holding where "an individual applies and prepays for specific insurance coverage, the insurer may not unilaterally change the coverage provided without an affirmative showing that the insured was notified of, and understood, the change, regardless of whether the insured read the policy"
How later courts described this case
- holding where "an individual applies and prepays for specific insurance coverage, the insurer may not unilaterally change the coverage provided without an affirmative showing that the insured was notified of, and understood, the change, regardless of whether the insured read the policy"
- holding that where an individual pays for *365 specific disability insurance coverage, the insurer may not unilaterally change that coverage without an affirmative showing that the insured was notified of the change, regardless of whether the insured read the policy
- holding that where an individual pays for specific disability insurance coverage, the insurer may not unilaterally change that coverage without an affirmative showing that the insured was notified of the change, regardless of whether the insured read the policy
- holding that where an "individual applies and prepays for specific insurance coverage, the insurer may not unilaterally change the coverage provided without an affirmative showing that the insured was notified of, and understood, the change”
Written by the judges who cited it.
Distinguished
Distinguished by Decker v. Nationwide Insurance, 1 Pa. D. & C.5th 147 (2007)
The district court, noting the factual distinctions between the Pennsylvania Supreme Court’s holdings in both Tonkovic and Standard Venetian Blind, determined that the language of the insurance policy governed the agreement between the parties: “We therefore decline to extend coverage based upon Pennsylvania’s reasonable expectations doctrine, contrary to the clear terms of the policy.
The opinion
ZAPPALA, Justice,
dissenting.
I must dissent from the majority’s conclusion that Standard Venetian Blind Co. v. American Empire Insurance Co., 503 Pa. 300 , 469 A.2d 563 (1983) is inapplicable to this case. Underlying the majority’s conclusion is its perceived distinction between an insured who requests a specific type of coverage, but obtains a policy which does not provide the requested coverage, and an insured who receives the re *460 quested coverage, but fails to read the policy provisions. The majority categorizes the Appellant among the former. Proceeding from this characterization, the majority then determines that the trial court’s charge on the issue of the exclusionary language of the policy was correct. The majority erroneously relies upon Rempel v. Nationwide Life Insurance Co., 471 Pa. 404 , 370 A.2d 366 (1977) and disregards the nature of the action filed by the Appellant.
In Rempel , the insured initiated a trespass action against the insurance company and its agent for negligent misrepresentation. The insured contended that the agent had negligently or fraudulently misrepresented that the insurance policy which had been procured by the agent would provide for a payment of any outstanding mortgage balance on the insured’s home on the date of his death, plus an additional $5,000. The policy was issued by the insurance company following an inquiry by the insured’s wife as to whether its agent could match a policy offered by another insurance company for mortgage protection and the $5,000 life insurance benefit. Representations were made to the insured’s wife that the policy would provide the requested coverage.
Unlike Rempel , however, the Appellant in this case brought an action in assumpsit asserting that the Appellee’s denial of coverage was wrongful as it was based upon a policy exclusion which was not brought to his attention. The Appellant did not set forth a separate cause of action in trespass for negligent misrepresentation, but sought only to recover on the insurance policy which had been issued.
Consistent with the contract cause of action stated in this complaint, the only testimony presented in the case in chief was that of the Appellant himself. The Appellant testified at length that he was not told about any exclusions in the policy, that he did not read the insurance policy, and that he never received an insurance policy pertaining to disability. It is noteworthy that the Appellant did not plead in his complaint or testify that he directed the Appellee’s agent to procure disability insurance that would be paid without *461 regard to the existence of workmen’s compensation coverage. The Appellant testified only to the following exchange with the agent:
Q: And would you tell the jury when you went there how the application was filled out and how it was executed and so forth?
A: Mr. LaPorte and I, we had a rapport where I don’t know insurance, and I still don’t, and maybe I’m guilty for taking things just for granted as far as insurance is concerned, I just told him basically what I needed, the mortgage payment the amount that I could cover, and Mr. LaPorte told me I didn’t make enough money to substantiate the whole payment but I could get $450 which was awful close, give or take a few dollars.
[R. 13a — 14a]. He further testified:
Q. Mr. Tonkovic, when you bought the insurance, did you desire to buy insurance which would cover you with this kind of exclusion?
A: I wouldn’t purchase an insurance policy with that type of exclusion. Where else would I get hurt than automobile or work. I just never gave any thought to it. It was never mentioned. I didn’t dream I would be hurt in October.
[R. 27a — 28a].
It was not until the Appellee presented the testimony of its agent, Norman LaPorte, that there was any reference to an understanding that the Appellant was applying for insurance which would provide coverage despite eligibility for workmen’s compensation. At no time did the Appellant move to amend or conform the pleadings to include a trespass action for negligent misrepresentation after this reference of the agent’s failure to obtain requested coverage was made. Instead, the Appellant proceeded with his assumpsit claim for wrongful denial of coverage on the insurance policy which had been issued. The majority’s holding depends upon its analysis of a cause of action which was not raised in the Appellant’s complaint or by the theory *462 of the case during the course of trial. Although the majority has raised a legal theory which may be applicable to the factual circumstances of this case, this Court is not at liberty to redraft the Appellant’s complaint or to dispose of the appeal on legal issues which were not presented by the parties.
The basis of Appellant’s claim was that the exclusionary language of the policy had not been explained to him. The trial court specifically charged the jury that the burden was upon the insurer to establish the insured’s awareness and understanding of the exclusion under the existing law of Hionis v. Northern Mutual Insurance Co., 230 Pa.Super. 511 , 327 A.2d 363 (1974). The Appellee took a specific exception to the charge, asserting that the policy was clear and unambiguous as to exclusion. Inasmuch as the Hionis decision was subsequently overruled by this Court, I believe that the Superior Court’s order reversing the judgment and remanding the matter for a new trial should be affirmed.