Nationwide Mutual Insurance Co. v. Gerlich

OPINION

LOPEZ, Justice.

Nationwide Mutual Insurance Company (“Nationwide”) appeals from a judgment rendered in favor of Catherine Gerlieh (“Ger-lieh”) in a breach of contract action. In its sole point of error, Nationwide contends that the evidence is legally insufficient to support the trial court’s finding that Nationwide was not entitled to offset the amount paid Gerlieh under the personal injury protection (“PIP”) provision of her policy against the amount to be paid to her under the uninsured/underin-sured motorists (“UM”) provision of that policy. We affirm the trial court’s judgment.

Factual and Procedural History

On March 22, 1995, Gerlieh suffered physical injuries when the car she was driving was hit by a car driven by an uninsured motorist. At the time of the collision, Gerlieh was covered by a Nationwide personal automobile liability policy that included PIP and UM coverage provisions. The policy also includ*457ed a limitation of liability clause which stated:

In order to avoid insurance benefits payments in excess of actual damages sustained, subject only to the limits set out in the Declarations and other applicable provisions of this coverage, we will pay all covered damages not paid or payable under any workers’ compensation law, disability benefits law, any similar law, auto medical expense coverage or Personal Injury Protection Coverage.

In April of 1995, Nationwide paid Gerlich $2,208.72 in PIP benefits. Subsequently, Gerlich settled her claim with Nationwide under the UM coverage provision for $3,500. Relying on the limitation of liability clause, Nationwide asserted that it was entitled to a credit against the settlement amount for the PIP benefits it previously paid to Gerlich, and Nationwide tendered to Gerlich a check for $1,291.28. Gerlich sued Nationwide for breach of contract, and the case was tried before the bench on stipulated facts. The trial court held that Nationwide was not entitled to a credit for the PIP benefits.

Argument and Authorities

In order for Nationwide to be entitled to an offset for the PIP benefits, Nationwide had the burden of demonstrating that a failure to allow the offset would result in a double recovery. See Bergmann v. Sentry Ins., 422 So.2d 972, 973 (Fla.Dist.Ct.App.1982). We find that Nationwide failed to meet this burden.

The stipulated facts were signed by counsel for both parties. The parties stipulated that they reached a settlement under the UM coverage for the total amount of $3,500.2 The parties never stipulated that the actual damages suffered by Gerlich as a result of the accident amounted to $3,500.

In its brief, Nationwide states: “the actual damages sustained by Gerlich in the present ease, as referenced in the stipulated facts and stated in the final judgment, were $3,500,” citing the stipulated facts and the trial court’s judgment. That is a correct statement. The trial court found that Gerlich sustained $3,500 in damages as a result of Nationwide’s breach of contract, which was the amount of the parties’ settlement under the UM coverage that Nationwide refused to pay. However, the trial court did not find that Gerlich sustained $3,500 in actual damages as a result of the accident. In fact, the trial court could not have made such a finding because no evidence regarding the damages Gerlich sustained was even presented.

For various reasons, parties often settle a claim for a sum that is less than the amount of damages that they believe they have actually sustained. Oftentimes, an amount that is drastically less. Therefore, the stipulation that Gerlich settled her claim under the UM coverage for $3,500 does not equate to a stipulation that Gerlich sustained only $3,500 in actual damages as a result of the accident. In fact, we cannot tell from our record what the basis for the $3,500 settlement amount was or what type of damages the settlement amount was intended to compensate. See Bergmann, 422 So.2d at 973 (offset disallowed where determination of duplication of benefit not possible from appellate record). In view of the fact that Gerlich had received PIP benefits, one logical conclusion was that she agreed to settle her UM claim for $3,500 to compensate her for the losses that the PIP benefits did not cover. Thus, there would not be a double recovery because Gerlich was compensated for the actual damage she sustained in an amount that was at least $5,708.72, the sum of $2,708.72 for her out of pocket costs for medical bills and lost wages and $3,500 for at least a portion of her damages for mental anguish, future medical expenses or future disability.

Nationwide relies on James v. Nationwide Property & Cas. Ins. Co., 786 S.W.2d 91 (Tex.App.—Houston [14th Dist.] 1990, no writ), to support its position. In view of the foregoing facts, however, James is easily distinguishable. In James, the parties did stip*458ulate the amount of actual damages sustained as a result of the accident as follows:

Plaintiff Betty James sustained total damages as a proximate cause of the acts and omissions of the uninsured motorist in the amount of $4,000 (including those damages paid under P.I.P. in the amount of $840.00).

No similar stipulation was made in this ease.

Because there is no evidence in our record supporting a finding that a failure to offset the PIP benefits would result in a double recovery by Gerlich, the trial court did not err in refusing to grant such an offset. We pause to note the irony presented by Nationwide’s double recovery assertion. If Nationwide prevailed in this case, Gerlich would have paid two premiums but received only one coverage, resulting in a double recovery for Nationwide. On the other hand, Nationwide would have been permitted to collect premiums for two types of coverage,3 but it would only have been required to pay benefits under one coverage.

In addition to Nationwide’s failure to prove a double recovery by Gerlich, the trial court’s judgment is further supported by the Texas Supreme Court’s holding in Dabney v. Home Ins. Co., 643 S.W.2d 386, 387 (Tex.1982). In Dabney v. Home Ins. Co., the petitioners sued Home Insurance Company (“Home”) for damages under the uninsured motorist provision of a policy issued by Home and were awarded damages by the trial court. 643 S.W.2d 386, 387 (Tex.1982). Home urged that it was entitled to reduce the judgment by the sums already paid to petitioners in PIP benefits. Id. at 389. The supreme court held:

In Westchester Fire Ins. Co. v. Tucker, 512 S.W.2d 679 (Tex.1974), we held an insurer is not entitled to set off payments under medical payments coverage against claims made under uninsured motorist coverage. PIP coverage under the standard automobile insurance policy is comparable to medical payments coverage in that both are no-fault and pay for similar expenses. Therefore, the trial court properly refused to reduce the judgment against Home by the amounts previously paid petitioners under the PIP coverage of the automobile insurance policy.

Nationwide contends that because the Dab-ney court relied on the Westchester Fire decision, we must look to Westchester Fire to determine the intended breadth of the Dab-ney holding. Nationwide concludes that because the Westchester Fire court only held the offset provision was ineffective to the extent it reduced the uninsured motorist protection below the minimum limits required by Article 5.06-1, an offset provision is effective so long as it does not reduce UM protection below the minimum limits set by the legislature. See Westchester Fire, 512 S.W.2d at 685. We disagree.

The supreme court in Dabney did not consider whether offsetting the PIP benefits against the uninsured motorist protection would reduce the UM protection to an amount less than the minimum limits set by the legislature. In fact, unlike the Westches-ter Fire decision, the opinion in Dabney does not even set forth what the limits of coverage were to enable us to determine whether the offset would have reduced the protection below the minimum limits. Compare Westchester Fire, 512 S.W.2d at 680, 685 with Dabney, 643 S.W.2d at 387-390. The effort, therefore, to limit the Dabney holding in this manner basically ignores what the opinion says. Other jurisdictions are split on whether similar limitation of liability clauses in insurance policies are valid. See generally A.S. Klein, Annotation, Uninsured Motorist Insurance: Reduction of Coverage by Amounts Payable Under Medical Expense Insurance, 24 A.L.R.3d 1353 (1969). To hold that the opinion in Dabney is necessarily limited by the holding in Westchester Fire prematurely decides that the supreme court was not persuaded by the various reasons *459given for invalidating similar offsetting provisions in other jurisdictions. Therefore, following the holding in Dabney, the trial court properly refused the offset in this ease.

Finally, we agree with Gerlieh that the PIP benefits should be treated as a collateral source. Legally speaking, an uninsured motorist carrier stands in the same shoes as the uninsured motorist. See Interstate Fire Ins. Co. v. First Tape, Inc., 817 S.W.2d 142, 145 (Tex.App. — Houston [1st Dist.] 1991, writ denied); Anchor Cas. Co. v. Robertson Transport Co., 389 S.W.2d 135, 139 (Tex.Civ.App. — Corpus Christi 1965, writ refd n.r.e.). The earner is entitled to the same defenses and is liable for the same wrongdoing as the uninsured motorist. In this case, for example, Nationwide would be entitled to use Gerlich’s own negligence as a defense to Gerlich’s claim just as the “wrongdoing” uninsured motorist could.

When Nationwide stepped into the shoes of the “wrongdoing” uninsured motorist, it became the “wrongdoer” for purposes of the collateral source rule. Nationwide’s stance as the “wrongdoer” for purposes of the UM benefits is distinct from its stance as an insurer paying documented PIP benefits. Given the unique posture of Nationwide in this situation, we hold that the PIP benefits became a collateral source.

Conclusion

Nationwide failed to demonstrate that Ger-lieh would receive a double recovery if the PIP benefits she was paid were not offset against the amount she received in settlement of her claim under the UM coverage provision. In addition, the Texas Supreme Court has held that such an offset is not available in Dabney v. Home. Therefore, the trial court did not err in refusing to allow such an offset, and the trial court’s judgment is affirmed.

Dissenting Opinion by ANGELINI, J., joined by GREEN and DUNCAN, JJ. RICKHOFF, J., concurring in the judgment only.

. Stipulation number 7 states: "A settlement was reached between Gerlich and Nationwide under the Uninsured/Underinsured Motorist Coverage for the total amount of $3,500.00. Nationwide contends that it is entitled to a credit for the amount of the PIP benefits paid to Gerlich by Nationwide. Gerlich's position is that Nationwide is not entitled to this credit.”

. PIP insurance coverage is a type of no-fault insurance designed to cover the immediate expenses associated with physical injuries due to an auto accident. Creighton v. Fidelity & Cas. Co. of New York, 581 S.W.2d 815, 816 (Tex.Civ. App.—Fort Worth 1979, no writ). UM coverage is designed to protect persons who are legally entitled to recover damages from owners or operators of uninsured motor vehicles. Tex Ins. Code Ann. art. 5.06-1(1) (Vernon 1981); Stracener v. United Services Auto. Assn, 777 S.W.2d 378, 382 (Tex.1989).