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Fulmer, Appellant, v. Insura Property & Casualty Company, d.b.a.
The Shelby Insurance Group, Appellee. [Cite as Fulmer
v. Insura Prop. & Cas. Co. (2002), 94 Ohio St.3d 85.] Insurance
— Underinsured motorist coverage — Insured gives underinsurance
carrier notice of a tentative settlement prior to release — Release will
not preclude recovery of underinsurance benefits, when — Insured
satisfies exhaustion requirement in underinsured motorist provision in
insurance policy, when. (No.
00-1788 — Submitted October 3, 2001 — Decided January 16, 2002.) Appeal from the Court of Appeals for Seneca County, No.
13-99-65. __________________ Syllabus of the Court 1.
When an insured has given her underinsurance carrier notice of a
tentative settlement prior to release, and the insurer has had a
reasonable opportunity to protect its subrogation rights by paying its
insured the amount of the settlement offer but does not do so, the release
will not preclude recovery of underinsurance benefits. (McDonald v.
Republic-Franklin Ins. Co. [1989], 45 Ohio St.3d 27, 543 N.E.2d 456,
paragraph two of the syllabus, extended and followed; Bogan v. Progressive Cas. Ins. Co. [1988], 36 Ohio St.3d 22, 521
N.E.2d 447, paragraph five of the syllabus, overruled.) 2.
An insured satisfies the exhaustion requirement in the underinsured
motorist provision of her insurance policy when she receives from the
underinsured tortfeasor’s insurance carrier a commitment to pay any
amount in settlement with the injured party retaining the right to proceed
against her underinsured motorist insurance carrier only for those amounts
in excess of the tortfeasor’s available policy limits.
(Bogan v. Progressive Cas.
Ins. Co. [1988], 36 Ohio St.3d 22, 521 N.E.2d 447, paragraph two of
the syllabus, clarified and followed.) __________________
Douglas, J. Plaintiff-appellant,
Catherine Fulmer, was injured when her automobile was struck by an
automobile driven by Albert Kulics. Kulics’s
negligence caused the collision. At
the time of the accident, Kulics, the tortfeasor, was insured under a
policy of automobile insurance with liability coverage limits of $50,000
per person. Fulmer was
insured under a policy of automobile insurance issued by defendant-appellee,
Insura Property & Casualty Insurance Company, that provided
underinsured motorist coverage with a limit of $100,000 per person. As
is generally true of insurance contracts that provide underinsured
motorist coverage, Fulmer’s contract with Insura contained an exhaustion
clause and a subrogation clause. These
clauses set forth prerequisites that Fulmer was required to meet before
she could settle with the tortfeasor if Fulmer intended to pursue an
underinsured motorist claim against Insura.
Specifically, the exhaustion clause prohibited Fulmer from settling
with a tortfeasor for less than the tortfeasor’s coverage limits unless,
of course, Insura consented.[1]
The subrogation clause required Fulmer to protect Insura’s
subrogation rights against the tortfeasor, i.e.,
it precluded Fulmer from executing a release of the tortfeasor without
Insura’s consent.[2]
According to the policy, Fulmer would forfeit her claim to
underinsured motorist benefits if she failed to satisfy these provisions.
After negotiations with Fulmer’s attorney, the tortfeasor’s
insurer offered $37,500 to settle Fulmer’s claim against the tortfeasor.
Although Fulmer believed that her damages exceeded the
tortfeasor’s policy limit of $50,000, she decided, for various reasons,
to accept the offer and forgo the additional $12,500 available under the
tortfeasor’s insurance policy. As
is generally required in settlement agreements, Fulmer’s acceptance of
the settlement offer required her to execute a release of all claims
against the tortfeasor.
Because Fulmer intended to pursue underinsured motorist benefits
from Insura for her damages in excess of the tortfeasor’s $50,000
liability limit, she advised Insura of the settlement offer and requested
Insura’s consent. In the
alternative, Fulmer requested that Insura pay her $37,500, the amount of
the settlement offer, so that Insura could preserve its subrogation rights
against the tortfeasor.
Insura refused to consent to the settlement, asserting that the
amount offered did not exhaust the tortfeasor’s insurance limit.
Insura also refused to pay Fulmer $37,500 to retain its subrogation
rights against the tortfeasor because, it contended, Fulmer’s damages
were less than the tortfeasor’s policy limit.
Thereafter, Fulmer, without Insura’s consent, settled the matter
with the tortfeasor’s insurer for $37,500.
Fulmer informed Insura of the settlement and requested arbitration
to determine whether she was entitled to underinsured motorist benefits, i.e.,
to determine whether she could prove that her damages exceeded the
tortfeasor’s available insurance limit of $50,000.
Insura rejected Fulmer’s demand for arbitration, asserting that
Fulmer had violated the exhaustion and subrogation clauses of her policy
and thereby forfeited her rights to underinsured motorist benefits.
Fulmer consequently filed a complaint against Insura, seeking a
declaratory judgment that she was entitled to underinsured motorist
benefits.
Insura moved for summary judgment and Fulmer filed a response in
opposition. To support their
respective positions with regard to the exhaustion issue, both parties
relied on conflicting courts of appeals’ interpretations of this
court’s holding in Bogan v.
Progressive Cas. Ins. Co. (1988), 36 Ohio St.3d 22, 521 N.E.2d 447.
Insura relied on the Third District Court of Appeals’
interpretation of Bogan set
forth in Stahl v. State Farm Mut.
Auto. Ins. Co. (1992), 82 Ohio App.3d 599, 612 N.E.2d 1260, to support
its position that an insured satisfies an exhaustion clause only if she is
able to show that the difference between the tortfeasor’s policy limit
and the settlement amount was approximately equal to the amount saved in
litigation expenses. Applying
that interpretation to this case, Insura argued that Fulmer could not show
that the $12,500 difference represented the amount she saved by avoiding a
trial against the tortfeasor and, thus, Fulmer violated the exhaustion
clause of her insurance policy.
In contrast, Fulmer relied on the Twelfth District Court of
Appeals’ interpretation of Bogan in Combs v. Nationwide
Mut. Ins. Co. (1997), 119 Ohio App.3d 137, 694 N.E.2d 555, to support
her contention that an insured satisfies the exhaustion clause of her
underinsured motorist contract when she accepts any
amount in settlement from the tortfeasor but is then limited to recovering
only those damages in excess of the tortfeasor’s available policy
limits. Therefore, Fulmer
argued, she satisfied the exhaustion clause and is entitled to
underinsured motorist benefits to the extent that her damages exceed the
$50,000 limit of the tortfeasor’s insurance policy.
Insura’s motion for summary judgment included the additional
argument that Fulmer was precluded from recovering underinsured motorist
benefits because she violated the subrogation clause of her insurance
contract. In this respect,
Insura argued that its decision to withhold consent to the settlement was
reasonable and, therefore, pursuant to Bogan,
Fulmer’s subsequent release of the tortfeasor violated the subrogation
provision of her insurance contract.
In response, Fulmer asserted that the court’s holding in McDonald
v. Republic-Franklin Ins. Co. (1989), 45 Ohio St.3d 27, 543 N.E.2d
456, controlled the subrogation issue.
In McDonald, we held that
an insured’s release of a tortfeasor will not preclude recovery of
underinsurance benefits if, prior to the release, she gave her
underinsurance carrier notice of the tentative settlement and the
underinsurer had a reasonable opportunity to protect its subrogation
rights by paying the amount of the offer.
Id. at paragraph two of
the syllabus. Because
Fulmer’s actions met these requirements, she argued, she satisfied her
obligation to protect Insura’s subrogation rights.
Fulmer did not introduce evidence to show that by settling with the
tortfeasor she saved litigation expenses of approximately $12,500.
The trial court reluctantly granted Insura’s motion for summary
judgment on the exhaustion issue, noting that it found the Combs
decision to be well reasoned but that it was obligated to follow the
earlier pronouncement of the Third District Court of Appeals in Stahl.
Fulmer appealed the trial court’s order to the Seneca County
Court of Appeals.
The court of appeals affirmed the trial court’s judgment on the
exhaustion issue and further held that summary judgment in favor of Insura
was proper on the additional grounds that Fulmer had violated the terms of
the subrogation clause. With regard to the subrogation issue, the court of appeals
found that the facts of this case more closely resembled the facts of Bogan
than McDonald and, therefore, the court of appeals applied the ruling in Bogan.
The cause is now before this court upon the allowance of a
discretionary appeal.
This case presents two issues for our determination.
One is whether an injured insured satisfies an exhaustion
requirement in her underinsured motorist contract when she accepts any
amount from the tortfeasor and then pursues underinsurance benefits for
only those damages in excess of the tortfeasor’s available policy
limits. The second issue is
whether an insurer is permitted to deny underinsured motorist benefits to
its insured based on a violation of a subrogation clause when, after
notifying the insurer of the settlement offer and providing the insurer
the opportunity to protect its subrogation rights by paying the amount of
the settlement offer, its insured settled with and released the tortfeasor.
Although these issues have been previously determined by this court
in Bogan and McDonald, supra, we are
called upon today to clarify the court’s decision in Bogan and to determine whether our holding in McDonald is applicable to this matter.
The facts in Bogan are virtually identical to the facts of the case now before
us. In Bogan, Michael Bogan was injured in an automobile accident, and the
tortfeasor’s liability insurer offered to settle the Bogans’ claim
against the tortfeasor for $21,000, $4,000 less than the tortfeasor’s
policy limit. The Bogans
notified their own insurer, Progressive Casualty Insurance Company, of the
settlement offer and of their intention to seek underinsured motorist
benefits through their policy with Progressive.
Progressive responded by letter indicating that (1) in
Progressive’s view, $21,000 adequately compensated all of the Bogans’
damages, (2) the Bogans must exhaust the limits of the tortfeasor’s
policy before making an underinsured motorist claim, and (3) acceptance of
the settlement offer and a general release of the tortfeasor by the Bogans
would destroy Progressive’s subrogation rights, thereby rendering the
underinsured motorist provision unenforceable.
Despite Progressive’s refusal to consent, the Bogans accepted the
settlement offer and executed a general release of the tortfeasor.
Thereafter, Progressive refused to pay underinsured motorist
benefits to the Bogans for their damages in excess of the tortfeasor’s
policy limit, contending that the Bogans had forfeited coverage by failing
to meet their contractual obligations to exhaust the tortfeasor’s policy
limits and to protect Progressive’s subrogation rights.
The majority of this court rejected Progressive’s
failure-to-exhaust argument and held that “[a]n injured insured
satisfies the ‘exhaustion’ requirement in the underinsured motorist
provision of his insurance policy when he receives from the underinsured
tortfeasor’s insurance carrier a commitment to pay an amount in
settlement with the injured party retaining the right to proceed against
his underinsured motorist insurance carrier only for those amounts in
excess of the tortfeasor’s policy limits.”
Bogan, 36 Ohio St.3d 22, 521 N.E.2d 447, at paragraph two of the
syllabus.
On the other hand, the majority accepted Progressive’s argument
regarding the subrogation clause. The
corresponding syllabus law read: “An insurer providing underinsured
motorist coverage is not required to give its consent to a proposed
settlement, the terms of which would destroy its right of subrogation
provided within the underinsured motorist insurance policy.”
Id. at paragraph five of
the syllabus. Accordingly,
the court found that, by executing a release of the tortfeasor without
Progressive’s consent, the Bogans materially breached the insurance
contract, thereby discharging Progressive from its obligation to provide
underinsured motorist coverage. Bogan
at 31, 521 N.E.2d at 456.
In summary, paragraph two of the syllabus in Bogan
offered insureds freedom to accept settlement offers for less than a
tortfeasor’s insurance limits without the underinsurer’s consent
without losing their claim to underinsured motorist benefits.
But because most settlement offers are contingent upon the injured
party’s releasing the tortfeasor, paragraph five of the syllabus, in
effect, removed that freedom by preventing the insured from releasing the
tortfeasor without the underinsurer’s consent.
Less than two years after Bogan,
this court was again presented with a case in which an insured settled
with and released the tortfeasor without the underinsurer’s consent and
was consequently denied underinsured motorist benefits for violating the
terms of a subrogation clause. In
McDonald v. Republic-Franklin Ins.
Co., 45 Ohio St.3d 27, 543 N.E.2d 456, the tortfeasor’s insurer
offered the injured party, Kendra McDonald, the full limit of the
tortfeasor’s liability policy. McDonald
notified her underinsurer, Republic-Franklin Insurance Company (“RFI”),
of the settlement offer and requested either consent to settle or a
payment equal to the settlement offer to preserve RFI’s right of
subrogation against the tortfeasor. Id.
at 33, 543 N.E.2d at 462 (Douglas, J., concurring).
Despite extensive communication between RFI and McDonald’s
stepfather, RFI never responded to the notice of the offer, and McDonald
ultimately settled with the tortfeasor’s insurer and released the
tortfeasor without RFI’s consent. RFI
then denied McDonald’s underinsured motorist claim, asserting that she
had forfeited her underinsured benefits by releasing the tortfeasor
without RFI’s consent. McDonald sued. The
trial court dismissed the complaint, and the court of appeals, relying on
paragraph five of the syllabus in Bogan,
affirmed.
In reversing the court of appeals’ judgment, this court
recognized and attempted to eliminate the unfair consequences resulting
from Bogan’s syllabus
paragraph five by modifying the law set forth therein.
In McDonald, we held that
“[w]hen an insured has given his underinsurance carrier notice of a
tentative settlement prior to release, and the insurer has had a
reasonable opportunity to protect its subrogation rights by paying the
underinsured motorist benefits before the release but does not do so, the
release will not preclude recovery of underinsurance benefits.”
Id., 45 Ohio St.3d 27,
543 N.E.2d 456, paragraph two of the syllabus.
The majority stopped short of overruling paragraph five of the
syllabus in Bogan and instead
classified that syllabus language as too broad and distinguished Bogan from McDonald on its
facts. Id. at 29-31, 543 N.E.2d at 458-460. Today we review that aspect of the McDonald court’s decision.
Comparing the facts of Bogan
to the facts of McDonald, we
find the differences insufficient to justify distinguishing the two cases. The McDonald
majority suggested that the length of time between the insured’s notice
to her insurer of the settlement offer and her acceptance of the offer was
a material difference between the two cases.
Id. at 32, 543 N.E.2d at
461. We disagree.
In McDonald, the insured notified RFI of the tortfeasor’s settlement
offer in May 1985, and then did not accept the offer until December of
that same year. Whereas, the McDonald
majority noted, the Bogans settled with the tortfeasor “just two days
after” receiving direction from their own insurer, Progressive, not to
do so. The McDonald
majority determined that by accepting the offer so quickly the Bogans had
deprived Progressive of the opportunity to consider the settlement offer.
A close examination of the facts in Bogan,
however, reveals that the Bogans notified Progressive in writing of the
settlement offer and the Bogans’ intent to accept it.
Bogan, 36 Ohio St.3d at 23, 521 N.E.2d at 449.
The letter requested that Progressive either consent to the
settlement or tender its own check
for the settlement amount to protect its subrogation rights.
Id.
In response, Progressive did not give its consent and
admonished the Bogans to notify Progressive if the tortfeasor’s insurer
offered the full policy limit, suggesting that only then would it consider
whether to tender a payment to protect its subrogation rights.
Id. at 24, 521 N.E.2d at
450. Thus, contrary to the McDonald
majority’s suggestion, Progressive did not indicate that it wanted more
time to consider whether to pay the amount of the settlement offer in
order to protect its subrogation rights.
In fact, we find that the Bogans could have reasonably construed
Progressive’s response as a rejection of the Bogans’ request for
Progressive to pay them the amount of the settlement offer, thereby
justifying the Bogans’ immediate acceptance of the tortfeasor’s
settlement offer. Therefore,
we find that this factual difference does not support distinguishing the
cases.
Another difference between the two cases is the amount of the
settlement offer. In McDonald,
the tortfeasor’s insurer offered the tortfeasor’s full policy limit in
settlement, whereas in Bogan the
offer was less than the tortfeasor’s full policy limit.
This difference is not significant, however, because the Bogan court determined that the settlement amount satisfied the
exhaustion clause. Moreover,
in both cases the underinsurer would have been obligated to pay the
insured’s damages only to the extent they exceeded the tortfeasor’s
policy limit.
A third difference between the two cases is that, in Bogan,
the underinsurer expressly denied its insured’s request for consent to
settle while in McDonald the
underinsurer simply did not respond to the insured’s request for its
consent. This distinction is
also insufficient to justify a different result because the manner in
which consent is withheld is irrelevant.
Furthermore, in McDonald,
the court’s holding specifically addressed the situation when an
underinsurer fails to respond to an insured’s notification of a
settlement offer: “The insurer’s failure to respond, within a reasonable
time, to notification by its insured of a settlement offer will operate to
void a subrogation clause in the insurer’s underinsured motorist
provision.” Id.
at paragraph three of the syllabus. If
the underinsurer’s failure to respond were the reason for the court’s
holding in paragraph two of the syllabus, then the court would not have
created a separate syllabus to address that situation.
Insura argues that the McDonald
majority was correct in distinguishing Bogan
because it would be unfair for the holding in McDonald
to be applied in cases such as Bogan.
In this regard, Insura contends that if applied in such cases the
underinsurer will be forced to pay the amount of a settlement offer to
retain its subrogation rights even when it believes that the insured’s
damages are less than the tortfeasor’s limits.
We find no merit to this argument because if the underinsurer is
correct then, by definition, the tortfeasor is not an underinsured
motorist. Consequently, the
underinsurer will not be obligated to pay underinsured motorist benefits
and, therefore, will not have any subrogation rights to protect.
Because we find no significant distinction between the facts of Bogan
and McDonald and no merit to
Insura’s argument that applying the McDonald
holding to cases like Bogan
would be unjust, we overrule McDonald
to the extent that it distinguishes Bogan
and thereby extend our holding in McDonald.
Accordingly, we hold that when an insured has given her
underinsurance carrier notice of a tentative settlement prior to release,
and the insurer has had a reasonable opportunity to protect its
subrogation rights by paying its insured the amount of the settlement
offer but does not do so, the release will not preclude recovery of
underinsurance benefits. Paragraph
five of the syllabus of Bogan is
therefore overruled.
Applying this holding to the facts of the case at bar, we find that
Fulmer’s actions did not violate the subrogation clause.
Fulmer gave Insura notice of the settlement offer and provided an
opportunity for Insura to pay her the offered amount.
Insura refused to pay Fulmer the amount offered and, therefore,
Fulmer’s release of the tortfeasor did not preclude her from recovering
underinsured motorist benefits.[3]
We now turn our attention to Insura’s contention that Fulmer
violated the exhaustion clause of her insurance contract and is,
therefore, precluded from recovering underinsured motorist benefits.
The court of appeals held that summary judgment was properly
granted in favor of Insura on this issue because Fulmer failed to offer
evidence to establish that the difference between the settlement amount
($37,500) and the tortfeasor’s policy limit ($50,000) represented a
“genuine savings in litigation expenses.”
The court of appeals relied on this court’s decision in Bogan
in reaching its conclusion that the insured was required to make such a
showing.
Fulmer argues that the court of appeals incorrectly interpreted the
holding in Bogan. Fulmer contends
that, according to Bogan, an
insured satisfies an exhaustion requirement in her underinsured motorist
contract when she accepts any
amount in settlement from the tortfeasor and retains her right to pursue
underinsurance benefits for her damages in excess of the tortfeasor’s
available policy limit.
We point out that the language in syllabus paragraph two of Bogan
favors the interpretation advocated by Fulmer.
Nevertheless, because several courts of appeals have interpreted Bogan
in the manner suggested by Insura, we review the court’s decision in Bogan
for verification that the language in paragraph two of the syllabus
accurately represents the court’s intent. In
its analysis, the Bogan court
first explained that public policy favors settlement of disputes and
acknowledged that there are various reasons why an insured would settle
for less than the tortfeasor’s policy limits.
36 Ohio St.3d at 25-26, 521 N.E.2d at 451. For example, the court pointed out, the unpaid amount might
represent the amount the insured saved in litigation expenses by settling.
The court then stated that more
important than saving litigation costs, a settlement “hastens the
payment to the injured party who obviously needs compensation soon after
the injuries when the medical expenses begin to amass and when the anxiety
level is probably quite high.” Id. at 26, 521 N.E.2d at 451.
We find that this language supports Fulmer’s interpretation and
undermines Insura’s because it recognizes that there are several reasons
an insured might settle for less than the tortfeasor’s policy limit.
A saving in litigation expenses is one reason the court mentioned
but not the only one. In
fact, the court specifically noted that receiving payment quickly was a
benefit that was even more important to the insured than saving litigation
expenses. Id. at 26, 521
N.E.2d at 451. The
Bogan court then examined the
insurer’s rationale for including an exhaustion provision in its
underinsured motorist policy. The
court acknowledged that the word “exhaust” means “ ‘to use up the
whole supply or store of: expend or consume entirely.’ ”
Id. at 27, 521 N.E.2d at
453, quoting Webster’s New Third International Dictionary (1986) 796.
But the court refused to apply the term strictly, concluding that
the objective of the exhaustion clause in an underinsured motorist
insurance policy is “quite clearly to absolve the insurer from liability
for those uncollected amounts which were below the stated limits of the
underinsured tortfeasor’s policy.”
Id. at 28, 521 N.E.2d at
453. That goal, the court
determined, is met when the insured agrees to seek underinsured motorist
coverage for only those damages in excess of the tortfeasor’s policy
limit. Id. This
portion of the court’s analysis also supports Fulmer’s interpretation
of Bogan by recognizing that,
from the underinsurer’s standpoint, the tortfeasor’s policy limits are
exhausted when the insured voluntarily decides to treat the proffered
settlement as a receipt of the entire policy limit.
The court went on to declare that it did not mean to suggest that
an injured party may voluntarily abandon her claim against the tortfeasor
and proceed directly against her underinsurer.
Id. at 28, 521 N.E.2d at
453. Insura and many courts
of appeals rely on this sentence, combined with the court’s mention that
the difference between the settlement amount and the tortfeasor’s policy
limit may represent savings in litigation expenses, to conclude that an
insured abandons her claim if she fails to show that the unpaid portion of
the tortfeasor’s policy was equivalent to her savings in litigation
costs. On
the contrary, we find that the court’s use of the word “abandon”
supports the interpretation urged by Fulmer.
The word “abandon” means “[t]o relinquish or give up with
intent of never again resuming one’s right or interest.
* * * To give up absolutely; to forsake entirely; to renounce
utterly; to relinquish all connection with or concern in; to desert.”
Black’s Law Dictionary (6 Ed.1990) 2.
Clearly, if an insured accepts a payment in
any amount from the tortfeasor she has not abandoned
her claim against the tortfeasor. Moreover,
the formula used by the court of appeals in determining whether the
injured party abandoned her claim against the tortfeasor takes into
account only one of the reasons given in Bogan
for the injured party’s decision to accept less than the tortfeasor’s
policy limits, i.e., savings in litigation expenses. In this way, the court of appeals ignored the Bogan
court’s reference to other factors that go into that decision.
In fact, the formula disregards one factor that the court
specifically recognized as more important than saving litigation
costs—the benefit of receiving payment quickly.
Of course, the benefit an injured party receives by receiving
payment quickly cannot be measured or proved, so it does not fit neatly
into a formula.
For the foregoing reasons, we reject the court of appeals’
interpretation of Bogan, which
takes the complex decision that an injured insured must make and boils it
down to an equation that does not, and cannot, take into account all of
the factors important in the decision.
Fulmer’s interpretation, on the other hand, accurately reflects
the Bogan court’s posture on
the issue. That is,
Fulmer’s interpretation permits an injured insured to take into account
all of the factors important to her in determining how much she is willing
to accept to settle her claim against the tortfeasor, and at the same time
protects her underinsurer from paying more than it bargained for by giving
it credit for the full amount of the tortfeasor’s available policy
limit.
Insura and amicus curiae, Ohio Association of Civil Trial Attorneys, contend
that the interpretation of Bogan
urged by Fulmer would defeat the Bogan
court’s intention of avoiding unnecessary litigation. Id., 36 Ohio St.3d
at 25-26, 521 N.E.2d at 451. We
find no merit in this argument. When
an insured settles with a tortfeasor, a lawsuit is avoided and only one
proceeding is then necessary to determine whether the insured is entitled
to underinsured benefits, i.e.,
to determine if damages exceed the tortfeasor’s available policy limit.
If the underinsurer pays the amount of the settlement offer in
order to preserve its subrogation rights, there is, again, only one
proceeding necessary—a trial against the tortfeasor.
The damages proved in that trial will determine whether the
tortfeasor is underinsured.
Insura also argues that the interpretation urged by Fulmer is
unfair to the underinsurer because, taken to its extreme, it would permit
the insured to settle with the tortfeasor for $.01 and then pursue her
underinsured motorist benefits. We
find this argument to be without merit for three reasons.
First, it is not likely that the insured would agree to settle for
such a small amount because she forfeits the difference between the
settlement amount and the tortfeasor’s available limits.
Second, if the insured does seek a settlement in that amount, the
underinsurer can prevent the release of the tortfeasor by paying just $.01
to its insured, and thereby preserve its subrogation rights.
And finally, even if the insured does settle for $.01, the
underinsurer is not prejudiced because it still has to pay only the amount
it contracted to pay, i.e., the insured’s damages in excess of the tortfeasor’s
available limits up to the insured’s policy limit. In
light of the foregoing, we reject the court of appeals’ interpretation
of Bogan.
Pursuant to Bogan, an insured satisfies the exhaustion requirement in the
underinsured motorist provision of her insurance policy when she receives
from the underinsured tortfeasor’s insurance carrier a commitment to pay
any amount in settlement with
the injured party retaining the right to proceed against her underinsured
motorist insurance carrier only for those amounts in excess of the
tortfeasor’s available policy limits.
We thus clarify paragraph two of the syllabus in Bogan.
Applying the holding in Bogan to the case before us, it is clear that Fulmer satisfied the
exhaustion provision of her insurance contract with Insura.
Having found that Fulmer satisfied her obligation to exhaust the
tortfeasor’s available insurance limits and her obligation to protect
Insura’s subrogation rights, we conclude that the court of appeals erred
in affirming the trial court’s ruling granting summary judgment in favor
of Insura. Fulmer is entitled
to underinsured motorist benefits as provided by her contract of insurance
with Insura to the extent that her damages exceed the tortfeasor’s
available insurance limit of $50,000.[4]
Accordingly, we reverse the court of appeals’ judgment and remand
the cause for proceedings consistent with this opinion. Judgment
reversed
and cause remanded.
Resnick,
F.E. Sweeney
and Pfeifer, JJ., concur. Moyer,
C.J., Cook and Lundberg
Stratton, JJ., dissent. __________________
Cook, J., dissenting.
Because today’s decision compounds a prior error of
law and reaches an issue that the court cannot address in this case, I
respectfully dissent. I The
UIM insurance policy at issue in this case provides for two events that
would trigger Insura’s payment of UIM benefits.
First, Fulmer could pursue UIM benefits if she had exhausted the
tortfeasor’s liability limits by payment of judgments or settlements.
Second, she could seek UIM benefits if she had sent Insura prompt
written notice of a tentative settlement between Fulmer and the tortfeasor,
and Insura had advanced payment equal to the settlement amount within
thirty days of the notification. Because
Insura did not tender payment, the only issue before this court is whether
exhaustion occurred.
In disposing of the exhaustion issue, the majority purports to
follow a “clarified” Bogan v. Progressive Cas. Ins. Co. (1988), 36 Ohio St.3d 22, 521
N.E.2d 447. This court stated
in Bogan that “[t]he precise
meaning of ‘exhaust,’ although not a legal term per
se, would seem rather easily ascertained,” and proceeded to quote a
dictionary definition of the term (“ ‘to use up the whole supply or
store of: expend or consume entirely’ ”).
Id. at 27, 521 N.E.2d at
453, quoting Webster’s Third New International Dictionary (1986) 796.
Although the court then “accept[ed] the above definition as
accurately describing the term at issue,” the court nonetheless
“disagree[d] with so strict an application” that would require that
the entirety of the tortfeasor’s policy be paid to the injured insured.
Id. at 28, 521 N.E.2d at
453. Instead, the court
reasoned that “[t]he exhaustion clause must be construed as it was
intended, i.e., a threshold
requirement and not a barrier to underinsured motorist insurance
coverage.” Id. Thus, the Bogan
court reached its “settlement plus credit” rule. But
Bogan strays from fundamental
contract interpretation principles. See
Hybud Equip. Corp. v. Sphere Drake
Ins. Co., Ltd. (1992), 64 Ohio St.3d 657, 665, 597 N.E.2d 1096, 1102
(insurance contracts must be construed by the same rules as other written
contracts). The problems with
Bogan are threefold.
First, its analysis fails to credit the contractual language that
bars UIM coverage when the party seeking coverage fails to meet the
policy’s threshold requirement. Second, the analysis disregards the plain meaning of
“exhaust.” Both the Bogan
exhaustion clause and the policy provision in the instant case require in
relevant part that the limits of the tortfeasor’s policy be “exhausted
by payment of judgments or settlements.”
Neither policy defines “exhausted.” But the commonly accepted
meaning of the term “exhaust” is “to consume entirely.”
Webster’s Third New International Dictionary (1986) 796.
Bogan, however, contrary to the text of the policy provision,
rewrites the policy so that “exhausted” means to have consumed less
than entirely. Third, the
analysis ignores the meaning of “payment.”
The policy provisions require exhaustion by payment.
Contrary to the Bogan rationale, this does not
encompass credit. The Supreme
Court of Wisconsin explains:
“[T]he exhaustion clause specifies that only one manner of
exhaustion will trigger the obligation to pay UIM benefits: exhaustion
‘by payment of judgements [sic] or settlements.’ *
* * “[A]
‘settlement plus credit’ does not constitute ‘payment’ of
liability limits as that term is commonly and ordinarily understood.
It is true that a settlement of this nature bars further claim
against the tortfeasor’s insurer and protects the UIM carrier against
liability of the difference between the settlement amount and the
tortfeasor’s full policy limits. But
it plainly does not exhaust the tortfeasor’s policy limits by
payment of those limits, as required by the UIM policy. “A
‘payment’ is ‘1.
something that is paid; an amount paid; compensation; recompense.
2. the act of paying * *
*.’ Random House Unabridged
Dictionary 1424 (2d ed.1993). The
court of appeals concluded that, in the context of this UIM exhaustion
clause, the term ‘payment’ is susceptible of only one reasonable
meaning: ‘compensation paid by the liability insurer and received by the
insured.’ [Citation
omitted.] We agree.”
(Emphasis and boldface sic.)
Danbeck v. Am. Family Mut.
Ins. Co. (2001), 245 Wis.2d 186, 195-196, 629 N.W.2d 150, 155. Thus,
giving the clear and unambiguous terms of the exhaustion clause their
natural and commonly accepted meanings, I conclude that the policy
requires that the tortfeasor’s policy be consumed
entirely, by payment of
either judgments or settlements. The
exhaustion clause does not provide for crediting.
Absent complete depletion via payment of the tortfeasor’s policy
amount, the injured insured fails to satisfy the threshold requirement to
pursuing UIM coverage. The
majority errs by adhering to—and extending—Bogan’s
rewriting of policy language. There
is no basis for concluding that “public policy” warrants such judicial
revision of the meaning of the policy language.
The statutory scheme, for example, does not directly address
exhaustion clauses. To the
contrary, R.C. 3937.18(A)(2) provides only for a setoff of the amounts
actually paid to the injured insured from the tortfeasor’s policy.
Littrell v. Wigglesworth
(2001), 91 Ohio St.3d 425, 437-439, 746 N.E.2d 1077, 1090-1091 (Cook, J.,
dissenting) (explaining that the Littrell
majority reached this correct conclusion, albeit using erroneous
reasoning, despite the fact that the case did not actually present the
issue). I
conclude that the exhaustion clause in this case requires the complete
depletion of the tortfeasor’s policy, by payment, before the insured can
pursue UIM recovery. I would
therefore overrule Bogan’s
second syllabus paragraph and reason that, because Fulmer failed to
satisfy the exhaustion clause of her policy, the trial court properly
entered summary judgment for Insura.
In reaching this conclusion, I am mindful that the issue before
this court is not the validity of exhaustion clauses, but solely the
meaning of such clauses. I
therefore express no opinion on whether such exhaustion clauses are void
as against public policy. See
Taylor v. Govt.
Employees Ins. Co. (1999), 90 Hawaii 302, 312-313, 978 P.2d 740,
750-751. II Today’s
majority also errs in deciding the subrogation issue and carrying that
decision over to the first syllabus paragraph.
The majority states in footnote 3 that “although the trial court
did not base its ruling on the subrogation clause, the court of appeals
held that failure to satisfy the subrogation clause was an additional
reason for upholding the trial court’s ruling.
Moreover, if we do not address subrogation, it will remain an issue
for Insura to argue on remand. Therefore,
we believe that it is prudent to address the issue herein.”
This rationale rejects the court’s inherently reactive role of
settling the law as it comes to us on appeal, in favor of proactively
addressing issues that the trial court did not develop.
Further, this reasoning bootstraps the majority’s overreaching by
relying in part on an error by the court of appeals’ majority. In
its judgment entry, the trial court stated that this case specifically
“asked [the court] to find whether the gap of $12,500.00 constitutes an
exhaustion of the policy for legal or practical purposes.”
That court also characterized the issue more generally: “[T]he
issue for this Court to decide is whether or not a settlement by the
Plaintiff with the tortfeasor constitutes exhaustion as a pre-condition to
the receipt of underinsured motorist coverage.” The trial court proceeded to grant summary judgment on the
basis of a lack of exhaustion. Nowhere
in the trial court’s judgment entry does that court analyze—or even mention—the
policy’s subrogation clause. Consequently,
the appeals court majority’s discussion of subrogation is mere dictum. As
today’s majority implies, it would be more convenient to address the
subrogation issue at this juncture. But convenience is not a substitute for following the law.
Cf. Murphy v. Reynoldsburg
(1992), 65 Ohio St.3d 356, 360, 604 N.E.2d 138, 141 (“[Civ.R. 56(C)]
mandates that the trial court make the initial determination whether to
award summary judgment; the trial court’s function cannot be replaced by
an ‘independent’ review of an appellate court”).
Judicial economy does not confer carte
blanche upon an appellate court to resolve potential issues that a
trial court did not decide. Because
even the most measured sense of judicial restraint confines this court to
passing upon only those issues developed below, the majority’s creation
of syllabus law on subrogation lacks legitimacy. I
would affirm the judgment of the court of appeals. Moyer,
C.J., and Lundberg Stratton,
J., concur in the foregoing dissenting opinion. __________________ Lackey,
Nusbaum, Harris, Reny & Torzewski, L.P.A., and Jay Harris, for appellant. John
S. Wasung and Susan Healy
Zitterman, for appellee. McCarthy,
Palmer, Volkema & Thomas and Michael
S. Miller; Law Firm of Frank
Todaro and Robert J. Wagoner, urging reversal for amicus
curiae Ohio Academy of Trial Lawyers. Gallagher,
Gams, Pryor, Tallan & Littrell, L.L.P., and James R. Gallagher, urging affirmance for amicus curiae Ohio Association of Civil Trial Attorneys. __________________ 1.
The Insura policy’s exhaustion clause provided:
“We will pay compensatory damages which an insured is legally
entitled to recover from the owner or operator of an uninsured [or
underinsured] motor vehicle because of bodily injury caused by an
accident. The owner’s
or operator’s liability for these damages must arise out of the
ownership, maintenance or use of the uninsured [or underinsured] motor
vehicle.
“We will pay under this coverage only if 1. or 2. below
applies:
“1. The limits of liability under any applicable bodily
injury liability bonds or policies have been exhausted by payment of
judgments or settlements; or
“2. A tentative settlement has been made between an insured
and the insurer of [the underinsured] vehicle * * * and we:
“a. Have been given prompt written notice of such settlement;
and
“b. Advance payment to the insured in an amount equal to the
tentative settlement within 30 days after receipt of notification.”
(Boldface omitted.) 2. The Insura policy’s subrogation clause provided: “If we make a payment under this policy and the person to or for whom payment was made has a right to recover damages from another we shall be subrogated to that right. That person shall do: “1. Whatever is necessary to enable us to exercise our rights; and “2. Nothing after loss to prejudice them.” 3. We note that the Ohio Association of Civil Trial Attorneys, which filed an amicus brief in this case in support of Insura, contends that this court should decline to consider the issue of whether Fulmer violated the subrogation clause. In this regard, the amicus asserts that the parties “neither pursued nor briefed this issue in the court below.” This is simply not true. Insura first raised the subrogation issue as an alternate reason for denying Fulmer underinsured motorist benefits in its motion for summary judgment. Fulmer and Insura then included opposing arguments on the issue in their court of appeals’ briefs and in their briefs before this court. In addition, although the trial court did not base its ruling on the subrogation clause, the court of appeals held that failure to satisfy the subrogation clause was an additional reason for upholding the trial court’s ruling. Moreover, if we do not address subrogation, it will remain an issue for Insura to argue on remand. Therefore, we believe that it is prudent to address the issue herein. |
SUMMARYPROPERTYAn underinsurance claim can be pursued by the insured since carrier had opportunity to pursue subrogation. When an insured has given her underinsurance carrier notice of a tentative settlement prior to release, and the insurer has had a reasonable opportunity to protect its subrogation rights by paying its insured the amount of the settlement offer but does not do so, the release will not preclude recovery of underinsurance benefits. |