Injury to One Spouse Not Injury to Other

Creative Argument Fails

Lawyers are creative people. They try to protect their clients and provide benefits to their clients by making creative arguments. Those creative arguments are often effective but are often just plain ridiculous.

In Lambert v. Nationwide Mutual Insurance Company, Slip Copy, United States District Court, S.D. West Virginia,  2017 WL 320926 (Signed 01/20/2017) the USDC for the Southern District of West Virginia was faced with what I would describe as a ridiculous argument that they dealt with with respect the argument did not deserve.

FACTUAL BACKGROUND

The Plaintiffs, George and Donna Lambert, alleged in their complaint that on or about June 23, 2014, Mr. Lambert was operating his truck along Route 3 in Beckley, West Virginia, with Ms. Lambert as a passenger. The Plaintiffs retained a motor vehicle insurance policy from the Defendant (“Lambert Policy”). The Lambert Policy contained limits of $20,000.00 per person and $40,000.00 per occurrence for injuries caused by underinsured motorists. The Lambert Policy also included a limit of $5,000 of coverage for medical services needed after an accident. On that same day, Mr. Bobby Bolen was operating his truck along Route 3 in Beckley, West Virginia. Mr. Bolen also retained a motor vehicle insurance policy from Nationwide (“Bolen Policy”), and that policy included coverage limits of $20,000.00 per person for bodily injury liability and $40,000.00 per occurrence for bodily injury liability. The Plaintiffs’ complaint alleges that on or about June 23, 2014, Mr. Bolen drove his truck into the truck of the Plaintiffs. Both parties concede that Mr. Bolen was wholly at fault for the accident. Ms. Lambert suffered a back injury from the accident, which required her to undergo two surgeries. However, both parties concede that Mr. Lambert suffered no physical injury from the accident.

On August 21, 2015, Ms. Lambert filed a demand for insurance benefits based on her injuries in the accident. Because the facts of the accident were not in dispute, Nationwide, who insured both Ms. Lambert and Mr. Bolen, tendered payment of all Ms. Lambert’s demands for a total of $45,000.

On December 14 and 15, 2015, Mr. Lambert made a separate demand of Nationwide for the exact same policy limits ($20,000 in liability from the Bolen policy, $20,000 in uninsured from the Lambert policy, and $5,000 in medical pay from the Lambert policy). Mr. Lambert asserted that he was due these policy limits because Ms. Lambert’s medical bills exceeded the $45,000 in policy limits she was entitled to, and, pursuant to West Virginia Code § 48-29-303, Mr. Lambert was now responsible for that outstanding debt as her husband. Nationwide denied Mr. Lambert’s claims for the additional policy limits, explaining that Mr. Lambert did not suffer bodily injury in the accident and therefore was not entitled to any benefit.

DISCUSSION

The Defendant argues in its motion for declaratory judgment that Mr. Lambert is not entitled to any additional insurance benefits regarding the June 23, 2014 automobile accident. The Defendant argues that the plain language of the Bolen policy limited insurance coverage to $20,000 per injured person, and the plain language of the Lambert policy limited insurance coverage for underinsured motorists to $20,000 per injured person and $5,000 for medical expenses. The Defendant argues that Mr. Lambert’s claim results from and arises out of Ms. Lambert’s injury and is subject to the same per person limits already exhausted by Ms. Lambert’s demand.

The Plaintiffs counter that Mr. Lambert is entitled to coverage because, although he did not suffer a physical injury, he was “injured.” The Plaintiffs suggest that, because Mr. Lambert is responsible for paying the remainder of Ms. Lambert’s medical bills as her husband pursuant any injury she suffered is imputed to him. The Plaintiffs assert that the effect of this statutory responsibility is to make Ms. Lambert’s injury Mr. Lambert’s injury, and Mr. Lambert is therefore entitled to another $25,000 from the Lambert Policy and $20,000 from the Bolen policy.

Pursuant to West Virginia law, like the law across the country, language in an insurance policy should be given its plain, ordinary meaning. Further, where the provisions in an insurance policy contract are clear and unambiguous they are not subject to judicial construction or interpretation, but full effect will be given to the plain meaning intended. To be ambiguous, the policy provision must be reasonably susceptible of two different meanings or be of such doubtful meaning that reasonable minds might be uncertain or disagree as to its meaning.

The insurance policies at issue are both issued by Nationwide and both define bodily injury as “a) physical injury; b) sickness; c) disease; or d) resultant death; of any person which results directly from a motor vehicle accident.”

The Court found that the language in both of these policies is neither reasonably susceptible of two different meanings, nor of such doubtful meaning that reasonable minds might differ as to its meaning. The Lambert Policy and the Bolen Policy define “bodily injury” in exactly the same manner, including physical injury, sickness, disease, or resultant death. Both policies further limit per-person coverage for bodily injury to include all claims arising out of one person’s bodily injury.

Both parties conceded that Mr. Lambert did not suffer any physical bodily injury as defined within the insurance policies. Mr. Lambert’s claims for additional policy limits, based solely on his responsibility to pay Ms. Lambert’s medical bills, are claims resulting from and arising out of Ms. Lambert’s injury. Giving the clear and unambiguous language from both policies its plain meaning, the Court concluded that Mr. Lambert is not entitled to any additional insurance benefits. Having received $45,000 from Nationwide based on her demand, Ms. Lambert has exhausted the limits of the Plaintiffs’ entitlement.

ZALMA OPINION

Whether Mr. Lambert needed to pay his wife’s medical bills or not he suffered no bodily injury. The policies have a single limit for bodily injury incurred as a result of a tort. Since Mr. Lambert suffered no bodily injury. He had no right to recover for bodily injury suffered by his wife.

ZALMA-INS-CONSULT                      © 2017 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant and expert witness specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 49 years in the insurance business.

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About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
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