An insurance policy is a contract. Insureds must read and understand their own insurance policy.
Right? Except no one reads an insurance policy. I’m not just talking about Joe Six-Pack here. I’m talking about you, my dear reader: You, me, all of us. Why? Because our busy and lazy lives don’t allow us time to do it. “Just give me the nutshell” is the mantra even insurance lawyers have in their personal lives.
In Maryland, GEICO and State Farm, in particular, write a lot of umbrella policies. Few of these standard policies have uninsured motorist coverage. But every victim that comes to us believes that they do.
The problem with this is that there are rare instances where reasonable people would expect insurance coverage but don’t because they didn’t read their insurance policies. What do we do in these cases when we know it is reasonable to expect coverage?
Household Exclusion
The umbrella policy contained a household exclusion, which denied payment of damages for bodily injury or personal injury resulting from the negligence of another insured household member.
After the accident, the plaintiff filed a claim under the motor vehicle liability and umbrella policies. State Farm offered the plaintiff the full amount in liability coverage under the former but denied the second claim because of the household exclusion. The plaintiff subsequently filed suit seeking to declare the household exclusion void.
Supporting her claim, the plaintiff cited Maryland Code § 19-504.1 of the Insurance Article. This statute requires an insurer to offer its insured, under a policy or binder of private passenger motor vehicle liability insurance (“PPMVLI”), the same amount of liability coverage for both claims made by family members and non-family members.
The plaintiff argued that the umbrella policy was a PPMVLI, and because State Farm never offered her and her husband equal coverage for family members, the household exclusion was void. Here, the court addressed two questions: (1) whether an umbrella policy that includes motor vehicle liability insurance constitutes a PPMVLI, and (2) whether the household exclusion violated public policy.
Policy or Binder of Private Passenger Motor Vehicle Liability Insurance.
The court first examined the plain language of the phrase “policy or binder of private passenger motor vehicle liability insurance.” The court noted that PPMVLI refers to a particular type of motor vehicle liability insurance, whereas a personal liability umbrella policy covers a variety of losses.
Thus, umbrella policies attach to the insured, whereas PPMVLIs attach to the motor vehicle. Also, the court stated that umbrella policies are a supplemental form of insurance distinguishable from primary policies including motor vehicle liability insurance or homeowner’s insurance.
Because they are supplemental, umbrella policies only kick in once the primary policy has been exhausted. For example, if an automobile policy had a liability limit of $100,000, the umbrella policy would pick up after that point and cover for an additional amount.
Statutory Context
Next, the court looked at the statutory context. Finding that the legislature used the term “motor vehicle liability insurance policy” in § 19-504 to discuss minimum liability coverage, the court determined that umbrella policies, which are supplemental and serve as an excess form of coverage, were by definition not “motor vehicle liability insurance polic[ies].”
Also, the legislature included § 19-504.1 within the subtitle “Motor Vehicle Insurance – Primary Coverage,” suggesting an intent to address household exclusions in primary policies. The plaintiff contended that one of the uninsured motorist statutes in §§ 19-509, 510 referring to primary coverage had been interpreted to apply to umbrella policies, thus showing legislative intent to treat umbrella policies the same as motor vehicle liability insurance.
However, the court rejected this argument, stating that the statute in question, § 19-509(h)(1), explicitly refers to policies different in kind from primary policies. Also, the plaintiff argued that where the legislature distinguished umbrella policies from primary motor vehicle policies in the uninsured motorist statute and chose not to do the same in the household exclusion law, the latter must be read to include all motor vehicle policies, including umbrella policies.
The court rejected this argument, explaining that a court “may neither add nor delete language to reflect an intent not evidenced in the plain and unambiguous language of the statute.” Finally, the court briefly noted that statutory interpretation requires the court to reach a conclusion consistent with common sense.
Here, common sense dictated that the umbrella policy differed from PPMVLI. As a result, the court determined that the umbrella policy was not a PPMVLI.
Public Policy Exclusion
Next, the court turned to the second question: whether the exclusion in the umbrella policy violated public policy. This is the court’s chance to do the right thing, right?
The court started by stating that parties are usually free to contract as they wish unless a contractual provision violates public policy, in which case that provision becomes invalid. Here, the public policy regarding household exclusions required the insurer to offer the same amount of insured liability coverage for family and nonfamily members in a PPMVLI.
As a result, enforcing a household exclusion provision would violate public policy if the insurer did not make that offer. However, the court stated that the legislature did not intend to eliminate household exclusions in insurance disputes exceeding minimum coverage, but wanted to offer the insured an opportunity to purchase liability limits for family members.
Ultimately, the court left the issue up to the legislature, stating that it “will not invade the province of the General Assembly . . . no matter how just or fair we may think such a new law or public policy would be.” They invade the province of the Maryland legislature, but they pick and choose their spots and decided not to here.
I wrote Irwin Weiss, a real good plaintiff’s lawyer (and sometimes defense counsel) in Baltimore County whose opinion I seek frequently on legal and tactical issues. He gave me another path the court could have gone down. This is from his email:
This is from Liberty Mutual v. Ben Lewis Plumbing, 121 Md. App 467, 473 (1998):
In Twelve Knotts, supra, this Court quoted from Shepard v. Keystone Insurance Company, 743 F.Supp. 429, 432 (D.Md.1990), to the effect that:
It is the obligation of the insured to read and understand the terms of his insurance policy unless the policy is so constructed that a reasonable man would not attempt to read it … If the terms of the policy are inconsistent with his desires, he is required to notify the insurer of the inconsistency and of his refusal to accept the condition.
The Twelve Knotts Court then pointed out that, though there were no Maryland cases requiring the result that the District Court had reached, nonetheless, it appeared to be the general rule:
[W]hen the insured accepts a policy, he accepts all of its stipulations, provided they are legal and not contrary to public policy. Where changes from the application appear in the delivered contract, under a more stringent doctrine, the insured must examine it promptly and notify the company immediately of his refusal to accept it. If such policy is accepted or is retained an unreasonable length of time, the insured is presumed to have ratified any changes and agreed to all its terms.” Twelve Knotts, 87 Md.App. at 104, 589 A.2d 105 (quoting l2, J. Appleman, Insurance Law and Practice, § 7155).
The court thinks this is a terrible result. Why not jump on this precedent and the wisdom behind it and say no reasonable person would attempt to read the policy?
The full opinion can be found here.
Bailer v. Erie Insurance Exchange
In Bailer v. Erie, a 1997 Maryland Court of Appeals case, the court looked at another umbrella insurance policy that provided coverage against false arrest, wrongful detention or imprisonment, malicious prosecution, wrongful entry or eviction, invasion of privacy, and so forth. I think it is worth talking about in this context to understand the limits of Maryland law in permitting unreasonable interpretations of umbrella policies.
This case involved an au pair who sued her host family because the creepy father was secretly videotaping her taking a shower. Erie denied the claim although it sounds like an invasion of privacy, right? Erie said the policy did not cover personal injury or property damage “expected or intended by anyone we protect.”
We can all agree that setting up the camera and filming the au pair taking a shower is an intentional act. The policy excluded intentional acts. Still, the Maryland high court found that the exclusion conflicted with the grant of insurance for “personal injury,” which included coverage for “invasion of privacy” claims. The court reasoned that under Erie’s interpretation, the exclusion would completely annihilate the coverage afforded under the policy.
So, ultimately, the court found it would be reprehensible not to provide insurance coverage for this reprehensible conduct. Ironic? Yes. But the ruling makes sense. The insurance company should be unable to give the insured coverage with one hand and take away the coverage with the other.
De Macedo v. The Hartford
The core issue in De Macedo v. The Hartford, revolved around the interpretation of a household insurance exclusion in an umbrella policy. The Maryland Supreme Court addressed whether the household exclusion in an umbrella insurance policy, which precludes coverage for claims brought by members of the insured’s household, is valid.
This issue arose from a tragic car accident that led to the death and injury of several family members, with the surviving family seeking coverage under both a primary automobile liability insurance policy and an umbrella policy held by the deceased.
The central legal question was whether the household exclusion in the umbrella policy was void against public policy or statutory provisions, particularly in light of Maryland Code, Courts and Judicial Proceedings Article (CJP) § 5-806(b), which limits the application of the doctrine of parent-child immunity and certain insurance policy provisions up to the limits of motor vehicle liability or uninsured motor vehicle coverage.
In this Montgomery County case, the court made two points relevant to our discussion here:
- The household insurance exclusion, part of the decedent’s umbrella policy, was valid and enforceable. This exclusion prevented claims against the named insured by members of the same household.
- The court interpreted Maryland Code Ann., Cts. & Jud. Proc. § 5-806(b) in the context of the entire statutory scheme, concluding that the term “motor vehicle liability coverage” explicitly referred to a primary motor vehicle liability policy, not an umbrella policy.
The court referenced its earlier decision in Stickley v. State Farm case we talked about above which distinguished between primary auto liability policies and umbrella policies, noting that umbrella policies are not inherently subject to the same requirements as motor vehicle liability insurance. As a result, the Court affirmed the lower courts’ rulings, holding that the household exclusion in the umbrella policy is valid and does not contravene Maryland law, thus denying the claimants coverage under the umbrella policy for the accident in question.
So this case stands for the principle that specific exclusions in umbrella insurance policies, specifically those excluding coverage for claims by household members against the named insured, are valid.
Additionally, the Maryland Supreme Court clarified the interpretation of statutory language concerning motor vehicle liability coverage, indicating that such language typically refers to primary coverage rather than supplementary umbrella policies.