Workman v. Carlisle Engineered Prod., Unpublished Decision (1-23-2003)
Workman v. Carlisle Engineered Prod., Unpublished Decision (1-23-2003)
Concurring Opinion
{¶ 69} The majority today affirms the decision of the common pleas court with respect to the Cincinnati Insurance policy. I concur in judgment only with respect to that conclusion.
{¶ 70} However, I respectfully write separately from the majority with respect to the National and the Travelers policies.
{¶ 71} Regarding the National policy, the majority has determined two issues of fact exist: the first, regarding the explicit terms of the policy, and the second, regarding the majority's inability to conclude Workman's status as an employee as a matter of law. Conceding both issues and construing all relevant facts most favorably to Workman, I am inclined to affirm the decision of the trial court because Workman has prejudiced National's right to subrogation by failing to provide notice of the resolution of this claim. See Ferrando, et al. v. Auto-Owners Mut.Ins. Co., ___ Ohio St.3d ___, 2002-Ohio-7217, where the court stated in its syllabus, "* * * An insured's unreasonable delay in giving notice is presumed prejudicial to the insurer absent evidence to the contrary." However, as the syllabus in Ohio no longer states the law of the case, I am constrained to agree that Ferrando mandates remand of this case for a hearing where the insured party bears the burden of presenting evidence to rebut a presumption of prejudice. See Ferrando, ¶ 101.
{¶ 72} Similarly, regarding the Travelers policy, the majority concludes the notice requirement appears only in the business auto section of the policy and not in the common policy conditions section, and therefore, it is inapplicable; I respectfully dissent. Here, no question exists but that the business auto section contains a notice provision. The majority urges it is located in the wrong section of the policy; however, this is the part of the policy pertaining to automobile coverage and is the section from which the UM/UIM coverage arises by operation of law. The deciding fact here is that the failure to provide notice of the accident to Travelers until almost three years after the accident and after settlement with the tortfeasor destroyed the subrogation rights Travelers enjoyed. This constitutes presumption of prejudice to the insurer absent evidence to the contrary. None exists. As the supreme court remanded Ferrando to the trial court, I agree we must do the same, despite Justice Stratton's caution expressed in her dissent that this renders contractual provisions of the policy meaningless and creates the necessity of a hearing every time a breach occurs.
Opinion of the Court
{¶ 2} It is not in dispute that Jeanetta Workman sustained injuries as a result of an automobile accident caused by an underinsured motorist on October 13, 1997. Ms. Workman was driving her own vehicle for personal, non-business related purposes at the time of the collision. Plaintiffs pursued litigation against the underinsured motorist tortfeasor in 1999. Plaintiffs settled their claims in that litigation with the tortfeasor and his insurer without giving notice to, or obtaining the consent of, any of the defendant-appellee insurers.
{¶ 3} In October 2000, plaintiffs commenced this action against several insurance companies seeking coverage pursuant to the authority ofScott-Pontzer v. Liberty Mut. Fire Ins. Co. (1999),
{¶ 4} All parties moved for summary judgment before the trial court. The trial court granted the motions for summary judgment filed by Cincinnati, National and Travelers. The court denied plaintiffs' corresponding cross-motions for summary judgment against those parties.2 Plaintiffs appeal assigning the following assignment of error for our review:
{¶ 5} "I. The trial court erred, as a matter of law, by granting summary judgment against plaintiff-appellee."
{¶ 6} We employ a de novo review in determining whether summary judgment was warranted. Grafton v. Ohio Edison Co. (1996),
{¶ 7} Summary judgment is appropriate where: "(1) there is no genuine issue of material fact, (2) the moving party is entitled to judgment as a matter of law, and (3) reasonable minds can come to but one conclusion and that conclusion is adverse to the nonmoving party, said party being entitled to have the evidence construed most strongly in his favor. Horton v. Harwick Chem. Corp. (1995),
{¶ 8} Once the moving party satisfies its burden, the nonmoving party "may not rest upon the mere allegations or denials of the party's pleadings, but the party's response, by affidavit or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial." Civ.R. 56(E); Mootispaw v. Eckstein,
{¶ 9} Plaintiffs assert various issues challenging the lower court's award of summary judgment to each of respective insurers. For purposes of clarity, we address the issues relating to each policy separately.
A. Cincinnati policies
{¶ 10} We first address plaintiffs' contention that Cincinnati's CGL and umbrella policies are motor vehicle policies since they provide coverage for the operation and use of "Hired" and "Non-owned" vehicles.
{¶ 11} The trial court found that Cincinnati's CGL policy was not a motor vehicle policy subject to the requirements of R.C.
{¶ 12} Cincinnati's CGL policy contained a Hired Auto and Non-Owned Auto Liability endorsement that provides in pertinent part:
{¶ 13} "A. Hired Auto Liability
{¶ 14} "The insurance provided under COVERAGE A (Section I) applies to "bodily injury" or "property damage" arising out of the maintenance or use of a "hired auto" by you or your "employees" in the course of your business.
{¶ 15} "B. Non-Owned Auto Liability
{¶ 16} "The insurance provided under COVERAGE A (Section I) applies to "bodily injury" or "property damage" arising out of the use of any "non-owned auto" in your business by any person other than you."
{¶ 17} In the policy "`Hired auto' means any `auto' you lease, hire, or borrow. This does not include any `auto' you lease, hire, or borrow from any of your `employees' or members of their households, or from any partner or `executive officer' of yours." And, "`Non-owned auto' means any `auto' you do not own, lease, hire, or borrow which is used in connection with your business."
{¶ 18} Like the policy in Selander, the Cincinnati policy involves a general liability policy that specifically provides liability coverage for injuries arising out of the use of motor vehicles. See Davidson v.Motorists Mut. Ins. Co. (2001),
{¶ 19} In Selander, the court found that "where motor vehicle liability coverage is provided, even in limited form, uninsured/underinsured coverage must be provided." Selander,
{¶ 20} We find the reasoning set forth by the federal court inLawler v. Fireman's Fund Ins. Co. (N.D.Ohio. 2001), No. 101CV503, relied upon by Cincinnati, and cited by the trial court, unpersuasive in distinguishing this case from the application of Selander. In Lawler, the court determined that a liability policy containing a non-owned vehicle endorsement did not qualify as a motor vehicle policy. In reaching this conclusion, the court attempted to distinguish Selander on the basis that the Lawler plaintiffs' injuries arose from an auto accident involving a personal vehicle being operated for personal use while the Selander plaintiffs' injuries arose from an auto accident that occurred in the scope of employment. Id. Thus, the court concluded that because plaintiff Lawler was injured outside the scope of employment, the policy did not qualify as a motor vehicle policy. Id.
{¶ 21} The reasoning in Lawler is flawed because it confuses the limitations of coverage with the classification of the policy as motor vehicle policy. As we read Selander and Davidson, a policy either qualifies as an automobile policy or it does not based upon the express policy terms. If a policy qualifies as such, the provisions of R.C.
{¶ 22} Based on the foregoing, we find that Selander controls the disposition of this issue and conclude that the Cincinnati CGL policy qualifies as a motor vehicle liability policy subject to the provisions of R.C. 3938.18.5 Accordingly, the version of R.C.
{¶ 23} Because Cincinnati's Umbrella policy provides coverage "in excess of the `underlying insurance,'" it also qualifies as a motor vehicle liability policy.6 As established, the underlying Cincinnati policy does provide coverage for hired and non-owned autos. Cincinnati did not offer UIM coverage in connection with the Umbrella policy, therefore, it is implied as a matter of law. Selander,
{¶ 24} We next address the issue of whether plaintiffs are insureds under the policies pursuant to the holding of Scott-Pontzer v.Liberty Mut. Fire Ins. Co. (1999),
{¶ 25} In Scott-Pontzer, a widow claimed UIM coverage under her deceased husband's employer's commercial automobile insurance policy and its excess/umbrella policy. Scott-Pontzer,
{¶ 26} "`B. Who Is An Insured
{¶ 27} "`1. You.
{¶ 28} "`2. If you are an individual, any family member.
{¶ 29} "`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 of destruction.
{¶ 30} "`4. Anyone for damages he or she is entitled to recover because of bodily injury sustained by another insured.'" Id. at 663.
{¶ 31} The Cincinnati CGL policy does not contain a UIM endorsement but defines the insured for purposes of the Hired Auto and Non-owned Auto Liability endorsement similar to the provisions examined in Scott-Pontzer and particularly as follows:
{¶ 32} "C. Section II — Who is Insured * * *
{¶ 33} "a. You; * * *."
{¶ 34} The excess/umbrella policy in Scott-Pontzer, like both Cincinnati's CGL and umbrella policies here, made no provision for UIM coverage. Id. at 665. However, the excess/umbrella policy inScott-Pontzer did restrict its coverage to employees acting within the scope of their employment as do provisions in Cincinnati's CGL and umbrella policies in this case. Id. at 666.7
{¶ 35} In Scott-Pontzer, the Ohio Supreme Court found ambiguity in the underlying policy language that defined the insured as "you" referring to the named insured. Id. at 664. The underlying policy examined in Scott-Pontzer only identified a corporate entity as the named insured on its declaration page. The term "you" as used throughout the policy referred to the named insured, that is the corporation. The court reasoned that UIM insurance coverage must be interpreted with regard to persons. Id. It, therefore, 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.
{¶ 36} In examining the excess/umbrella policy for UIM coverage inScott-Pontzer, the Ohio Supreme Court further determined that such coverage existed by operation of law. Id. at 665. This conclusion was driven by the fact that the excess/umbrella insurance policy failed to offer such coverage in contravention to the statutory requirements of R.C.
{¶ 37} Having found coverage under both polices in Scott-Pontzer, the Ohio Supreme Court proceeded to examine whether any exclusion or restriction applied to bar UIM coverage. Id. at 666. The court applied the principle articulated in King v. Nationwide Ins. Co. (1988),
{¶ 38} After careful review of Cincinnati's policies, we find that plaintiffs are not insureds under the policies. Plaintiffs claim coverage on the basis that the term "you," as used in the Cincinnati policies, suffers from the same ambiguity perceived by the Ohio Supreme Court inScott-Pontzer and compels inclusion of corporate employees as insureds. However, unlike the policies examined in Scott-Pontzer, both the Common Policy Declarations of Cincinnati's CGL policy and the policy declarations (along with the named insured endorsement) of Cincinnati's umbrella policy identify an individual in addition to corporate entities as a named insured, that is, "George Fonseca." As a result, when the term "you" is used throughout the Cincinnati policies, it does, in fact, reference an actual person as opposed to only a corporate entity as was the case in Scott-Pontzer. The rationale behind the decision inScott-Pontzer, as set forth previously, does not exist here since the term "you" "extends to some person or persons" and is not limited to the corporate entity.8 In this case, "you" is not ambiguous for purposes of UIM coverage. Accordingly, plaintiffs are not insured under the terms of these policies.
{¶ 39} Because plaintiffs are not insured under the policies, the trial court did not err in granting summary judgment in favor of Cincinnati.
B. National policy
{¶ 40} With regard to the National policy, the trial court found that UIM arose by operation of law, that Ms. Workman was an employee of Carlisle (the insured) at the time of the accident, but that plaintiffs breach of the notice and subrogation conditions of the business auto policy barred coverage. For the reasons that follow, we find genuine issues of material fact exist concerning Ms. Workman's status as an employee of Carlisle at the time of the accident as well as the terms of UIM coverage provided by the policy.
{¶ 41} The record on appeal indicates that the parties dispute the terms of UIM coverage provided by the policy. In particular, plaintiffs contend that UIM coverage was neither offered by National nor rejected by Carlisle and therefore assert that UIM coverage arises by operation of law. National contends that the policy has a UIM endorsement with specific terms. In fact, the record contains evidence to that effect. (R. 100). The record also contains evidence and averments that would suggest that UIM coverage was not included in the policy. (See, generally, R. 102 and exhibits thereto). The trial court's summary judgment determination did not address this factual discrepancy but simply stated that "UM coverage is imposed as a matter of law. R.C.
{¶ 42} In its cross-motion National contends that a genuine issue of material fact exists as to Ms. Workman's status as an employee of Carlisle at the time of the accident. After carefully reviewing the record, we agree. Based upon the evidence, including Ms. Workman's deposition testimony, reasonable minds could conclude that Ms. Workman was not an employee of Carlisle at the time of the accident.10 Construing the evidence in a light most favorable to National, we cannot say that Ms. Workman was an employee of Carlisle at the time of the accident as a matter of law. Accordingly, National's cross-appeal on this issue is sustained.
{¶ 43} Travelers' policy
{¶ 44} Travelers issued a Commercial Automobile Liability policy to plaintiff Larry Workman's employer, Unicco Service Company. The policy did not provide UIM coverage and therefore this coverage arises by operation of law. Traveler's asserts that the trial court erred in finding that Larry Workman is an insured under the policy.
{¶ 45} The policy identifies the named insured solely in reference to a corporate entity, Unicco Service Comany ("Unicco"). As inScott-Pontzer, the term "you," as used throughout the policy, refers to the named insured shown on the declaration page, which is Unicco. The policy defines "insureds" in relevant part as:
{¶ 46} "a. You for any covered `auto.'
{¶ 47} "b. Anyone else while using with your permission a covered `auto' you own, hire or borrow except:
{¶ 48} "* * *
{¶ 49} "(2) Your employee if the covered `auto' is owned by that employee or a member of his or her household."
{¶ 50} This policy contains similar language to that the Ohio Supreme court found to afford UIM coverage to employees of the corporate entity in Scott-Pontzer. In fact, Traveler's bases its argument that Larry Workman does not qualify as an insured on its opinion that the Ohio Supreme Court wrongly decided Scott-Pontzer. Since Scott-Pontzer controls we find that the trial court correctly determined that Larry Workman is an insured. Scott-Pontzer, supra.; Moore v. State Auto Ins. Co. (2000),
{¶ 51} Travelers claims that because plaintiffs settled and released the tortfeasor, they are not legally entitled to recover damages from the tortfeasor. In support, Travelers relies on the established principle that UIM coverage is dependent on the tortfeasor's legal liability to the injured persons. The Ohio Supreme Court directs that "the phrase `legally entitled to recover' means that the insured must be able to prove the elements of his or her claim' against the tortfeasor."Ohayon v. Safeco Ins. Co. of Ill. (2001),
{¶ 52} We agree with the reasoning in Martin which provides that because plaintiffs settled with the tortfeasors, their ability to prove the elements of their claim and recover damages from the tortfeasor is not in issue. Martin v. Liberty Mutual Ins. Co. (2001),
{¶ 53} Lastly, we address the effect of notice and subrogation provisions on the plaintiffs' ability to recover UIM insurance from Travelers. The trial court found that notice and subrogation conditions of liability coverage cross-applied to UIM coverage imposed as a matter of law. The trial court found that because plaintiffs failed to "provide timely notice of the accident" to Travelers, they destroyed Travelers' subrogation rights which precluded their ability to make a claim for UIM coverage under the policy. The trial court relied on the reasoning of the Second Appellate District in Lukenbill v. Midwestern Indemnity Co.
(2001),
{¶ 54} Plaintiffs argue that because UIM coverage arises by operation of law, it cannot include any language that exists in the actual policy. Plaintiffs refer to this as the "Pontzer 666 Rule" as a short-hand reference to the following reasoning from that case:
{¶ 55} "[W]e have already found that Liberty Mutual had failed to offer underinsured motorist coverage through the umbrella policy issued to Superior Dairy. Thus, any language in the Liberty Mutual umbrella policy restricting insurance coverage was intended to apply solely to excess liability coverage and not for purposes of underinsured motorist coverage." Scott-Pontzer,
{¶ 56} Plaintiffs also refer us to Demetry v. Kim (1991),
{¶ 57} Travelers asserts that a claimant's failure to comply with policy conditions precludes UIM coverage even when UIM is impressed upon the policy by law. To that end, Travelers contends there is a distinction between policy exclusions and policy conditions. Travelers relies uponDuriak v. Globe Am. Cas. Co. (1986),
{¶ 58} It is well-settled that insurers may include notice and subrogation clauses as valid provisions in UIM policies. Ferrando,
___ Ohio St.3d ___, 2002 Ohio 7217 at ¶ 83.12 Consequently, and for the reasons that follow, we find that common policy conditions that were meant to be applied to any and all coverages provided in the policy would apply to a coverage engrafted upon the policy by operation of law. See, generally, Heiney v. The Hartford, Franklin App. No. 01AP-1100, 2002 Ohio 3718, following Duriak v. Globe American Cas. Co. (1986),
{¶ 59} While the trial court and Travelers rely upon the outcome in Lunkenbill, we decline to apply it here to the extent that it involved differing policy terms and/or that the court employed different reasoning. In Lukenbill, the Second Appellate District addressed the issue of cross-applying terms found in a liability policy of insurance to UIM coverage that arose by implication of law. The policy contained a notice provision as a "general condition." The court reasoned that a "general condition [is] imposed upon the policy with respect to anyliability coverage it provides." Id. at 506-507 (emphasis added).
{¶ 60} A careful review of the Travelers' policy reveals that the notice and subrogation provisions relied upon by Travelers' are neither "common policy conditions" nor "general conditions" as set forth in the policy. The Travelers' policy contains certain "Common Policy Conditions." These conditions purport to apply to "[a]ll Coverage Parts included in [the] policy." However, there are no notice or subrogation provisions contained in that section.
{¶ 61} Rather than relying upon any common policy condition, Travelers relies upon conditions contained only within the "business auto conditions" which specifically apply "in addition to the common policy conditions" under that particular coverage part. While the Travelers' policy also contains "general conditions" under Section IV, the Business Auto Conditions, those "general conditions" do not include notice or subrogation provisions.
{¶ 62} We further note that Travelers included specific notice and subrogation clauses in policy endorsements that provide UIM coverage under the policy in certain states. However, Travelers did not provide Ohio UIM coverage as a matter of contract in this policy. As established, the UIM coverage here arises as a matter of law.
{¶ 63} Because Travelers did not include notice or subrogation as a common policy condition nor as general conditions, the notice and subrogation provisions in the Travelers' policy are apparently different than those examined in Lukenbill which were referred to as "general conditions." Ibid. Therefore, Travelers' reliance on conditions that arise under, and apply to, a specific coverage part, as opposed to a condition that applies to the policy as a whole, is misplaced. Our reasoning is further supported by the fact that Travelers negotiated specific notice and subrogation conditions with reference to the UIM endorsements that do exist in the policy but that are not applicable to this case.
{¶ 64} Since there are no valid or enforceable notice or subrogation clauses that could be cross-applied from the policy as common and/or general policy conditions to UIM coverage arising by operation of law, the trial court should not have premised summary judgment in Travelers' favor on this ground.
{¶ 65} Our reasoning adheres to the principle that subrogation clauses are "reasonably includable in contracts providing underinsured motorist insurance". Bogan,
{¶ 66} Accordingly, the trial court should not have awarded summary judgment to Travelers on Larry Workman's claim for UIM coverage with regard to the issue of notice and subrogation.
{¶ 67} Based on the foregoing, plaintiffs' assignment of error is sustained in part and overruled in part. National's cross-appeal is sustained on the issue of Ms. Workman's status as an employee.
{¶ 68} The trial court's judgment awarding summary judgment in favor of Cincinnati is affirmed; the trial court's award of summary judgment to National is reversed as genuine issues of material fact remain concerning coverage under National's policy and Ms. Workman's status as an employee of Carlisle. The trial court's judgment awarding summary judgment in favor of Travelers on Larry Workman's claim for coverage is reversed. This matter is remanded for further proceedings consistent with this opinion.
KENNETH A. ROCCO, P.J., CONCURS.
TERRENCE O'DONNELL, J., CONCURS WITH SEPARATE CONCURRING OPINION. (See separate concurring opinion attached).
{¶ b} "This policy does not apply to the following:
{¶ c} "* * *
{¶ d} "12. Non-owned Auto Limitation
{¶ e} "Any liability of the owner or anyone else, except `executive officers' and owners of insured organizations, arising out of the ownership, maintenance or use of any `auto' which you do not own, unless such coverage is provided by a valid and collectible policy listed in the Schedule of Underlying Policies, and then only for such hazards for which coverage is provided by such `underlying insurance.'"
Case-law data current through December 31, 2025. Source: CourtListener bulk data.