Buder v. Indiana Ins. Co., Unpublished Decision (6-5-2003)
Buder v. Indiana Ins. Co., Unpublished Decision (6-5-2003)
Opinion of the Court
{¶ 2} The operative facts are not in dispute. In January 1998, plaintiff sustained injuries in an automobile accident allegedly caused by the negligence of another motorist. Although plaintiff worked at Shoney's Restaurant, CHHC, Inc., the accident occurred outside the course and scope of her employment and while she was engaged in personal, non-business related purposes. At the time of the accident, plaintiff was a passenger in a vehicle owned and operated by Timothy Matthews.
{¶ 3} Plaintiff filed an action against the tortfeasor in 1998. It is undisputed that plaintiff recovered a total of $50,000 in insurance proceeds from Grange Insurance Company and State Farm; the insurers of the tortfeasor and Mr. Matthews respectively. Plaintiff settled and released both insurers without notice to Indiana. Plaintiff assigned her rights to collect against the tortfeasor to State Farm. State Farm ultimately settled and dismissed the lawsuit against the tortfeasor.
{¶ 4} Both plaintiff and defendant moved for summary judgment. The court issued its memorandum of opinion and order granting defendant's motion and overruling plaintiff's corresponding motion. The court concluded, inter alia, that plaintiff failed to qualify as an insured under the terms of the policy and that plaintiff had breached the notice and subrogation provisions of the policy. We will address plaintiff's assignments of error in the order asserted and together where it is appropriate for discussion.
{¶ 5} "I. The trial court erred in granting defendant-appellee Indiana Insurance Company's motion for summary judgment and denying plaintiff-appellant's motion for summary judgment where it held that liability policy language which defines an "insured" as "you for any covered auto" is not ambiguous where the policy was issued to "CHHC, Inc., dba Shoney's Restaurant" as set forth by the Ohio Supreme Court inScott-Pontzer v. Liberty Mutual Insurance Company (1999),
{¶ 6} We employ a de novo review in determining whether summary judgment was warranted. Grafton v. Ohio Edison Co.,
A. Who Is An Insured
{¶ 7} Both parties direct our attention to the same policy terms which define "Who is an insured" under the business auto coverage form of the policy. In pertinent part, the policy provides:
{¶ 8} "SECTION II — LIABILITY COVERAGE
{¶ 9} "A. COVERAGE
{¶ 10} "* * *
{¶ 11} "1. WHO IS AN INSURED
{¶ 12} "The following are `insured':
{¶ 13} "a. You for any covered `auto.'
{¶ 14} "b. Anyone else while using with your permission a covered `auto' you own, hire or borrow except:
{¶ 15} "* * *
{¶ 16} "(2) Your employee if the covered `auto' is owned by that employee or a member of his or her household." (R. 5, Ex. B).
{¶ 17} This particular policy defines "covered autos" to include only the following:
{¶ 18} "HIRED `AUTOS' ONLY. Only those `autos' you lease, hire, rent or borrow. This does not include any `auto' you lease, hire, rent, or borrow from any of your employees or partners or members of their households" and
{¶ 19} "NONOWNED `AUTOS' ONLY. Only those `autos' you do not own, lease, hire, rent or borrow that are used in connection with your business. This includes `autos' owned by your employees or partners or members of their households but only while used in your business or your personal affairs."
{¶ 20} Plaintiff relies on the holding in Scott-Pontzer to support her position that the above-quoted language extends coverage to her. InScott-Pontzer, a widow claimed UIM coverage under her deceased husband's employer's commercial automobile insurance policy and its excess/umbrella policy. Scott-Pontzer,
{¶ 21} "Who is An Insured
{¶ 22} "You.
{¶ 23} "If you are an individual, any family member,
{¶ 24} "3. Anyone else occupying a covered auto or a temporary substitute for a covered auto. The covered auto must be out of service because of its breakdown, repair, servicing, loss or destruction.
{¶ 25} "4. Anyone for damages he or she is entitled to recover because of bodily injury sustained by another insured." Id. at 663.
{¶ 26} The excess/umbrella policy in Scott-Pontzer made no provision for UIM coverage. Id. at 665. However, unlike the underlying policy the excess/umbrella policy in Scott-Pontzer did restrict its coverage to employees acting within the scope of their employment. Id. at 666.
{¶ 27} In Scott-Pontzer, the insurer had argued that the conditional language defining "Who Is An Insured" as "if you are an individual, any family member" meant that "you" in the Superior Dairy policy was not an individual but was the corporation. The Supreme Court responded that "[w]hile that is one interpretation of the policy, it is not the only interpretation." The court noted that policy provisions"`reasonably susceptible of more than one interpretation, will be construed strictly against the insurer and liberally in favor of the insured.'" Id. at 664, quoting King v. Nationwide Ins. Co. (1988),
{¶ 28} The court then found ambiguity in the underlying policy language that defined the insured as "you" referring to the corporate entity. Id. at 664. The court reasoned that UIM insurance coverage must be interpreted with regard to persons. Id. Thus, it concluded that "`you,' while referring to Superior Dairy, also includes Superior's employees, since a corporation can act only by and through real live persons. It would be nonsensical to limit protection solely to the corporate entity, since a corporation, itself, cannot occupy an automobile, suffer bodily injury or death, or operate a motor vehicle." Id. Applying this principle, the court found that the underlying policy extended coverage to Scott-Pontzer.
{¶ 29} While the excess/umbrella policy did, in fact, restrict coverage to employees acting in the scope of employment, the court refused to insert the restriction into UIM coverage it implied by operation of law. Id. at 666. The court distinguished the application of this restriction to liability insurance of an excess/umbrella policy and UIM insurance of such policies. Id. (Emphasis in original). Presumably, the definition of the insured contained in the underlying policy of insurance in Scott-Pontzer sufficed for determining who was an insured for UIM coverage implied by operation of law in the excess/umbrella policy.2
{¶ 30} With this precedent in mind, we examine the terms of the Indiana policy. In this case, the definition of an insured includes "[y]ou for any covered `auto.'" The terms "you" and "your" as used throughout the policy "refer to the Named Insured shown on the Declarations page" which is CHHC, Inc., dba Shoney's Restaurant in Sandusky, Ohio. The policy defines an insured under the policy to include "`you' for any covered `auto.'" Following Scott-Pontzer, the terms "you" and "your" include plaintiff as an employee of the named insured.3 Therefore, we must now determine whether plaintiff was in a "covered auto."
{¶ 31} Covered auto includes only "hired autos" and "nonowned autos" as those terms are defined in the policy and set forth previously herein. It is undisputed that plaintiff was a passenger in a car that she did not lease, hire, rent or borrow rendering the hired autos provision inapplicable. Plaintiff did not own the vehicle and was engaged in her own personal affairs at the time of the accident and was not using the vehicle in connection with her employment.
{¶ 32} By giving the terms "you" and "your" consistent meaning throughout the policy the applicable covered auto provision would actually read: "NONOWNED `AUTOS' ONLY. Only those `autos' [CHHC, Inc., dba Shoney's Restaurant and its employees] do not own, lease, hire, rent or borrow that are used in connection with [CHHC, Inc., dba Shoney's Restaurant and its employees] business. This includes `autos' owned by [CHHC, Inc., dba Shoney's Restaurant and its employees] employees or partners or members of their households but only while used in [CHHC, Inc., dba Shoney's Restaurant and its employees] business or [CHHC, Inc., dba Shoney's Restaurant and its employees] personal affairs."
{¶ 33} This results in an ambiguity that must be resolved in favor of the insured. Ibid. Even assuming arguendo that this is a strained interpretation of the policy language, we cannot find it unreasonable given the precedent of Scott-Pontzer.
{¶ 34} Indiana relies on Edmondson v. Premier Industrial Corp, 2002-Ohio-5573, Cuyahoga App. No. 81132 and urges us to "limit coverage to employees operating covered autos." While there is no requirement that the employee be "operating" the covered auto, we have construed coverage under the policy within the context of employees for covered autos. Ibid. Thus, the outcome here is consistent with the reasoning employed by this Court in Edmondson. Id. at ¶ 26 ("the CNA policy qualifies its definition by requiring that coverage applies only when a covered auto is in use.") While we are not favored with the policy definition of "covered auto" that this Court examined in Edmondson, the court in Edmondson concluded that "a covered auto was obviously not being used at the time of the accident because [plaintiff] was a pedestrian when he was struck by a car." Unlike the facts in Edmondson, the operative facts here effectively establish that plaintiff was in a covered auto, that being a nonowned auto, as set forth previously.
{¶ 35} Under these particular facts and policy terms, plaintiff is an insured as that term is defined in the policy and pursuant to the authority of Scott-Pontzer. This assignment of error has merit and is sustained.
{¶ 36} B. Is This A Motor Vehicle Liability Policy
{¶ 37} The parties dispute which version of R.C.
{¶ 38} The Ohio Supreme Court finds it "clear that the scope of coverage of an automobile liability insurance policy is defined by the statutory law in effect at the time of contracting" and that the law supports the proposition that "subsequent legislative enactments cannot alter the binding terms of a pre-existing agreement entered into by contracting parties under the law as it existed at the time that the contract was formed." Ross v. Farmers Ins. Group of Companies (1998),
{¶ 39} "1. Pursuant to R.C.
{¶ 40} "2. The commencement of each policy period mandated by R.C.
{¶ 41} "3. The guarantee period mandated by R.C.
{¶ 42} In McPherson, this Court held that "R.C.
{¶ 43} "`As used in sections
{¶ 44} "`* * *
{¶ 45} "`(D) Does not insure more than four motor vehicles";McPherson, 2002-Ohio-6060 at ¶¶ 15-18. The record evidence inMcPherson reflected that the policy under examination in that case "refer[ed] to a fleet of vehicles listed on a vehicle schedule on file with the company" and the director of risk management had stated in an "unrebutted affidavit that the policy insures `hundreds of vehicles.'" Id. at ¶ 21.
{¶ 46} Unlike the policy in McPherson, the policy here fails to specifically identify any vehicles, let alone four. We make note that Indiana actually relies on this fact in arguing that the policy does not qualify under the post-HB 261 version of R.C.
{¶ 47} Under Wolfe, the parties must establish the two-year guarantee period. This must be done in order to determine which version of the law applies. The analysis begins with the original issuance date of the automobile liability insurance policy and then counting successive two-year policy periods from that date. Johnston v. Wayne Mutual Ins.Co., Fourth Appellate Dist. App. No. 02CA3, 2002-Ohio-6157, ¶ 31, following Wolfe, supra.
{¶ 48} In this case, plaintiff submitted an unrefuted affidavit establishing the original issue date as being December 6, 1994. Counting successive two-year periods, the relevant two-year guarantee period is December 6, 1996 to December 6, 1998. Thus, the pre-HB 261 version of R.C.
{¶ 49} "II. The trial court erred in finding that appellant's assignment of her rights to her personal UM/UIM carrier on December 24, 1998, well prior to the Supreme Court's decision in Scott-Pontzer, was unreasonable as a matter of law, where appellant provided notice to appellee within two years from the date on which appellant's claim for underinsured motorist coverage arose, i.e., within two years from June 23, 1999, the date of the decision in Scott-Pontzer.
{¶ 50} "III. The trial court erred by not finding that the appellant's failure to provide notice prior to setting [sic] with the tortfeasor and failure to protect appellee's alleged subrogation rights were excused as appellant did not have a claim recognized by the courts of this jurisdiction on December 24, 1998."
{¶ 51} During the pendency of this appeal, the Ohio Supreme Court announced its decision in Ferrando v. Auto Owners Mutual Ins. Co.,
{¶ 52} "The two-step approach in late-notice cases requires that the court first determine whether the insured's notice was timely. This determination is based on asking whether the UIM insurer received notice `within a reasonable time in light of all the surrounding circumstances.'Ruby, syllabus. If the insurer did receive notice within a reasonable time, the notice inquiry is at an end, the notice provision was not breached, and UIM coverage is not precluded. If the insurer did not receive reasonable notice, the next step is to inquire whether the insurer was prejudiced. Unreasonable notice gives rise to a presumption of prejudice to the insurer, which the insured bears the burden of presenting evidence to rebut.
{¶ 53} "In cases involving the alleged breach of a consent-to-settle or other subrogation-related clause, the first step is to determine whether the provision actually was breached. If it was not, the inquiry is at an end, and UIM coverage must be provided. * * * If the consent-to-settle or other subrogation-related clause was breached, the second step is to determine whether the UIM insurer was prejudiced. If a breach occurred, a presumption of prejudice to the insurer arises, which the insured party bears the burden of presenting evidence to rebut." Id. at ¶¶ 90-91.
{¶ 54} As both parties agree that Ferrando impacts the resolution of these issues, we sustain the second and third assignments of error and remand for further proceedings in accordance with Ferrando.
Judgment reversed and matter remanded for further proceedings consistent with this opinion.
It is ordered that appellant recover of appellee her costs herein taxed.
The Court finds there were reasonable grounds for this appeal.
It is ordered that a special mandate issue out of this Court directing the Court of Common Pleas to carry this judgment into execution.
A certified copy of this entry shall constitute the mandate pursuant to Rule 27 of the Rules of Appellate Procedure.
FRANK D. CELEBREZZE, JR., P.J., and COLLEEN CONWAY COONEY, J.,concur.
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