneficiaries combined was $100,000. Because the combined total amount the wrongful death beneficiaries received from the tortfeasor was also $100,000, the beneficiaries were not entitled to receive UIM benefits under their policy.
The instant case presents the same scenario. Appellants argue that the amount each person received should be separately set-off from the $50,000 policy limit, so that each person is entitled to receive the difference between the $50,000 limit and the $15,988.89 received by that person from the tortfeasor.1 However, the policy at issue in this case contains limiting language similar to the policy in Clark. The West American policy limits liability for payment of UIM benefits in the following paragraph:
The limit of liability shown in the Schedule or in the Declarations for each person for Underinsured Motorists Coverage is our maximum limit of liability for all damages including damages for care, loss of services or death, arising out of "bodily injury" sustained by any one person in any one accident. Subject to this limit for each person, the limit of liability shown in the Schedule or in the Declarations for each accident for Uninsured Motorists Coverage is out maximum limit of liability for all damages for "bodily injury" resulting from any one accident. This is the most we will pay regardless of the number of:
1. "Insureds;"
2. Claims made;
3. Vehicles or premiums shown in the Declarations; or
4. Vehicles involved in the accident.
This provision limits UIM recovery for an accident in which only one person is injured or dies to the "per person" limitation for all injuries, regardless of the number of insureds who make claims under the policy. Thus, in this case, appellants collectively are limited to the $50,000 per person limit under the West American policy as the maximum payable under UIM coverage. Because collectively appellants have received an amount greater than $50,000 from the tortfeasor, they are not entitled to UIM benefits under the West American policy. See Clark at 284. Appellants' first assignment of error is overruled.
In conclusion, we find that appellant Andrea Mejia is not entitled to UIM coverage under the State Farm policy because California law applies to the policy. We also find that appellants are correct in their argument that the set-off in the West American policy is to be calculated by a comparison of the amounts actually received from the tortfeasor, not a policy-limit to policy-limit comparison. However, because the West American policy contains language limiting the total of appellants' recovery to the per-person limitation and the total amount received by appellants is greater than the per-person limit, appellants are not entitled to UIM benefits under the West American policy.
Judgment affirmed.
VALEN and POWELL, JJ., concur.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.