Erie Insurance Exchange v. Karoly

43 Pa. D. & C.4th 240, 1999 Pa. Dist. & Cnty. Dec. LEXIS 98
CourtPennsylvania Court of Common Pleas, Lehigh County
DecidedApril 9, 1999
Docketno. 96-C-0892
StatusPublished

This text of 43 Pa. D. & C.4th 240 (Erie Insurance Exchange v. Karoly) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Lehigh County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Erie Insurance Exchange v. Karoly, 43 Pa. D. & C.4th 240, 1999 Pa. Dist. & Cnty. Dec. LEXIS 98 (Pa. Super. Ct. 1999).

Opinion

GARDNER, P.J.,

This matter is before the court on the motion for summary judgment on behalf of Peter J. Karoly, Joseph Pulcini Jr., Michele R. Killian,1 and Peter J. Karoly & Associates, filed November 2,1998. Oral argument was held December 11,1998, and March 12 and 15, 1999. For the reasons expressed below, we deny the motion.

This is an action for fraud by plaintiff insurance company against defendant attorneys in connection with the settlement of an underinsured motor coverage claim resulting from a motor vehicle accident.

On May 1, 1993, Dean Stern was operating a motorcycle owned by Kimberly J. Catón, who was riding as a passenger. The motorcycle collided with a vehicle driven by Lorraine Semmel. Unfortunately, Miss Catón was killed in the accident and Mr. Stem was injured.

At the time of the accident, the motorcycle was insured by plaintiff with an underinsured motorist coverage of $100,000 per person. The policy included an exhaustion clause which provided that when a claim involved an underinsured motorist claim, plaintiff would not pay benefits until all other policies had been exhausted. The policy also provided that in the event of a fraudulent claim, plaintiff would not make any payment for the accident.

Plaintiff contends that defendant Karoly committed fraud in a telephone conversation with Hugh Gallagher, a claims adjuster of plaintiff, prior to December 16,1993. [242]*242At that time, defendant Karoly allegedly represented to Mr. Gallagher that CNA Insurance Company, the insurance carrier for Lorraine Semmel, had agreed to settle Mr. Stem’s claim. Defendant Karoly then demanded the underinsured motorist benefits under the insurance policy carried by plaintiff.

Plaintiff also contends that on April 18,1994, Mr. Stem executed an underinsured motorist release in favor of plaintiff, and that on April 28,1994, Mr. Stern executed a joint tort-feasor release in favor of Lorraine Semmel. Plaintiff alleges that defendant Pulcini instmcted his secretary Michele Killian to forward the documents. Defendant’s contend that both documents were sent to plaintiff and neither release was sent to CNA.

Plaintiff alleges that defendants represented that CNA had settled the case by payment of its full $300,000 policy limit: $225,000 to the Catón estate and $75,000 to Mr. Stem. Thereafter, on May 2, 1994, plaintiff sent defendant Karoly a check for $100,000 in settlement of the underinsured motorist claim.

Plaintiff avers that in June 1994, defendant Karoly contacted CNA and demanded that CNA tender the policy limits. CNA refused and indicated it never agreed to settle the claims. Plaintiff alleges that defendants did not inform plaintiff that CNA refused to tender the policy limits. Plaintiff contends that defendants committed fraud by representing to plaintiff that CNA had settled the claim against Lorraine Semmel by tendering its policy limits when, in fact, CNA had not.

In their motion, defendants contend that they are entitled to summary judgment because there is no genuine issue of material fact as to whether fraud occurred, because the exhaustion clause was satisfied and because plaintiff has not established damages. We disagree.

[243]*243To deny coverage under an insurance policy based upon a misrepresentation, the insurer must establish: (1) that the representation was false, (2) that the subject matter was material to the risk, and (3) that the person making the statement knew it to be false or made the representation in bad faith. Tudor Insurance Company v. Township of Stowe, 697 A.2d 1010 (Pa. Super. 1997).

In this case, defendants contend that Leslie K. Romas-co, a claims adjuster for CNA, offered to settle the claims against Lorraine Semmel during a telephone conversation. Thus, defendants contend that they believed a settlement had been reached and, therefore, they contacted plaintiff and advised plaintiff of the settlement. Defendants contend that at most their representation to plaintiff was a mistake, but was not fraudulent.

However, plaintiff contends that Miss Romasco denies that the conversation occurred and denies that she offered to settle the claim on behalf of CNA. (Notes of Testimony of Leslie Romasco, September 10, 1998, pp. 114,123,131-32,135.) Thus, there is a genuine issue of fact as to whether defendants’ representation that a settlement had occurred was false and whether defendants knew that the representation was false or whether they were merely mistaken. Accordingly, summary judgment is not appropriate on plaintiff’s claim for fraud.

Next, we turn to defendants’ claim that the exhaustion clause of the insurance policy was not violated. Defendants contend that the exhaustion clause of the Catón insurance policy did not require Mr. Stern to settle with CNA as a precondition for the settlement of his underinsured motorist claim with plaintiff. Therefore, defendants contend that it is irrelevant that Mr. Stem did not actually settle his claim against Lorraine Semmel until [244]*244June 12, 1996, two years after plaintiff paid its under-insured motorist benefits to Mr. Stern.

An exhaustion clause is a condition precedent which precludes an insured from recovering underinsured motorist benefits unless his damages exceed the maximum liability coverage provided by the liability carriers of other drivers involved in the accident. However, an exhaustion clause does not bar an insured who settles his claim against the tort-feasor’s liability carrier for less than policy limits from recovering underinsured motorist benefits, provided the underinsured motorist carrier is credited the full amount of the tort-feasor’s liability coverage against the insured’s damages. Boyle v. Erie Insurance Company, 441 Pa. Super. 103, 656 A.2d 941 (1995).

More simply stated, if an insured settles a claim against a third-party’s liability coverage for less than the policy limits, the underinsured motorist carrier may apply the full amount of the liability coverage to the insured’s damages before the underinsured motorist carrier is obligated to pay benefits. If the insured’s damages do not exceed the full amount of the liability coverage, the underinsured motorist carrier is not obligated to pay benefits.

However, while the insured is not obligated to settle his claim for the full policy limits to satisfy an exhaustion clause, the insured is required to actually settle his claim before a claim may be made for underinsured motorist benefits. In Boyle, supra, the Superior Court of Pennsylvania held that an exhaustion clause is a “threshold requirement” which must be satisfied before recovery of underinsured motorist benefits could be had. See also, Kelly v. State Farm Insurance Company, 447 Pa. Super. 214, 668 A.2d 1154 (1995); Chambers v. Aetna [245]*245Casualty and Surety Company, 442 Pa. Super. 155, 658 A.2d 1346 (1995).

Defendants contend that settlement of an insured’s claim against the liability carrier is not actually necessary to satisfy a condition precedent exhaustion clause.

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Related

Boyle v. Erie Insurance
656 A.2d 941 (Superior Court of Pennsylvania, 1995)
McClellan v. Health Maintenance Organization
604 A.2d 1053 (Superior Court of Pennsylvania, 1992)
Kelly v. State Farm Insurance
668 A.2d 1154 (Superior Court of Pennsylvania, 1995)
Chambers v. Aetna Casualty & Surety Co.
658 A.2d 1346 (Superior Court of Pennsylvania, 1995)
Tudor Insurance v. Township of Stowe
697 A.2d 1010 (Superior Court of Pennsylvania, 1997)

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43 Pa. D. & C.4th 240, 1999 Pa. Dist. & Cnty. Dec. LEXIS 98, Counsel Stack Legal Research, https://law.counselstack.com/opinion/erie-insurance-exchange-v-karoly-pactcompllehigh-1999.