Pennsylvania High Court Declines to Apply Make Whole Doctrine to Pro Rated Deductible Reimbursements - Jones v. Nationwide Property & Casualty Ins.
As a Philadelphia personal injury lawyer, I'm very familiar with the legal concept of subrogation. In personal injury cases, subrogation allows an insurance company to "stand in the shoes" of the insured person, which permits it to sue an at-fault driver even if the insured won't, or collect on any lawsuit judgment the insured wins on his or her own. Courts have frequently stepped in to keep insurance companies from collecting unfair amounts, however, and one way they've done that is applying a legal doctrine saying the insured must be "made whole" before the insurer can collect. So I was interested to see that the Pennsylvania Supreme Court rejected the make-whole doctrine in an insurance subrogation case, in Jones v. Nationwide Property & Casualty Insurance Co..
Brenda Jones of Philadelphia County was hit by an at-fault driver and, luckily, suffered only damage to her car. She had collision coverage that allowed her to collect an insurance settlement for the amount of the damage, minus a $500 deductible she paid herself. Nationwide's contract gave it a subrogation right to sue the at-fault driver's insurance company for reimbursement of that payment, so it did. That recovery was 90 percent of the amount that Nationwide actually paid, however. As a result, when Nationwide paid Jones back for her deductible from that money, it paid only 90 percent of the deductible -- $450. This was pursuant to Nationwide's ordinary practice and mirrored a state Insurance Department regulation. Jones filed a class-action lawsuit alleging violations of the make-whole doctrine, breach of contract, unjust enrichment, conversion and insurance bad faith. The trial court dismissed the case and the Superior Court affirmed, finding that a practice permitted by state insurance regulators implicitly modifies the common-law make-whole doctrine.
After reviewing arguments from both sides and Pennsylvania's acting Insurance Commissioner, which filed an amicus brief supporting Nationwide, the Pennsylvania Supreme Court started by ruling that applying the make-whole doctrine to subrogation in collision-coverage-only cases would undermine state laws requiring at least some deductible on any insurance policy. By allowing full recovery of the deductible, it said, the courts would essentially create a no-deductible situation. Furthermore, it said, allowing full recovery in collision coverage cases would be inequitable because the insurer assumes the risk and expense of litigation in such cases. And because there's a deductible, requiring the insurer to pay more than the pro-rated amount would amount to preferential treatment for the insured, who after all agreed to take on the risk of a deductible. Thus, it upheld the lower courts, but on different grounds.
Though this decision was not good for the driver, I believe the underlying logic might be good news for Philadelphia accident lawyers like me. This decision reverses the usual situation in subrogation of personal injury claims, because normally, the driver has sued the at-fault driver and the insurance company steps in to claim a piece of the recovery. In that situation, it's well-established that the insured must be made whole before the insurer may be paid. This decision repeats the equitable principles -- what might be called principles of fairness -- that underlie this policy decision by the Pennsylvania courts. As a Philadelphia injury lawyer, I believe this benefits injured people fighting money grabs more often than it harms them.