Cole v. Holland

667 N.E.2d 353, 76 Ohio St. 3d 220
Ohio Supreme Court·Decided August 7, 1996·No. No. 94-2569·Published·Cited by 57 cases

Opinions

Alice Robie Resnick, J.

The issue presented is whether a provider of underinsurance coverage may set off money received by its insured from a tortfeasor’s insurer against the insured party’s damages, or whether the setoff may be against the relevant policy limit.

Former R.C. 3937.18(A)(2) required “[ujnderinsured motorist coverage, which shall be in an amount of coverage equivalent to the automobile liability or motor vehicle liability coverage and shall provide protection for an insured against loss for bodily injury, sickness, or disease, including death, where the limits of coverage available for payment to the insured under all bodily injury liability bonds and insurance policies covering persons liable to the insured are less than the limits for the insured’s uninsured motorist coverage at the time of the accident. The limits of liability for an insurer providing underinsured motorist coverage shall be the limits of such coverage, less those amounts actually recovered under all applicable bodily injury liability bonds and insurance policies covering persons liable to the insured.” Am.Sub.H.B. No. 1,142 Ohio Laws, Part I, 1661, 1739-1740.

At this point, we note that if an injured party’s damages do not exceed the amount of recovery available from the tortfeasor’s liability insurers, the tortfeasor is not underinsured and underinsurance coverage does not come into play. Likewise, if the injured party’s damages do exceed the amount available from the tortfeasor’s liability insurers, but do not exceed the relevant policy limit of the injured party’s underinsurance coverage, that injured party will recover the full extent of his or her damages, with the underinsurance provider paying those damages not covered by the tortfeasor’s liability insurers. In that situation, the tortfeasor is underinsured, but the setoff issue does not come into play. The setoff issue arises only when the party seeking to recover pursuant to underinsurance coverage suffers damages that exceed the policy limit of underinsurance coverage after the injured party has been partially compensated for those injuries by the tortfeasor’s liability insurers.

It is therefore clear that no issue of double recovery arises when considering setoff, because any analysis involving setoff begins at the starting point that the tortfeasor’s liability insurance is not sufficient to adequately compensate the injured party seeking the underinsurance coverage. Furthermore, in cases of very, serious injury when sizable damages are involved, the injured party as a practical matter faces severe undercompensation, even if the setoff question is [223]*223resolved in the injured party’s favor, because the limit of the underinsurance policy acts as a cap on the amount of recovery.

In James v. Michigan Mut. Ins. Co. (1985), 18 Ohio St.3d 386, 18 OBR 440, 481 N.E.2d 272, this court construed a predecessor statute to former R.C. 3937.18(C), virtually the same as current R.C. 3937.18(E),1 and held at paragraph two of the syllabus: “An insurer may apply payments made by or on behalf of an underinsured motorist as a setoff directly against the limits of its underinsured motorist coverage, so long as such setoff (1) is clearly set forth in the terms of the underinsured motorist coverage and (2) does not lead to a result wherein the insured receives a total amount of compensation that is less than the amount of compensation that he would have received if he had been injured by an uninsured motorist.”

In In re Nationwide Ins. Co. (1989), 45 Ohio St.3d 11, 543 N.E.2d 89, we held at the syllabus: “A setoff against the limits of underinsured and uninsured motorist coverage is permitted under R.C. 3937.18(E) provided the setoff is clearly set forth in the provisions of the insurance policy.”

As a result of James and In re Nationwide, it was then settled that former R.C. 3937.18 allowed an insurer to set off payments received by its insured from other sources against the underinsured motorist coverage policy limit to reduce the amount to be paid to the insured.

However, our decision in Savoie, supra, has affected the way the courts of this state have been resolving the setoff question. Although Savoie did not overrule James and In re Nationwide, and moreover did not specifically find any provision of former R.C. 3937.18 to be ambiguous or unconstitutional relative to setoffs, courts of this state (including the trial court and the court of appeals in the case sub judice) have been relying on paragraph three of the syllabus of Savoie, as well as on the discussion in Part III of that opinion, and on their own independent reasoning, to decide that insurers must set off proceeds received by their insureds from tortfeasors’ liability insurers against the insureds’ damages, rather than against the policy limit.

In Savoie, this court held at paragraph three of the syllabus: “An underinsurance claim must be paid when the individual covered by an uninsured/underinsured policy suffers damages that exceed those monies available to be paid by the [224]*224tortfeasor’s liability carriers. (Hill v. Allstate Ins. Co. [1990], 50 Ohio St.3d 243, 553 N.E.2d 658, overruled.)”

In concurring opinions in two cases summarily decided on the authority of Savoie, members of this court appeared to clarify paragraph three of the syllabus of Savoie to indicate that the insurer’s setoff applies against the insured’s damages, not against the policy limit of underinsurance coverage. See Hillman v. Hastings Mut. Ins. Co. (1994), 68 Ohio St.3d 238, 239, 626 N.E.2d 73, 74 (Pfeifer, J., concurring) (“Savoie, in all personal injury cases, eliminates the setoff against underinsurance policy limits”); Newman v. United Ohio Ins. Co. (1994), 69 Ohio St.3d 1204, 1205, 631 N.E.2d 157, 158 (Douglas, J., joined by A.W. Sweeney, Resnick, F.E. Sweeney and Pfeifer, JJ., concurring in denial of motion for reconsideration) (“Savoie [1] requires setoff; [2] requires that any setoff be against the insured’s damages [not the written limits of underinsured coverage]; and [3] that paragraph three of the syllabus of Savoie applies to ‘ * * * all personal injury cases ***’*** and not just to wrongful death cases.”). (Emphasis sic.)

We note that, effective October 20, 1994, R.C. 3937.18(A)(2) was amended to provide, in part: “Underinsured motorist coverage is not and shall not be excess insurance to other applicable liability coverages, and shall be provided only to afford the insured an amount of protection not greater than that which would, be available under the insured’s uninsured motorist coverage if the person or persons liable were uninsured at the time of the accident. The policy limits of the underinsured motorist coverage shall be reduced by those amounts available for payment under all applicable bodily injury liability bonds and insurance policies covering persons liable to the insured.” Am.Sub.S.B. No. 20, 145 Ohio .Laws, Part I, 204, 210-211.

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Cole v. Holland, 667 N.E.2d 353, 76 Ohio St. 3d 220 (Ohio 1996).

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