Nationwide Mutual Insurance Co. v. Gerlich

982 S.W.2d 456, 1998 WL 315982
CourtCourt of Appeals of Texas
DecidedSeptember 4, 1998
Docket04-96-00417-CV
StatusPublished
Cited by2 cases

This text of 982 S.W.2d 456 (Nationwide Mutual Insurance Co. v. Gerlich) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nationwide Mutual Insurance Co. v. Gerlich, 982 S.W.2d 456, 1998 WL 315982 (Tex. Ct. App. 1998).

Opinions

OPINION

LOPEZ, Justice.

Nationwide Mutual Insurance Company (“Nationwide”) appeals from a judgment rendered in favor of Catherine Gerlieh (“Ger-lieh”) in a breach of contract action. In its sole point of error, Nationwide contends that the evidence is legally insufficient to support the trial court’s finding that Nationwide was not entitled to offset the amount paid Gerlieh under the personal injury protection (“PIP”) provision of her policy against the amount to be paid to her under the uninsured/underin-sured motorists (“UM”) provision of that policy. We affirm the trial court’s judgment.

Factual and Procedural History

On March 22, 1995, Gerlieh suffered physical injuries when the car she was driving was hit by a car driven by an uninsured motorist. At the time of the collision, Gerlieh was covered by a Nationwide personal automobile liability policy that included PIP and UM coverage provisions. The policy also includ[457]*457ed a limitation of liability clause which stated:

In order to avoid insurance benefits payments in excess of actual damages sustained, subject only to the limits set out in the Declarations and other applicable provisions of this coverage, we will pay all covered damages not paid or payable under any workers’ compensation law, disability benefits law, any similar law, auto medical expense coverage or Personal Injury Protection Coverage.

In April of 1995, Nationwide paid Gerlich $2,208.72 in PIP benefits. Subsequently, Gerlich settled her claim with Nationwide under the UM coverage provision for $3,500. Relying on the limitation of liability clause, Nationwide asserted that it was entitled to a credit against the settlement amount for the PIP benefits it previously paid to Gerlich, and Nationwide tendered to Gerlich a check for $1,291.28. Gerlich sued Nationwide for breach of contract, and the case was tried before the bench on stipulated facts. The trial court held that Nationwide was not entitled to a credit for the PIP benefits.

Argument and Authorities

In order for Nationwide to be entitled to an offset for the PIP benefits, Nationwide had the burden of demonstrating that a failure to allow the offset would result in a double recovery. See Bergmann v. Sentry Ins., 422 So.2d 972, 973 (Fla.Dist.Ct.App.1982). We find that Nationwide failed to meet this burden.

The stipulated facts were signed by counsel for both parties. The parties stipulated that they reached a settlement under the UM coverage for the total amount of $3,500.2 The parties never stipulated that the actual damages suffered by Gerlich as a result of the accident amounted to $3,500.

In its brief, Nationwide states: “the actual damages sustained by Gerlich in the present ease, as referenced in the stipulated facts and stated in the final judgment, were $3,500,” citing the stipulated facts and the trial court’s judgment. That is a correct statement. The trial court found that Gerlich sustained $3,500 in damages as a result of Nationwide’s breach of contract, which was the amount of the parties’ settlement under the UM coverage that Nationwide refused to pay. However, the trial court did not find that Gerlich sustained $3,500 in actual damages as a result of the accident. In fact, the trial court could not have made such a finding because no evidence regarding the damages Gerlich sustained was even presented.

For various reasons, parties often settle a claim for a sum that is less than the amount of damages that they believe they have actually sustained. Oftentimes, an amount that is drastically less. Therefore, the stipulation that Gerlich settled her claim under the UM coverage for $3,500 does not equate to a stipulation that Gerlich sustained only $3,500 in actual damages as a result of the accident. In fact, we cannot tell from our record what the basis for the $3,500 settlement amount was or what type of damages the settlement amount was intended to compensate. See Bergmann, 422 So.2d at 973 (offset disallowed where determination of duplication of benefit not possible from appellate record). In view of the fact that Gerlich had received PIP benefits, one logical conclusion was that she agreed to settle her UM claim for $3,500 to compensate her for the losses that the PIP benefits did not cover. Thus, there would not be a double recovery because Gerlich was compensated for the actual damage she sustained in an amount that was at least $5,708.72, the sum of $2,708.72 for her out of pocket costs for medical bills and lost wages and $3,500 for at least a portion of her damages for mental anguish, future medical expenses or future disability.

Nationwide relies on James v. Nationwide Property & Cas. Ins. Co., 786 S.W.2d 91 (Tex.App.—Houston [14th Dist.] 1990, no writ), to support its position. In view of the foregoing facts, however, James is easily distinguishable. In James, the parties did stip[458]*458ulate the amount of actual damages sustained as a result of the accident as follows:

Plaintiff Betty James sustained total damages as a proximate cause of the acts and omissions of the uninsured motorist in the amount of $4,000 (including those damages paid under P.I.P. in the amount of $840.00).

No similar stipulation was made in this ease.

Because there is no evidence in our record supporting a finding that a failure to offset the PIP benefits would result in a double recovery by Gerlich, the trial court did not err in refusing to grant such an offset. We pause to note the irony presented by Nationwide’s double recovery assertion. If Nationwide prevailed in this case, Gerlich would have paid two premiums but received only one coverage, resulting in a double recovery for Nationwide. On the other hand, Nationwide would have been permitted to collect premiums for two types of coverage,3 but it would only have been required to pay benefits under one coverage.

In addition to Nationwide’s failure to prove a double recovery by Gerlich, the trial court’s judgment is further supported by the Texas Supreme Court’s holding in Dabney v. Home Ins. Co., 643 S.W.2d 386, 387 (Tex.1982). In Dabney v. Home Ins. Co., the petitioners sued Home Insurance Company (“Home”) for damages under the uninsured motorist provision of a policy issued by Home and were awarded damages by the trial court. 643 S.W.2d 386, 387 (Tex.1982). Home urged that it was entitled to reduce the judgment by the sums already paid to petitioners in PIP benefits. Id. at 389. The supreme court held:

In Westchester Fire Ins. Co. v. Tucker, 512 S.W.2d 679 (Tex.1974), we held an insurer is not entitled to set off payments under medical payments coverage against claims made under uninsured motorist coverage. PIP coverage under the standard automobile insurance policy is comparable to medical payments coverage in that both are no-fault and pay for similar expenses.

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Related

Mid-Century Insurance Co. of Texas v. Kidd
997 S.W.2d 265 (Texas Supreme Court, 1999)
Nationwide Mutual Insurance Co. v. Gerlich
982 S.W.2d 456 (Court of Appeals of Texas, 1998)

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982 S.W.2d 456, 1998 WL 315982, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nationwide-mutual-insurance-co-v-gerlich-texapp-1998.