Plunket v. Metropolitan Life Insurance

34 Pa. D. & C.3d 102, 1984 Pa. Dist. & Cnty. Dec. LEXIS 196
CourtPennsylvania Court of Common Pleas, Blair County
DecidedNovember 2, 1984
Docketno. 588 C.P. 1983
StatusPublished

This text of 34 Pa. D. & C.3d 102 (Plunket v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Blair County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Plunket v. Metropolitan Life Insurance, 34 Pa. D. & C.3d 102, 1984 Pa. Dist. & Cnty. Dec. LEXIS 196 (Pa. Super. Ct. 1984).

Opinion

PEOPLES, P.J.,

On March 23, 1983, plaintiff, a Pennsylvania resident, initiated this action by filing a complaint in assumpsit, seeking the recovery of benefits under the terms of a group health insurance plan issued by defendant to plaintiffs employer. On July 7, 1983, defendant filed an answer containing new matter to which plaintiff filed his answer on September 2, 1983. On March 8, 1984, the parties to this action filed stipulations of fact and thereafter plaintiff and defendant filed motions for summary judgment on May 17, 1984, and August 7, 1984, respectively. Legal counsel for each of the parties duly filed briefs and argued orally regarding the motions on August 29, 1984. The matter is now before the court for disposition of those motions.

According to the aforementioned stipulation of facts on November 7, 1981, a step-daughter of plaintiff sustained serious injuries in an automobile-pedestrian accident and as a result thereof hospital and medical bills were incurred totaling $2,813.58. [104]*104At all times relevant to this proceeding plaintiff and his step-daughter were insured under their own no-fault insurance policy issued by Nationwide Insurance Company. The step-daughter’s hospital and medical expenses were paid by the Nationwide Company pursuant to the provisions and terms of that policy.

During the same period both plaintiff and his step-daughter were also insured by defendant herein under the terms of a group health care policy issued to plaintiffs employer, Frye Metals, Inc. Defendant corporation maintains its principal place of business in the State of New York. The subject group health care policy was negotiated, delivered and issued in the State of New York on standardized forms approved by that state’s insurance department.

A claim made by plaintiff upon defendant for the payment of the aforementioned medical expenses was denied by defendant upon the ground that the policy in question contained a coordination of benefits clause. That clause stipulates that if an employee, or a dependent of an employee, is insured by motor vehicle no-fault coverage, then the benefits otherwise available under defendant’s group policy are subject to reduction by the amount of the proceeds received from the no-fault insurance carrier. Defendant’s refusal of plaintiffs claim led to the filing of the instant action.

In support of plaintiffs motion for summary judgment the argument is advanced that if this case be deemed to be controlled by Pennsylvania law, then plaintiff would be entitled to recover from defendant despite a prior recovery for the same expenses from plaintiffs no-fault carrier. In support of its motion for summary judgment, defendant argues that the case is governed by the law of the State of New York [105]*105and that, therefore, plaintiff is not entitled to a double recovery. Thus, posed for decision by this court are the following issues:

1. Whether the controversy is governed by the law of Pennsylvania or the law of New York; and

2. Whether a duplicate recovery may be had by plaintiff even if the law of Pennsylvania is found applicable to the case.

In Griffith v. United Airlines, Inc., 416 Pa. 1, 203 A.2d 796 (1964), the Supreme Court of Pennsylvania in dealing with a question of applicable law adopted an approach which is a combination of the theory of governmental interest and the theory of significant contacts (Restatement (Second) of Conflict of Laws). The prescription of the Supreme Court in Griffith, supra, calls for the court to consider both the significant contacts of the contract with the competing jurisdictions and the interest of each of the jurisdictions in the subject matter of that contract. Melville v. American Homes Assurance Company, 584 F.2d 1306 (3rd Cir., 1978).

Applying the rationale of the Griffith, supra, decision we seek to determine which state (Pennsylvania or New York) has the most significant contact with the group policy in question. The policy was negotiated, delivered and issued in the State of New York on a form approved by the insurance department of that state. In all these respects, the contract of insurance has significant contacts with the State of New York. Pennsylvania’s significant contacts with the policy in question consist of the residence of plaintiff and the location of plaintiffs employer’s plant.

In Henning v. Metropolitan Life Insurance Company, 546 F.Supp. 442, (M.D. Pa. 1982), a group disability insurance policy had been negotiated, signed, delivered and issued in the State of New [106]*106York by a New York corporation to plain tifffs employer, a company doing business in the State of Pennsylvania. Plaintiff, a Pennsylvania resident, had become totally disabled and applied for and ultimately received social security benefits. The employee also filed a claim under the aforementioned disability insurance policy which resulted in the announcement by defendant insurer that any benefits paid would be reduced by the amount of social security benefits paid to plaintiff in connection with the same disability. The policy involved in Henning, supra, contained a coordination of benefits clause which provided for a reduction of benefit payments to the extent of any social security benefits received by claimant.

The court in Henning, supra, determined that New York had the most significant contacts with the policy of insurance because that policy had been requested, negotiated, signed, issued and delivered in New York State. Further, the court determined that the policy had also been approved by the Insurance Department of the State of New York while Pennsylvania had only two significant contacts. Those contacts were determined to be the domicile of plaintiff and the location of one of plaintiffs employer’s plants in the Commonwealth.

The similarity of factual situations existing in the instant matter and in Henning, supra, causes this court to find the Henning, supra, decision significantly applicable to this matter. Our measure of the facts in this case leads to the conclusion that the state having the' most significant contacts is the State of New York.

Turning attention to the question of which of the two states has the greatest interest in the subject matter of this action, we note that under the provisions of the group insurance policy here involved [107]*107the insured is actually the body of persons who are employees of the plant’s employer. Thus, the employer as the representative of that group of employees is the actual agent of the insured. Layman v. Continental Assurance Company, 416 Pa. 155, 205 A.2d 93 (1964). The employer is presumed to have greater bargaining power and expertise in business and insurance concerns. Ostensibly, the employer’s bargains and contracts are made at arms length. The employer acting as agent for the group of employees negotiates the insurance coverage as well as the price and terms of the policy and all such negotiations are binding upon the employee group. The coordination of benefits clause contained in the subject policy was accepted by the employer as a part of its agreement with defendant. Plaintiff as a member of the group, is bound by that clause as well as all other provisions of the policy.

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Related

Boseman v. Connecticut General Life Insurance
301 U.S. 196 (Supreme Court, 1937)
Henning v. Metropolitan Life Insurance
546 F. Supp. 442 (M.D. Pennsylvania, 1982)
Griffith v. United Air Lines, Inc.
203 A.2d 796 (Supreme Court of Pennsylvania, 1964)
Layman v. Continental Assurance Co.
205 A.2d 93 (Supreme Court of Pennsylvania, 1964)

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Bluebook (online)
34 Pa. D. & C.3d 102, 1984 Pa. Dist. & Cnty. Dec. LEXIS 196, Counsel Stack Legal Research, https://law.counselstack.com/opinion/plunket-v-metropolitan-life-insurance-pactcomplblair-1984.