Time Limitations in Accidental Benefit Policies

65 Pa. D. & C.2d 17
CourtPennsylvania Department of Justice
DecidedApril 26, 1974
DocketOfficial opinion no. 22
StatusPublished

This text of 65 Pa. D. & C.2d 17 (Time Limitations in Accidental Benefit Policies) is published on Counsel Stack Legal Research, covering Pennsylvania Department of Justice primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Time Limitations in Accidental Benefit Policies, 65 Pa. D. & C.2d 17 (Pa. 1974).

Opinion

PACKEL, Attorney General,

Former Commissioner Denenberg requested our opinion as to whether the Insurance Department should change its policy in regard to the enforcement of the existing insurance laws of Pennsylvania, including the approval and disapproval of submitted policies, when court decisions are rendered which modify existing interpretations of specific insurance contract language. He also asked if such changes should be interpreted by the Insurance Department itself or whether such matters should be referred to the Justice Department for its interpretation. More specifically, he asked what effect Burne v. Franklin Life Insurance Company, 451 Pa. 218, 301 A. 2d 799 (1973), should have on the enforcement of present laws of Pennsylvania, especially in regard to acceptable language for accidental death benefit clauses.1 In accordance with this request, we submit our opinion.

I

Periodically, State or Federal court decisions are rendered which modify existing interpretations of specific insurance contract language. Decisions of the Supreme Court constitute part of the law of the Commonwealth: Stitt v. Consolidated Gas Supply Corp., 3 Comm. Ct. 482, 284 A. 2d 313 (1971). It has also been held that decisions of higher courts are binding on lower tribunals. See Townsend Trust, 349 [19]*19Pa. 162, 36 A. 2d 438 (1944); Beckham v. Travelers Ins. Co., 206 Pa. Superior Ct. 488, 214 A. 2d 299 (1965); Hilbert v. Heller, 13 Lehigh 369 (1930). On the other hand, even though Federal court decisions may be looked to for guidance (Ronnie’s Bar, Inc. v. Pennsylvania Labor Relations Bd., 411 Pa. 459, 192 A. 2d 664 (1963)), State courts are not bound by these decisions unless they are decided upon questions of Federal law: Rader v. Pennsylvania Turnpike Commission, 407 Pa. 609, 182 A. 2d 199 (1962).

Sections 354 and 616 of the Insurance Company Law of 1921, May 17, 1921, P. L. 682, 40 PS §§477b, 751, direct the Insurance Commissioner to approve or disapprove the form of insurance contracts before they are sold. It has been contended that the department has no authority under this law to approve or disapprove policies based upon court opinions. We find this contention to be without merit. The commissioner must apply and follow the law of the Commonwealth in approving insurance contracts. This necessarily includes pertinent common law and equity principles as well as constitutional and statutory provisions. The commissioner thus has quasi-judicial power in determining whether a proposed policy contract violates any law or principle of equity: Mutual Benefit Life Ins. Co. v. Welch, 71 Okla. 59, 175 P. 45 (1918). In construing an Oklahoma law nearly identical to section 354, the court there held that the Insurance Commissioner must disapprove an insurance contract whenever he determines, in the exercise of his quasi-judicial power, that it is violative of any applicable law, written or unwritten or any principle of equity. More particularly, the court stated:

“The common law, of course, forbids among other things, any ‘form’ of policy of life insurance which [20]*20violates the public policy in any respect”: 71 Okla. at page 62.

In regard to the effect of the disapproval of the form of a contract by the Insurance Commissioner, the court stated:

“ [I] t shall be conclusively unlawful for such company to issue any policy in the ‘form’ so disapproved, without regard to whether his disapproving decision is correct or erroneous, provided he did not act arbitrarily or fraudulently in the same”: 71 Okla. at page 63.

The above analysis indicates that it would certainly be an abuse of discretion for you to approve contracts containing terms that the Supreme Court has held to be unfair and unenforceable as against public policy.

It has also been contended that no changes need be made in the policies themselves, since the Supreme Court has found them unenforceable, and, perforce, lower courts will be bound by that decision in subsequent cases. But, insurance policies containing such terms, even though unenforceable, are likely to cause policyholders to forego meritorious claims in the mistaken belief that the terms are, in fact, enforceable. The general public relies on the Insurance Department’s duty to approve policies, and, consequently, terms appearing in policies have a greater appearance of State-sanctioned enforceability than terms appearing in ordinary contracts. While your department’s approval of a policy is not a statement that all terms are, in your opinion, enforceable, you should act to eliminate indubitably unenforceable terms in order that claimants will not be misled-. See Ice City, Inc. v. Insurance Company of North America, 456 Pa. 210, 314 A. 2d 236 (1974). Therefore, when court decisions modify interpreta[21]*21tions of specific contract language, the Insurance Department must take cognizance of these changes in carrying out its responsibilities under law.

II

It next becomes relevant to ask whether the Insurance Department should itself interpret these court decisions or whether such matters should be referred to the Department of Justice. The determination of whether a particular court decision is based solely on the facts of the particular case or whether it is a construction of the law generally applicable is a legal question. Section 902 of The Administrative Code of April 9, 1929, P. L. 177, 71 PS §292, provides that:

“The Department of Justice shall have the power, and its duty shall be:

“(b) To supervise, direct and control all of the legal business of every administrative department, board, . . . and commission of the State Government.”

In carrying out his duty under the law, the Attorney General has assigned assistant attorneys general to various State agencies to be responsible for their day-to-day legal affairs. Initially, all legal questions of the Insurance Department must be referred to its legal counsel. The advice of the Department of Justice should be sought in matters of great importance, matters that are controversial and matters in which the outcome is not clear. Applying these guidelines, the Insurance Commissioner and the assistant attorneys general assigned to the Insurance Department must use their discretion in determining when to submit this and other legal questions to the Department of Justice for its review and determination.

[22]*22III

Applying the principles enunciated above, we are of the opinion that the Insurance Department must apply the holding of the Burne case to approve or disapprove submitted contracts.

The Pennsylvania Supreme Court in Burne dealt with accidental death benefits in a life insurance policy and held that a provision requiring the insured to die within 90 days of an accident for the benefits to be payable is arbitrary and unreasonable when there is no dispute that death was caused by accidental means. The benefit in question usually provides that the insurer will pay double indemnification to the beneficiary of the insured when the death of the insured is the result of an accident; it is usually qualified, as it was in Burne, by a provision which requires that the death occur within 90 days of that accident. In Burne, the insured died four and one-half years after the accident, but as a result of the accident. In holding the 90-day provision unenforceable, the court stated, 451 Pa. at page 222:

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

Related

Beckham v. Travelers Insurance
214 A.2d 299 (Superior Court of Pennsylvania, 1965)
Burne v. Franklin Life Insurance
301 A.2d 799 (Supreme Court of Pennsylvania, 1973)
Stitt v. Consolidated Gas Supply Corp.
284 A.2d 313 (Commonwealth Court of Pennsylvania, 1971)
Rader v. Pennsylvania Turnpike Commission
182 A.2d 199 (Supreme Court of Pennsylvania, 1962)
City of Mangum v. Todd
1918 OK 497 (Supreme Court of Oklahoma, 1918)
Norlund v. Reliance Life Insurance
128 A. 93 (Supreme Court of Pennsylvania, 1925)
Tennant v. Hartford Steam Boiler Inspection & Insurance
40 A.2d 385 (Supreme Court of Pennsylvania, 1944)
Townsend Trust
36 A.2d 438 (Supreme Court of Pennsylvania, 1944)
Grandin v. Rochester German Insurance
107 Pa. 26 (Supreme Court of Pennsylvania, 1884)
Ronnie's Bar, Inc. v. Pennsylvania Labor Relations Board
192 A.2d 664 (Supreme Court of Pennsylvania, 1963)
Ice City, Inc. v. Insurance Co. of North America
314 A.2d 236 (Supreme Court of Pennsylvania, 1974)

Cite This Page — Counsel Stack

Bluebook (online)
65 Pa. D. & C.2d 17, Counsel Stack Legal Research, https://law.counselstack.com/opinion/time-limitations-in-accidental-benefit-policies-padeptjust-1974.