Stern v. West American Insurance

28 Pa. D. & C.3d 438, 1982 Pa. Dist. & Cnty. Dec. LEXIS 126
Pennsylvania Court of Common Pleas, Somerset County·Decided August 24, 1982·No. no. 13 Civil 1981·Published

Opinion

SHAULIS, J.,

This matter is before the Court on the joint motion of both parties for summary judgment.

FACTS

Plaintiff, Robert W. Stern, was involved in a single motor vehicle accident on January 11, 1979 resulting in bodily injury to himself. At the time of the accident, plaintiff was operating a coal truck owned by his employer, Tom Moran Trucking, and in the course of his employment. Due to the injuries sustained, plaintiff was unable to return to his employment for the period beginning January 12, 1979 and ending January 13, 1980.

Plaintiff and defendant, West American Insurance Company, have stipulated that plaintiffs average monthly gross wage would have been $1,776.32 had plaintiff been able to work. Plaintiff received workmen’s compensation benefits at the rate of $983.67 per month during this time, thus realizing a net loss of $792.65 per month or $9,511.80 for 12 months.

Plaintiff filed an insurance claim demanding that defendant, plaintiffs personal no-fault insurance carrier, tender this total net loss (less 20 percent as [440] provided in the No-fault Act) to him. Defendant refused this demand but offered to pay plaintiff the difference between $1,000 and $983.67 for each of the 12 months that plaintiff was disabled. The matter was submitted to arbitration and the panel ruled in favor of the plaintiff. Defendant filed an appeal.

Since both parties allege that no material facts remain to be determined, they have filed a joint motion for summary judgment.

DISCUSSION

The real issue in this case is whether the limit as set forth in the Pa. No-fault Act in § 202(b)(1)(A) is a limit on recovery by the plaintiff or a limit on liability of defendant.

We conclude that the $1,000 maximum limit as set forth in 40 P.S. § 1009.202(b)(1)(A) is a limit on the liability of defendant and that summary judgment should be granted in favor of plaintiff on this issue.

The relevant sections of the No-fault Act for purposes of this discussion are as follows:

40 P.S. §1009.103. Definition

As used in this Act:

“Loss” means accrued economic detriment resulting from injury arising out of the maintenance or use of a motor vehicle consisting of, and limited to, allowable expense, work loss, replacement services loss, and survivor’s loss.

“Loss of income” means gross income actually lost by a victim or that would have been lost but for any income continuation plan reduced by:

[441] “Net loss” means loss less benefits or advantages required to be subtracted from loss in calculating net loss pursuant to this act.

“Work loss” means:

(A) loss of gross income of a victim as calculated pursuant to the provisions of Section 205 of this Act.

40 P.S. §1009.202. Basic loss benefits:

“(b) Work loss limits. — Work loss, as defined in Sec. 103 shall be provided:

(1) up to a monthly maximum of:

(A) $1,000.00 multiplied by a fraction whose numerator is the average per capita income in this Commonwealth and whose denominator is the average per capita income in the United States, according to the latest available United States Department of Commerce figures.

(2) up to a total amount of $15,000.00.

40 P.S. §1009.206 — Net Loss:

(a) General. — Except as provided in section 108 (a)(3) of this act, all benefits or advantages (less reasonably incurred collection costs) that an individual receives or is entitled to receive from social security (except those benefits provided under Title XIX of the Social Security Act and except those medicare benefits to which a person’s entitlement depends upon use of his so-called “life-time reserve” of benefit days) workmen’s compensation, any State-required temporary, nonoccupational disability insurance, and all other benefits (except the proceeds of life insurance) received by or available to an individual because of the injury from any government, unless the law authorizing or providing for such benefits or advantages makes them excess or secondary [442] to the benefits in accordance with this act, shall be subtracted from loss in calculating net loss.

(b) Tax deduction. — If a benefit or advantage received to compensate for loss of income because of injury, whether from No-fault benefits or from any source of benefits or advantages subtracted under subsection (a) of this section, is not taxable income, the income tax saving that is attributable to such loss of income because of injury is subtracted in calculating net loss for work loss. Subtraction may not exceed twenty per cent (20%) of the loss of income and shall be in such lesser amount as the insurer reasonably determines is appropriate based on a lower value of the income tax advantage.”

A case in which the facts closely resemble the case at bar was Augostine v. Pennsylvania National Mutual Casualty Insurance Co., 293 Pa. Super. 50, 437 A.2d 985 (1981). The Superior Court stated that although the insured, who was injured while alighting from one of his employer’s trucks during the course of his employment, and who applied for and was currently receiving total disability benefits under the Pennsylvania Workmen’s Compensation Act. . . could proceed against his own insurer under the No-fault Act for the basic work loss benefits to make up the difference between the actual wage loss and Workmen’s Compensation benefits, with Workmen’s Compensation benefits deducted from recovery against his insurer. It is thus clear that the recovery of Workmen’s Compensation benefits is not the exclusive remedy for an injured employee.

The regulations of the Pennsylvania Code, more specifically 31 Pa. Code §66.54(b), sets forth the formula from which work loss for a regularly employed person is to be determined.

The first step is to compute the gross income actually lost. The parties have agreed by stipulation [443] that plaintiffs average gross wage per month would have been $1,776.32 but for the accident.

The second step is to compute the net loss. This is accomplished by taking the gross income actually lost and subtracting the value of the benefits and advantages specified in 40 P.S. § 1009.206(a), and subtracing the income tax savings in 40 P.S. § 1009.206(b). The parties have stipulated that plaintiff received $983.67 per month in Workmen’s Compensation benefits. This in turn results in a net loss of $792.65 per month $1,776.32 -$983.67). Of this amount, 20 percent must be deducted to reach the final monthly net loss figure of $634.12 [$792.65 -$158.53 ($792.65 x .20)].

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Stern v. West American Insurance, 28 Pa. D. & C.3d 438, 1982 Pa. Dist. & Cnty. Dec. LEXIS 126 (Pa. Super. Ct. 1982).

28 Pa. D. & C.3d 438 (Stern v. West American Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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