Cole v. CALIFORNIA INS. GUAR. ASS'N

18 Cal. Rptr. 3d 801, 122 Cal. App. 4th 552
CourtCalifornia Court of Appeal
DecidedSeptember 20, 2004
DocketB172631
StatusPublished
Cited by3 cases

This text of 18 Cal. Rptr. 3d 801 (Cole v. CALIFORNIA INS. GUAR. ASS'N) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cole v. CALIFORNIA INS. GUAR. ASS'N, 18 Cal. Rptr. 3d 801, 122 Cal. App. 4th 552 (Cal. Ct. App. 2004).

Opinion

18 Cal.Rptr.3d 801 (2004)
122 Cal.App.4th 552

Jocelyn COLE, Plaintiff and Appellant,
v.
CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Defendant and Respondent.

No. B172631.

Court of Appeal, Second District, Division Seven.

September 20, 2004.
Rehearing Denied October 5, 2004.
Review Denied January 12, 2005.

*803 Plotkin, Marutani & Kaufman, Jay J. Plotkin, Nancy Marutani and Warren W. Kaufman, Sherman Oaks, for Plaintiff and Appellant.

Lord, Bissell & Brook, C. Guerry Collins, William S. Davis and Tom K. Ara, Los Angeles, for Defendant and Respondent.

*802 ZELON, J.

This appeal raises a question of first impression: may federal disability and state unemployment benefits be offset against payment of an uninsured motorist claim by the California Insurance Guarantee Association (CIGA)? Plaintiff and appellant Jocelyn Cole sued defendant and respondent CIGA, which was obligated to discharge her covered claim when her automobile insurance provider became insolvent. On cross-motions for summary judgment raising the meaning and application of Insurance Code[1] section 1063.2, subdivision (e), (subdivision (e)) to Cole's claim, CIGA prevailed. The court held CIGA may reduce payments to Cole by amounts payable to her under the federal Social Security Disability Insurance (SSDI) (42 U.S.C. § 423 et seq.) and the State of California's unemployment compensation insurance (UCI) benefits. (Unemp. Ins.Code, § 1251 et seq.). We disagree and reverse.

FACTUAL AND PROCEDURAL BACKGROUND

The parties stipulate to the underlying facts. Cole was insured under an automobile liability insurance policy issued by National Automobile and Casualty Insurance Company (National), a member of CIGA. The National policy contained uninsured and underinsured motorist coverage[2] with a $100,000 limit.

When the National policy was in effect, Cole sustained bodily injury and damages from a multiple-party automobile accident, in which four other persons were also injured. The driver of the other vehicle had a liability insurance policy of $15,000/$30,000 per occurrence, which paid Cole $5,500, her allocated share of the policy limit.

The Social Security Administration commenced paying, and continues to pay Cole SSDI benefits, because of her "inability to engage in any substantially gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 *804 months. . . ." (42 U.S.C. § 423(d)(1)(A).) The State of California paid Cole UCI benefits in the amount of $5,980 for the unemployment caused by her disability. (Unemp. Ins.Code, § 1251 et seq.)

Cole claims damages in excess of $100,000. She submitted a claim to National for the $94,500 difference between what she received from the other driver's insurance and the underinsured limits of the National policy. When National did not pay her claim, Cole instituted arbitration proceedings.

While the arbitration was pending, National became insolvent and CIGA assumed its defense pursuant to section 1063 et seq.[3] CIGA asserted it was entitled to credit Cole's SSDI and UCI benefits against the covered claim. CIGA also maintained Cole was required to exhaust her right of recovery under SSDI and UCI before she could seek recovery from CIGA. The trial court, in granting summary judgment to CIGA, upheld that position.

This appeal followed.

DISCUSSION

A. STANDARD OF REVIEW

The issue before us is whether subdivision (e) authorizes the offset of SSDI and UCI benefits against payment of an uninsured motorist claim by CIGA.

"The policy underlying motions for summary judgment and summary adjudication of issues is to `"promote and protect the administration of justice, and to expedite litigation by the elimination of needless trials."' [Citations.]" (Hood v. Superior Court (1995) 33 Cal.App.4th 319, 323, 39 Cal.Rptr.2d 296.) "When the motion has been submitted to the trial court on undisputed and stipulated facts, we are not bound by the trial court's construction of the insurance policies and the applicable statutes, and instead determine these issues as a matter of law. [Citations.]" (Travelers Indemnity Co. v. Maryland Casualty Co. (1996) 41 Cal.App.4th 1538, 1543, 49 Cal.Rptr.2d 271.) CIGA's practices are evidence of the Insurance Commissioner's interpretation of the applicable statutes to which we give great weight unless clearly erroneous or unauthorized. (Interstate Fire & Casualty Ins. Co. v. California Ins. Guarantee Assn. (1981) 125 Cal.App.3d 904, 914, 178 Cal.Rptr. 673.) "Although CIGA's interpretation of a statute may be entitled to great weight, the ultimate responsibility for the interpretation of the law rests with the courts. [Citation.]" (CD Investment Co. v. California Ins. Guarantee Assn. (2000) 84 Cal. App.4th 1410, 1418, 101 Cal.Rptr.2d 806.) We, therefore, apply the pertinent statutes to the undisputed facts and review the trial court's decision de novo. (See State Farm Mut. Auto. Ins. Co. v. Department of Motor Vehicles (1997) 53 Cal.App.4th 1076, 1081, 62 Cal.Rptr.2d 178.)

B. THE CIGA STATUTORY SCHEME PAYS ONLY COVERED CLAIMS OF INSOLVENT INSURERS

In the late 1960s and early 1970s, the high rate of insolvencies among "high risk" automobile insurers led to the establishment of guaranty association legislation. Due to the threat of federal regulation of insurer insolvency, the states sought to create a system that would protect the public from such insolvencies. (See Comment, Reinsurance and Insurer Insolvency: The Problem of Direct Recovery by the Original Insured or Claimant (1982) 29 UCLA L.Rev. 872, 882.) In 1970, the National *805 Association of Insurance Commissioners (NAIC) developed the Model Act,[4] which has been adopted by many states. (Comment, supra, 29 UCLA L.Rev. at pp. 882-883.) All 50 states have since enacted statutes that establish mechanisms for paying claims against insolvent insurers in the form of "guaranty associations" or "guaranty funds," which derive their income from taxes or assessments against insurers doing business within the state. Depending on their statutory schemes, these guaranty associations or funds may be regarded as either "public corporations" connected to the administration of government or "nongovernmental bodies." (1 Couch on Insurance (3d ed. 1997) § 6:27, pp. 6-54 to 6-56; see Nat. Conf. of Ins. Guaranty Funds, Capacity of the National Network of State Guaranty Associations to Protect Consumers of Nationally Chartered Insurance Companies (2002) p. 1 (as of Sept. 20, 2004) (hereafter NCIGF paper).)

In 1969, one year before the publication of the Model Act, the California Legislature established CIGA "to pay and discharge covered claims" of insolvent members "and in connection therewith to furnish loss adjustment services and defenses of claimants when required by policy provisions." (§ 1063.2, subd. (a); see Isaacson v. California Ins. Guarantee Assn. (1988) 44 Cal.3d 775, 786-788, 244 Cal.Rptr. 655, 750 P.2d 297; Nowlon v. Koram Ins. Center, Inc. (1991) 1 Cal.

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