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Legal Updates for Insurance Services

Pennsylvania Superior Court Strikes Down the Regular Use Exclusion

Legal Updates for Insurance Services – October 25, 2021

October 25, 2021

by Patricia A. Monahan

Rush v. Erie Insurance Exchange, No. 1443 EDA 2020 (Pa. Super. Oct. 22, 2021)

In an October 22, 2021, precedential panel decision, the Pennsylvania Superior Court in Rush v. Erie Insurance Exchange extended the reasoning of Gallagher v. Geico Indemn. Co., 201 A.3d 131 (Pa. 2019), to the regular use exclusion for UM/UIM coverage. In Gallagher, the Pennsylvania Supreme Court held that stacking applies to UM/UIM claims unless a waiver of stacked coverage was executed under §1738 of the Pennsylvania Motor Vehicle Responsibility Law (MVFRL). The household exclusion that traditionally applied to preclude stacking of a resident relative’s policy was eroded. The Superior Court has now similarly held in Rush that underinsured motorist coverage may only be precluded by the waiver process under §1731 of the MVFRL, and not by a policy exclusion.
  
In Rush, a City of Easton police detective was injured in an automobile accident caused by two negligent tortfeasors while he was driving his police vehicle that he regularly used for work. The Easton automobile policy provided for $35,000 in underinsured motorist coverage. Having received the limits of the tortfeasors’ policies and the $35,000 limits of the Easton policy, the detective sought underinsured motorist coverage from Erie pursuant to two insurance policies that covered three personal vehicles and provided for $750,000 in total stacked underinsured motorist coverage.

Erie denied the underinsured motorist claim, citing the regular use exclusion applicable to bodily injury resulting from the use of a non-owned vehicle that was not identified on the Erie policies. The detective then filed a declaratory judgment action in the Court of Common Pleas of Northampton County against Erie contending that the regular use exclusion violated the MVFRL. The exclusion provided:  

This insurance does not apply to:

Bodily injury to ‘you’ or a ‘resident’ using a non-owned ‘motor vehicle’ or a ‘non-owned’ miscellaneous vehicle which is regularly use by ‘you’ or a ‘resident’, but not insured for uninsured or underinsured motorist coverage under this policy.

Rush, Slip op. at p. 2-3.

The trial court held the regular use exclusion unenforceable under the MVFRL and entered summary judgment in favor of the detective. Erie appealed to the Superior Court, which affirmed.
 
The Superior Court held that absent an express waiver of coverage under 75 Pa.C.S. §1731, uninsured and underinsured motorist coverage must be provided in an amount equal to the bodily injury liability limits. The court reasoned that the regular use exclusion “conflicts with the broad language of Section 1731(c), which requires UIM coverage in those situations where an insured is injured arising out of the ‘use of a motor vehicle.’” Rush, at p. 7. It rejected Erie’s reliance upon Williams v. GEICO Gov’t Emp. Ins. Co., 32 A.2d 1195, 1199 (Pa. 2011), despite the identical facts presented therein.

In Williams, a state trooper injured while occupying a police vehicle not identified on his personal GEICO policy was precluded from recovering underinsured motorist benefits due to the regular use exclusion in his policy. The Pennsylvania Supreme Court concluded therein that the insured had failed to meet his high burden of establishing that the regular use exclusion violated the public policy supporting the MVFRL. The Superior Court in Rush read the public policy holding of Williams as not controlling. Interestingly, the Rush panel also rejected Williams’s express statement that the regular use exclusion did not violate the express terms of the MVFRL, holding that it was mere dicta.  Rush further rejected Erie’s reliance upon Erie Ins. Exch. v. Baker, 972 A.2d 507 (Pa. 2008), where the Pennsylvania Supreme Court had enforced the regular use exclusion, finding that Gallagher had abrogated that decision. 
 
Since Gallagher, and prior to Rush, numerous federal judges had rejected the argument that the regular use exclusion contravened the MVFRL. The Honorable Edward G. Smith identified several such decisions recently in Eberly v. LM General Ins. Co., 2021 WL 4284521 (E.D. Pa. Sept. 21, 2021). In that case, the regular use exclusion precluded the plaintiff’s claim for underinsured motorist benefits arising out of an accident that occurred while he was operating his employer’s vehicle. Judge Smith held that Gallagher was not controlling as it applied to stacking and not to regular use exclusions. He also recognized the Pennsylvania Supreme Court’s decision in Burstein v. Prudential Property and Cas Ins. Co., 809 A.2d 204 (Pa. 2002), which held that the regular use exclusion comported with the policies underlying the MVFRL. Burstein was also reaffirmed in Williams.

The Rush decision has immediate and wide-sweeping ramifications for the insurance industry. Unless there is a stay, all claims for uninsured or underinsured motorists benefits that have been denied based upon the regular use exclusion, and which are within the applicable statute of limitations, may become payable. The panel decision in Rush may be appealed to the Pennsylvania Supreme Court, where review is discretionary. If an appeal is not successful, it is likely that only a legislative change will be able to reduce an insurer’s risk of exposure to uninsured and underinsured motorist claims arising from the use of motor vehicles, including motorcycles, of which the insurer is unaware and has no control.
 

Legal Updates for Insurance Services – October 25, 2021, has been prepared for our readers by Marshall Dennehey Warner Coleman & Goggin. It is solely intended to provide information on recent legal developments, and is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We welcome the opportunity to provide such legal assistance as you require on this and other subjects. If you receive the alerts in error, please send a note to tamontemuro@mdwcg.com ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2021 Marshall Dennehey Warner Coleman & Goggin. All Rights Reserved.

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Thought Leadership

Ohio Supreme Court Holds That a Binding Appraisal Award May Not Be Set Aside Absent Specific Evidence of Manifest Mistake or Fraud

On July 23, 2026, the Ohio Supreme Court issued a rare opinion on the binding effect of an appraisal award in a property insurance policy.  The Court in One Church held: A binding appraisal award will not be set aside unless an error is so palpably wrong that it undermines the intent of the agreement, such as corruption or gross mistake, not a mere error of judgment—To plead a claim of mistake with particularity as required by Civ.R. 9(B), facts alleged in a complaint must constitute the elements of mistake—Allegation that additional, hidden damage was discovered after appraisal award failed to state a claim of mistake that could justify setting aside binding appraisal.  The case arose out of a claim brought by One Church against its insurer, Brotherhood Mutual Insurance Company for roof damage from a storm. Pursuant to the terms of the insurance policy, the parties agreed to submit the matter to appraisal. The two appraisers inspected the building, and both appraisers agreed that the damages were $313,271.98. The insurer paid the agreed appraised amount.  Thereafter, the insured submitted a claim for an additional $206,663.09 in damages. The insured argued that these additional damages were not discovered until after the repairs began, and that they should be permitted to submit an additional claim, even though there had already been a binding appraisal of damages. The insurer refused to pay the additional damages, and the insured sued for breach of contract and bad faith.  In the trial court, the insurer moved to dismiss for failure to state a claim, arguing that the binding appraisal award barred any further claims. The insured took the position that additional hidden damages could not be discovered until after the repairs began, and therefore there was a mutual mistake. The trial court dismissed the case on the insurer’s motion, because there was no “evidence of fraud, misfeasance, or mistake”. The Court of Appeals agreed that appraisal awards are generally binding, but noted that an appraisal award can be set aside for fraud or manifest mistake. The Court of Appeals reversed and remanded the case to the trial court, finding that the insured had pled mistake with sufficient particularity. The insurer appealed to the Ohio Supreme Court. On appeal, the Ohio Supreme Court reversed the Court of Appeals, and reinstated the trial court decision dismissing the case for failure to state a claim upon which relief can be granted. The Supreme Court found that since the insured had already demanded appraisal, and the appraisal award was binding, “something more than error of judgement, such as corruption in the arbitrator, or gross mistake” must be pled with particularity, and proven for the insured to override the appraisal award. Since the complaint did not allege fraud or manifest mistake with sufficient particularity, something more than a mere error of judgment, the complaint was insufficient to state a claim.  The complaint in this case did not challenge the appraisal award. It pled that additional damages were discovered that were not apparent when the appraisal was done. It did not specify “who discovered the damages, how they were discovered, where they were found, why they were previously hidden, or why they rise to the level of a manifest mistake that the “appraiser would have corrected...had it been called to his attention”. Id at ¶22 citing Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970). Cases deciding the effect of appraisal awards are unusual. The Ohio Supreme Court’s decision in One Church relies primarily on 19th century case law for its conclusion. This emphasizes the fact that there is minimal case law deciding the effect of binding appraisal clauses in property insurance policies, and makes this case all the more significant. A lengthy dissent was written by Justice Fisher, who would have affirmed the Court of Appeals decision reversing and remanding the case for a decision on the merits. Of course, the decision works both ways, and an insurer dissatisfied with a binding appraisal award will likewise be without further recourse absent evidence of corruption, fraud, misfeasance, or manifest mistake, which must be pled with particularity. To constitute manifest mistake, “the mistake must be of such character that the arbitrator or appraiser would have corrected it had it been called to his attention.”  Lakewood Mfg. Co. v. Home Ins. Co. of New York, 422 F.2d 796, 798 (6th Cir. 1970).  The majority opinion does not specifically identify what would have been sufficient to plead mistake with particularity, or if the insured could have amended the complaint to overcome the deficiencies. The dissent argues that this was not really a case alleging mistake, but rather a question of contract interpretation. The insured did not challenge the appraisal, but argued that the hidden damage was not part of the appraisal, and the appraisal only covered the known damages.  However, this argument did not carry the day with the majority.  *Thomas F. Glassman, a shareholder in Marshall Dennehey’s Cincinnati office, filed a brief in the Ohio Supreme Court on behalf of the Ohio Association of Civil Trial Attorneys, in support of the insurer’s position.