Rancosky v. Washington National Ins. Co., Aplt.

170 A.3d 364, 2017 Pa. LEXIS 2286
Supreme Court of Pennsylvania·Decided September 28, 2017·No. 28 WAP 2016·Published·Cited by 223 cases

Opinions

OPINION

JUSTICE BAER

In this discretionary appeal, we consider, for the first time, the elements of a bad faith insurance claim brought pursuant to Pennsylvania’s bad faith statute found at 42 Pa.C.S. § 8371.1 For the reasons set forth below, we adopt the two-part test articulated by the Superior Court in Terletsky v. Prudential Property & Cas. Ins. Co., 437 Pa.Super. 108, 649 A.2d 680 (1994), which provides that, in order to recover in a bad faith action, the plaintiff must present clear and convincing evidence (1) that the insurer did not have a reasonable basis for denying benefits under the policy and (2) that the insurer knew of or recklessly disregarded its lack of a reasonable basis. Additionally, we hold that proof of an insurance company’s motive of self-interest or ill-will is riot a prerequisite to prevailing in a bad faith claim under Section 8371, as argued by Appellant. While such evidence is probative of the second Terletsky prong, we hold that evidence of the insurer’s knowledge or recklessness as to its lack of a reasonable basis in denying policy benefits is sufficient. Therefore, we affirm the judgment of the Superior Court, which partially vacated the trial court’s judgment and remanded for further proceedings on Appel-lee’s bad faith claim.

I. Background2

In March of 1992, while working for the United States Postal'Service (“USPS”) Ap-pellee LeAnn Rancosky (“Rancosky”) purchased a cancer insurance policy as a supplement to her primary employer-based health insurance. The cancer policy was issued by Appellant Conseco Health Insur-anee Company (“Conseco”).3 To pay for the policy, Rancosky’s employer automatically deducted bi-weekly payments of $22.00 from her paycheck.. , •

Of particular importance to the case sub judioe, the policy contained a waiver-of-premium provision, which excused premium payments in the event Rancosky became disabled due to cancer. The waiver-ofr-premium provision read, . in. relevant part, as follows: .

Subject to the .conditions of this policy, you will not be required to make premium payments if:
• you are diagnosed as having cancer more. than 30 days after the , Effective Date; and
• you are disabled due to cancer for a continuous period of more than 90 consecutive, days beginning- on or after the date of diagnosis.
After it has been determined, as shown below that you are disabled, we will waive your premium payments for the period of disability, except those during the first 90 days of such period.

PROOF OF DISABILITY

You must send us a physician’s statement containing the following:

• the date you were diagnosed as having cancer;
• the date you were disabled due to such cancer; and,
• the expected date, if any, such disability will end.

Plaintiffs Complaint In Civil Action, Exhibit 5, Conseco Cancer Policy at Section 5 (Reproduced Record (“R.R.”) Yol. I at 115a). Additionally, Rancosky’s policy provided that “disabled” means that: . •

• for the first 24 months you are unable-to perform all the substantial and material duties of your regular occupation; and,

After 24 months, “disabled” means that:

• you are unable to work at any job for which you are qualified by reason of education, training or experience;
•' you are not working at any job for pay or benefits; and
• you are under the care of a physician for the treatment of cancer.

Plaintiffs Complaint In Civil Action, Exhibit 5, Conseco Cancer Policy at Section 1 (R.R. Vol. I at 109a). Thus, pursuant to the above provisions, a policyholder who is “disabled,” in that she is unable to work due to cancer, is excused from paying premiums on her policy following ninety days of such disability.

On February 4, 2003, Rancosky was admitted to the hospital due to intense abdominal pain. She was ultimately diagnosed with ovarian cancer and, over the subsequent months, underwent surgery and chemotherapy. Though, Rancosky did not return to her job with USPS following her February 4, 2003, hospital admission, she remained on her employer’s payroll for several months because she had. accrued unused vacation and sick days. Consequently, Conseco continued to receive payroll-deducted premiums from Rancosky until June 24, 2003, when Rancosky went on disability retirement. As the premium payments were made in arrears, and therefore paid for the prior month’s coverage, the final' premium payment extended coverage* under her policy to May 24, 2003.4 ■ .

Beginning in April 2008, Rancosky made several attempts to obtain waiver-of-premium status, claiming that she was-unable to work and was thus “disabled” under her policy since her admission to the hospital in February of 2003. Upon Conseco’s request, on November 18, 2003, she submitted waiver-of-premium forms along with the required • physician statement. Unbeknownst to Rancosky, however, the submitted physician’s statement inaccurately specified her date of disability as beginning on April 21, 2003-, rather than on February 4, 2003.5 Believing that the premiums had been waived and that no further premiums were due on the policy because of her disability from cáncer, Ran-eosky’s final premium payment came from her June 24, 2003, payroll-deducted premium. Thus, over the next two years, as Rancosky experienced several recurrences of her cancer, she continued to submit claims to Conseco.

In early 2005, during an audit of its payroll-deducted premium policies,, Conse-co discovered, apparently for the first time, that Rancosky ceased making premium payments on her policy in June of 2003. Despite Rancosky’s prior submissions and inquiries regarding her waiver-of-premium status in which she indicated the start date of her disability as February 4, 2003, and authorized Conseco to obtain information from her physicians and employer about her disability, Conseco informed Rancosky on January 28, 2005, that it deemed her policy, to have lapsed as of May 24,2003, the date to which her final payroll-deducted premium payment extended her coverage. Over the following months and years, Rancosky had an ongoing disagreement with Conseco as to whether she was on waiver-of-premium status, and thus entitled to continued coverage under her cancer policy. During this time, Rancosky, again reflecting February 4, 2003, as her disability start date, submitted numerous claim forms, waiver-of-premium requests, and authorizations permitting Conseco to - contact- her physicians, employer, or anyone else who might have information regarding her disability start date.

Free access — add to your briefcase to read the full text and ask questions with AI

Rancosky v. Washington National Ins. Co., Aplt., 170 A.3d 364, 2017 Pa. LEXIS 2286 (Pa. 2017).

170 A.3d 364 (Rancosky v. Washington National Ins. Co., Aplt.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Spilled Milk v. Nautilus Insurance Company
Superior Court of Pennsylvania, 2025
DeVincenzo, D. v. Erie Insurance Exhange
2025 Pa. Super. 235 (Superior Court of Pennsylvania, 2025)
TATUM v. PROGRESSIVE INSURANCE CO.
E.D. Pennsylvania, 2025
Kalili, P. v. State Farm Fire and Casualty
2024 Pa. Super. 311 (Superior Court of Pennsylvania, 2024)
Cid, H. v. Erie Insurance Group
Superior Court of Pennsylvania, 2024
Watchword Worldwide v. Erie Insurance Exchange
2024 Pa. Super. 2 (Superior Court of Pennsylvania, 2024)