Estate of Cabral v. AIG Hawaii Insurance Co.

966 P.2d 1071, 88 Haw. 345, 1998 Haw. App. LEXIS 6
CourtHawaii Intermediate Court of Appeals
DecidedFebruary 11, 1998
DocketNo. 20683
StatusPublished
Cited by1 cases

This text of 966 P.2d 1071 (Estate of Cabral v. AIG Hawaii Insurance Co.) is published on Counsel Stack Legal Research, covering Hawaii Intermediate Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Estate of Cabral v. AIG Hawaii Insurance Co., 966 P.2d 1071, 88 Haw. 345, 1998 Haw. App. LEXIS 6 (hawapp 1998).

Opinion

KIRIMITSU, Judge.

I. INTRODUCTION

After reviewing the legal arguments advanced on appeal, the dispositive issue in this case is whether Hawai'i Revised Statutes (HRS) §§ 431:10C-304 and 431:100-103(10) (Spec. Pamph. 1987)2 confers upon an insured a survivors’ loss benefit equivalent to the aggregate limits of no-fault benefits less any no-fault benefits paid or payable under the policy. We hold that it does.

II. BACKGROUND

On May 7, 1992, George Cabral (Cabral) was crossing the street when he was struck by an uninsured motor vehicle.3 Cabral died shortly after the accident as a result of injuries sustained in the motor vehicle accident.

At the time of the accident, Cabral and his wife, Nora H. Cabral, lived with their daughter and son-in-law, Deborah and Lester Luahiwa (collectively, the Luahiwas). The Luahiwas had purchased no-fault automobile insurance from Respondent-Appellee AIG Hawaii Insurance Company (AIG). The no-fault automobile insurance policy (the policy) extended coverage to Cabral as a family member who resided with the Luahiwas.

Originally, the Luahiwas purchased the statutory minimum no-fault benefits of $15,-000. Pursuant to the “No-Fault Benefits” section of the Luahiwa’s Basic No-Fault Endorsement (the Endorsement), the policy covered the following no-fault benefits: (1) medical expenses; (2) rehabilitation expenses; (3) work loss; (4) substitute service expenses; (5) funeral expenses; (6) survivors’ loss; (7) attorney’s fees and costs; and (8) other appropriate and reasonable expenses.4

[347]*347Pursuant to the “Limits of Liability” section of the Endorsement, survivors’ loss benefits were limited to the following:

Regardless of the number of persons insured, policies or self-insurance applicable, claims made or insured motor vehicles to which this coverage applies, the Company’s Lability for all No-Fault benefits to or on behalf of any one eligible injured person who sustains accidental harm in any one motor vehicle accident shall be $15,000 in the aggregate. Subject to such aggregate limit:
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(D) The maximum amount payable for survivors’ loss is $15,000 reduced by the amount of any other No-Fault benefits paid or payable under this coverage.5

[348]*348(Emphasis added) (internal emphases omitted).

However, at some point prior to the accident, the Luahiwas purchased optional additional coverage that increased the total aggregate no-fault benefits limit from $15,000 to $50,000. This increase was reflected in the Additional No-Fault Coverage Endorsement that modified the Basic No-Fault Endorsement as follows:

ADDITIONAL NO-FAULT COVERAGE ENDORSEMENT

(HAWAII)

It is agreed that the Basic No-Fault Endorsement (Hawaii) is amended as follows:

SCHEDULE

A. All No-Fault Benefits Total Aggregate Limit $50,000

B. Work Loss Maximum Monthly Limit $ 1,200

1. With respect to any amounts payable under the Basic No-Fault Endorsement (Hawaii) because of accidental harm sustained by an eligible injured person the introductory paragraph of the Limits of Liability provision is amended by substituting the amount set forth opposite A in the Schedule for the amount of “$15,000”;

2. With respect to any amounts payable under the Basic No-Fault Endorsement (Hawaii) because of accidental harm sustained by an eligible injured person who is a named insured or relative, paragraph (A)(i) of the Limits of Liability provision is amended by substituting the amount set forth opposite B in the Schedule for the amount of “$900”;

3. Additional no-fault coverage does not apply to accidental harm sustained by any person while occupying or while a pedestrian through being struck by a motor vehicle, owned by such person and with respect to which additional no-fault coverage has not been provided during the policy period;

4. Exclusion (D) of the Basie No-Fault Endorsement (Hawaii) does not apply to Additional No-Fault Coverage;

5.This endorsement is subject to all the terms and provisions of the Basic No-Fault Endorsement (Hawaii) not expressly modified herein[.]

(Emphasis added) (internal emphases omitted).

As a result of Cabral’s death, Nora H. Cabral, as Special Administratrix of the Claimant-Appellant Estate of George Cabral (Claimant), sought to recover no-fault benefits under the terms of the policy. Based on its interpretation of the policy, AIG paid Claimant $3,844.22 in medical expenses, $1,500 in funeral expenses, and $15,000 in survivors’ loss benefits.

Claimant disagreed with the amount of benefits paid by AIG and, therefore, requested an administrative hearing with the Insurance Commissioner (the Commissioner), pursuant to HRS § 431:10C-212(a) (1993).6 Specifically, Claimant argued that, when the policy limits were amended to reflect an increase from $15,000 to $50,000, it also amended the amount of survivors’ loss benefits payable under the policy. As such, instead of the policy reading, “The maximum amount payable for survivors’ loss is $15,000 reduced by the amount of any other No-Fault benefits paid or payable under this [349]*349coverage^]” it should be amended to read, “The maximum amount payable for survivors’ loss is $50,000 reduced by the amount of any other No-Fault benefits paid or payable under this coverage.”

The Hearings Officer disagreed with Claimant and determined that when the aggregate limits of the no-fault benefits were increased from $15,000 to $50,000, the increase did not change that part of the policy relating to survivors’ loss benefits.7 On February 27, 1996, the Hearings Officer issued Findings of Fact, Conclusions of Law, and recommended Order, that provided in pertinent part:

It is also worth noting that in addition to the “loss of earnings” issue as framed on the face of the denial, the Claimant sought to expand this issue by incorporating arguments relating to “survivor’s loss” [sic] (death benefits). In examining this approach it became apparent, however, that: 1) the statutes and rules are relatively silent on the subject of “survivor’s loss”; 2) the Claimant’s theory of attempting to include such benefits within “loss of earnings” is not convincing; and 3) the amount of “survivor’s loss” payable to any particular claimant as a separate category of no-fault benefits is a contractual matter determined by the terms of his or her insurance policy. In the present matter, although the aggregate coverage under the applicable policy had been increased from $15,000.00 to $50,000.00, this increase did not modify the pre-existing limit which had been specifically set at $15,000.00 for survivor’s loss benefits (nor for that matter did it effect [sic] the preexisting limits for loss of earnings by other eligible injured persons, substitute services, or funeral expenses).

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Related

Estate of Cabral v. AIG Hawaii Insurance Co.
966 P.2d 1070 (Hawaii Supreme Court, 1998)

Cite This Page — Counsel Stack

Bluebook (online)
966 P.2d 1071, 88 Haw. 345, 1998 Haw. App. LEXIS 6, Counsel Stack Legal Research, https://law.counselstack.com/opinion/estate-of-cabral-v-aig-hawaii-insurance-co-hawapp-1998.