Allstate Insurance v. Clarke
Allstate Insurance v. Clarke
Opinion of the Court
This is an appeal from an order entering summary judgment in favor of Appellee-plaintiff in the amount of $4,007.00.
Appellant has raised two issues in this appeal: (1) whether a subrogee is entitled to full payment when an entire matter has not been litigated and only a portion of the claimed damage has been recovered by settlement; and (2) whether the subrogor may make payment in full less reasonable attorneys fees where the fund against which a subrogee attempts to collect has been created by the work of the attorney for the subrogee.
Appellee, Allstate Insurance Company, instituted the action below seeking the sum of $4,007.00 from appellant, Samuel Clarke. Appellant had insurance coverage provided by appellee on an automobile which was damaged severely in a collision with two other vehicles. Appellee paid the value of the car to appellant who was also seeking damages in legal proceedings against the other two drivers involved in the collision. Appellant received a $100,000 settlement against one of the drivers and his insurance carrier, which represented the extent of liability coverage of the driver, and executed a joint tort-feasor release agreement releasing the driver and his carrier from any further damages. Ap-pellee, who had previously notified appellant of its subrogation interest and after learning of the settlement, demanded repayment of the sum paid to appellant citing a subrogation provision in the insurance contract as grounds for the repayment. Appellant, through his attorneys, notified ap-pellee that the sum in question was being held in escrow pending resolution of the action against the other driver and the City of Pittsburgh, for whom that driver was employed at the time of the collision. Appellee then filed the action which is the subject of this appeal.
Appellant, while acknowledging appellee’s subrogation right, has maintained throughout this case, that appellee’s interest cannot be determined until appellant has resolved all actions and claims arising out of the collision in question. Appellant has maintained this position because it is also his contention that appellee cannot recover, in subrogation, the full amount paid to appellant unless appellant in turn recovers the full amount of his claim against the alleged tort-fea-sors. Given this premise, appellant argues, the percentage of repayment on the subrogation claim cannot be determined until after resolution of the other claim and attempts
Associated Hospital Service of Philadelphia v. Pustil-nik, 262 Pa.Super. 600, 396 A.2d 1332 (1979), (vacated on other grounds), 497 Pa. 221, 439 A.2d 1149 (1981), dealt with a similar factual pattern to the one presently before the Court. In Pustilnik the insured was injured when struck by a subway car operated by SEPTA and was hospitalized on three occasions. Accumulated medical bills approximated $30,000 but Pustilnik was credited with only $18,960.18 under the terms of a subscription agreement with Associated Hospital Service of Philadelphia (Blue Cross). Pustilnik claimed this amount as an element of damages in a suit against SEPTA which settled in its fifth day of trial for $235,000. Blue Cross, having previously notified the insured of its subrogation interest, notified the trial court of its claim as well. Subsequent to the settlement, a trial was held to determine the amount of Blue Cross’ subrogation interest. The court accepted the credited value of $18,-960.18 as a starting point but reduced the amount by 50% because it found the settlement was at less than full value of the damages suffered. The court then made further deductions for attorney’s fees and litigation expenses, both parties filed appeals.
This Court found that the trial court erred in reducing Blue Cross’ subrogation interest by 50% to reflect settlement at less than full value of the claim. Citing Illinois Automobile Insurance Exchange v. Braun, 280 Pa. 550, 124 A. 691 (1924), this Court recited the status of the law in this regard: “that when a subrogor settles instead of pressing his suit against an alleged tort-feasor to verdict, he cannot defeat a subrogee’s claim by asserting that his loss exceeded the settlement recovery.” This Court, after further discussion, concluded that “when a subrogor settles, he waives his right to a judicial determination of his losses, and
It is well established that the action for subrogation is one based on considerations of equity and good conscience. The goal is to place the burden of the debt upon the person who should bear it. The right of subrogation may be contractually declared or founded in equity, but even if contractually declared, it is to be regarded as based upon and governed by equitable principles. Pustilnik, supra. It has often been said that the equitable doctrine of subrogation places the subrogee in the precise position of the one to whose rights and disabilities he is subrogated. Michel v. City of Bethlehem, 84 Pa.Cmwlth. 43, 478 A.2d 164 (1984); Fell v. Johnston, 154 Pa.Super. 470, 36 A.2d 227 (1944). Hence, when an individual who has been indemnified for a loss subsequently recovers for the same loss from a third party, equity compels that the indemnifying party be restored that which he paid the injured party; thereby placing the cost of the injury upon the party causing the harm while preventing the injured party from profiting a “double recovery” at the indemnifying party’s expense. However, as the subrogee stands in the precise position of the subrogor the subrogee should be limited to recovering in subrogation the amount received by the subrogor relative to the claim paid by the subrogee, for equity will not
Application of the doctrine of subrogation is a relatively easy task when there exists only one element of damage to the insured party. If an individual suffers $5,000.00 damage to an automobile, for example, and is paid this amount pursuant to collision coverage of an insurance contract and then is later successful in recovering $5,000 in a suit for damage to the vehicle against a third party, the insurer is entitled to the $5,000 judgment. If the insured were to recover only $4,000 in a suit against the third party, the insurer would still be entitled to the $4,000. If for some reason, say a favorable valuation of the automobile, the insured were to recover $6,000 against the third party, the insurer would remain entitled to only $5,000, the excess would belong to the insured.
In Pustilnik, Blue Cross had an equitable right to the proceeds of the insured’s settlement with the third party tort-feasor to the extent that settlement reflected payment for hospital expenses incurred by the insured and paid by Blue Cross. This equitable right existed to the extent of Blue Cross’ payment of medical bills on Pustilnik’s behalf and, of course, could not exceed that amount. However, the right was also limited by the amount recovered by Pustilnik relative to this claim.
Appellant also challenges the trial court’s refusal to set Allstate’s recovery in subrogation at an amount representing that paid Clarke minus reasonable attorney’s fees and costs. We are inclined to agree with Appellant that this constituted error. The trial court found appellant’s contention to be without merit because he had not raised the claim in his pleadings. However, as the subrogation action is equitable in nature the recovery must be limited by equitable principles. Our Supreme Court stated in Associated Hospital Service v. Pustilnik, 497 Pa. 221, 439 A.2d 1149 (1981), that the insurer in that case, Blue Cross, was “entitled to receive under the equitable doctrine of subrogation only what is actually paid on appellant’s behalf, less a reasonable attorney’s fee and a proportionate share of costs.” It would seem, therefore, that appellant was not obliged to plead attorney’s fees as a counterclaim
We are aware that appellee expressed a desire to appellant and his attorney not to have appellant’s attorney represent their subrogation interest. However, under these circumstances, we do not see how appellant could have protected himself and accomodated appellee, nor do we find that appellee was prejudiced by appellant’s actions. If appellee will not join in appellant’s recovery attempts or allow appellant’s attorney to represent appellee’s interest then appellee is effectively asking appellant to split the cause of action pursuing only damages for personal injury and thereby allowing appellee to proceed for damage to appellant’s automobile. However, such a cause of action could conceivably run afoul of our rules on joinder as well as the doctrine of res judicata. Furthermore, these concerns aside, this would appear feasible only where there existed no limitations on the ability to recover. However, where, as here, there exist effective limitations on recovery, the only way appellant could have realistically preserved the subrogation rights of appellee without itself recovering the maximum amount and holding the sum for appellee, which appellant did, would be to settle the personal injury aspect of the case at an amount less than the coverage provided. But, as indicated previously, the exact sum of appellee’s subrogation interest is not yet known. All that is known is that it may rise to its fullest level, in which case it would be worth the $4,007.00 claimed. We believe appellant has fully protected appellee’s subrogation interest by recovering the maximum liability coverage and holding the disputed amount in escrow.
As appellee reached no agreement with appellant and his attorney regarding fees, appellee will not be bound by a set formula of compensation or by appellant’s fee agreement with his attorney, but will, nevertheless, have its subroga
We do not think the insurer can create a practical conflict of interests by asserting a subrogation right to proceeds from an insured’s action for damages and then refusing to grant the insured’s attorney authority to represent the subrogation interest as well. Nor do we think that such refusal warrants excusal of the subrogee insurer’s equitable duty to share in a proportionate share of the costs in attaining such recovery. We realize that the insured’s settlement with the alleged tort-feasor, in circumstances like those here, destroys the insurer’s right to bring an action in its own right. However, we do not view that as a breach of the insured’s duty to protect the insurer’s subrogation interest when, as here, it appears the insured has maximized recovery against the alleged tort-feasor. We note further that, to the extent there existed a conflict in the rights of the insured and insurer it arose due to the insurer’s refusal to assent to appellant’s attorney’s joint representation of their respective interests. While we cannot compel the insurer to assent or acquiesce in appellant’s choice of representation or course of recovery, we do not
For the reasons discussed above, we vacate the order granting summary judgment to appellee Allstate until such time as appellant’s suit against the City of Pittsburgh is resolved, at which time appellee’s subrogation interest can be determined.
Order vacated, jurisdiction relinquished.
. The same results would occur if the subrogee sued the third party in its own right.
. This could be as a result of a determination of comparative negligence on the insured’s part or due to limitations on the ability to collect the judgment.
. This is consistent with the concept of placing the subrogee in the precise position of the subrogor.
. Hence, in effect, our law indicates that when an individual settles his suit he is later estopped from claiming that his damages exceeded the amount settled for. However, we feel compelled to express our concern over this position which we are equally compelled to apply. In our opinion the treatment of a settlement as conclusively establishing the value of the subrogor’s damage is neither supported in reason, sound policy or equity. There can be no doubt that many claims are settled for far less than the actual value of the damages sustained. This can be attributed to many factors. For example, the liability case may be weak for a number of reasons or there may be a readily ascertainable limit on the plaintiffs ability to collect on a judgment. This is often the case when liability coverage is limited and there exists little or no other assets to satisfy a judgment. Hence, as the Pustilnik court stated there may be many cases in which the subrogor “will be well advised to settle for substantially less than his claim.”
While a full analysis of this presumption is beyond the scope of the issue presented in this appeal, suffice it to say that upon closer scrutiny, equity is not served by engaging in a legal myth which profits an insurer at the insured's expense and could encourage a plaintiff to litigate a matter which could otherwise be settled without great difficulty.
. To illustrate this point further consider, for example, a situation where an injured insured receives a judgment in his favor for $500,-
Concurring in Part
concurring and dissenting:
I join in the order vacating the summary judgment entered in favor of appellee, Allstate Insurance Company, and remanding this case to the trial court for further proceedings. I also join in the holding that summary judgment at this time is premature and that a final determination of the amount due the appellee must await the resolution of appellant’s claim against the city of Pittsburgh. Therefore, I join in Judge Brosky’s careful and persuasive analysis of this issue.
However, I find myself in disagreement with the majority’s disposition of the issue concerning counsel fees and expenses as discussed at pages 1026-1027 of their opinion. I agree that, if properly raised, the subrogee’s recovery should be reduced by an amount equal to a reasonable attorney’s fee for creation of the fund from which recovery is to be had. Appellant, however, did not, in his pleadings, raise any claim for such a reduction. The trial court held, therefore, that the issue was not properly before it. The majority, however, holds that “appellant was not obliged to plead attorney’s fees as a counterclaim or setoff____” I respectfully dissent from that holding and agree with the trial court’s conclusion.
Under Pennsylvania’s fact-pleading procedure, each party to a lawsuit is entitled to be informed of the facts material to the original claim and defenses thereto. It is felt that such a system of pleading is necessary to enable the parties to properly prepare and present their case at the time of trial. Moreover, such a system of pleading is useful in narrowing the factual and legal issues to be resolved at trial. See II Goodrich-Amram 2d § 1017:1. Therefore, I would hold that appellant was obliged to plead the necessary facts giving rise to his claim to reasonable attorney’s fees and that his failure to do so precluded the trial court from deciding that issue. However, since I agree that the judgment must be vacated and the case remanded to the trial court, my decision on this issue would be without prejudice to the right of appellant to seek permission to file an appropriate amendment to his answer and new matter upon remand. Given my conclusion that the issue of attorney’s fees is not properly before us at this time, I do not join in the majority’s discussion thereof contained in its opinion, pages 1026-1027.
Reference
- Full Case Name
- ALLSTATE INSURANCE COMPANY v. Samuel K. CLARKE and Lebovitz & Lebovitz, P.A. Appeal of Samuel K. CLARKE
- Cited By
- 52 cases
- Status
- Published