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IN THE SUPREME COURT OF APPEALS OF WEST
VIRGINIA
September 1997 Term
_____________
No. 23964
_____________
VERNON R. HAMRIC AND DEBRA HAMRIC,
INDIVIDUALLY AND AS GUARDIANS AND NEXT FRIENDS
OF STACEY HAMRIC,
Appellants
v.
JOHN DOE AND STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY,
Appellees
____________________________________________________________________
Certified Questions from the Circuit Court of
Fayette County
Honorable Charles M. Vickers, Judge
Civil Action No. 96-C-0033
CERTIFIED QUESTIONS ANSWERED
____________________________________________________________________
Submitted: September 17, 1997
Filed: December 5, 1997
Scott S. Segal,
Esq. R.
Carter Elkins, Esq.
Mark R. Staun,
Esq. Laura
L. Gray, Esq.
Lori A. Simpson,
Esq. Campbell,
Woods, Bagley,
Charleston, West
Virginia
Emerson, McNeer & Herndon
Attorneys for the Appellants
Huntington,
West Virginia
Attorneys
for the Appellees
JUSTICE MAYNARD delivered the Opinion of the
Court.
JUSTICE DAVIS, deeming herself disqualified, did not participate
in the decision of this case.
SYLLABUS BY THE COURT
1. "'The
uninsured motorist statute, West Virginia Code § 33-6-31 (Supp.
1986), is remedial in nature and, therefore, must be construed
liberally in order to effect its purpose.' Syllabus point 7, Perkins
v. Doe, 177 W.Va. 84, 350 S.E.2d 711, 714 (1986)."
Syllabus Point 1, State Farm Mut. Auto. Ins. Co. v. Norman, 191
W.Va. 498, 446 S.E.2d 720 (1994).
2. "In
order to satisfy the 'physical contact' requirement set forth in
W.Va. Code § 33-6-31(e)(iii), it is necessary to establish a
close and substantial physical nexus between an unidentified
hit-and-run vehicle and the insured vehicle." Syllabus Point
2, in part, State Farm Mut. Auto. Ins. Co. v. Norman, 191
W.Va. 498, 446 S.E.2d 720 (1994).
3. A
close and substantial physical nexus exists between an
unidentified hit-and-run vehicle and the insured for uninsured
motorist insurance coverage under W.Va. Code § 33-6-31(e)(iii)
when an insured can establish by independent third-party evidence
to the satisfaction of the trial judge and the jury, that but for
the immediate evasive action of the insured, direct physical
contact would have occurred between the unknown vehicle and the
victim.
4. The
"but for" test is satisfied and the uninsured motorist
claim can go forward only if the injured insured presents
independent third-party testimony by
disinterested individuals which clearly shows
the negligence of an unidentified vehicle was a proximate cause
of the accident.
5. "Whenever
the language of an insurance policy provision is reasonably
susceptible of two different meanings or is of such doubtful
meaning that reasonable minds might be uncertain or disagree as
to its meaning, it is ambiguous." Syllabus Point 1, Prete
v. Merchants Property Ins. Co. of Indiana, 159 W.Va. 508, 223
S.E.2d 441 (1976).
6. "Ambiguous
. . . provisions of an insurance policy should be construed
strictly against the insurer and liberally in favor of the
insured, although such construction should not be unreasonably
applied to contravene the object and plain intent of the
parties." Syllabus Point 2, Marson Coal Co. v. Ins. Co.
of State of Pennsylvania, 158 W.Va. 146, 210 S.E.2d 747
(1974).
7. Medical
coverage benefits should be available to an insured under the
medical payments coverage provisions of his or her automobile
insurance policy or policies when an insured is struck as a
pedestrian in the same way coverage is available under the
uninsured motorist statute. In order for the claim to go forward,
the insured must satisfy the "but for" test and the
corroborative evidence test.
Maynard, Justice:
Facts
In this case we
are presented with two certified questions from the Circuit Court
of Fayette County, West Virginia, regarding whether uninsured
motorist coverage and/or medical payment coverage will be made
available to Stacey Hamric under the insurance policies issued to
her father by State Farm Mutual Automobile Insurance Company
(State Farm).
The
questions certified to this Court and the circuit court's answers
are:
1. Whether
the physical contact requirement of W.Va. Code § 33-
6-31(e)(iii) is satisfied so that uninsured motorist coverage is
available to Stacey Hamric, who was injured as a pedestrian while
avoiding being struck by a vehicle driven by an unknown driver.
Circuit court's
answer: NO
2. Whether
the provisions of the State Farm policies providing medical
payment coverage which provide that "the bodily injury
through being struck as a pedestrian by a motor vehicle"
prior to being applicable are satisfied when Stacey Hamric was
injured as a pedestrian while avoiding being struck by a vehicle
driven by an unknown driver.
Circuit court's
answer: NO
The facts are not in dispute and were stipulated by the parties below. On September 9, 1994, Stacey Hamric, then twelve years old, and her friends, Leann Frame,
Kirk Frame, and Hanna Frame, traveled from
Braxton County to Midland Trail High School in Fayette County to
attend a football game. The minors were accompanied to the game
by adults George Keener, Audrey Keener, and Terry Frame. Upon
arrival at Midland Trail High School, Terry Frame parked her
vehicle on the berm of Route 60 across the road from the school
since no parking was available on school property.
When
the game ended, Terry Frame and Audrey Keener accompanied Stacey
Hamric, Kirk Frame, and Hanna Frame out of the gate of Midland
Trail High School, where they walked onto the berm of Route 60
and waited for traffic to clear so they could cross the road.
While they were waiting, a vehicle operated by an unknown driver
traveling on Route 60 swerved off the paved portion of the road
surface and continued onto the berm directly toward the group.
Terry Frame saw the careening vehicle bearing down on them and
yelled to the children to get out of the way. Stacey Hamric
jumped or was pushed by Terry Frame off the berm down into a
ravine. The fall caused her to fracture her left ankle and leg.
The parties all agree the unknown vehicle did not strike Stacey.
The parties also agree that had Stacey not jumped out of the path
of the oncoming vehicle, the vehicle unquestionably would have
struck her.
Stacey is the
daughter of Vernon Hamric and Debra Hamric. As a relative and a
resident of her parents' home, Stacey qualifies as an additional
insured under the six policies of automobile liability insurance
issued by State Farm to Vernon Hamric. The six
policies had the following pertinent coverages
in force and effect on September 9, 1994:
1. Policy
number 2494 489 48 providing medical payment coverage of $100,000
and uninsured motorist coverage of $100,000 per person and
$300,000 per occurrence;
2. Policy
number 2406 701 48 providing medical payment coverage of $25,000
and uninsured motorist coverage of $100,000 per person and
$300,000 per occurrence;
3. Policy
number 2175 661 48 providing medical payment coverage of $100,000
per person and uninsured motorist coverage of $100,000 per person
and $300,000 per occurrence;
4. Policy
number 1286 865 48 providing medical payment coverage of $25,000
and uninsured motorist coverage of $100,000 per person and
$300,000 per occurrence;
5. Policy
number 1970 899 48 providing medical payment coverage of $100,000
and uninsured motorist coverage of $100,000 per person and
$300,000 per occurrence; and
6. Policy
number 2070 788 48 providing medical payment coverage of $100,000
and uninsured motorist coverage of $100,000 per person and
$300,000 per occurrence.
Vernon Hamric and Debra Hamric filed an action against John Doe and State Farm in circuit court, seeking recovery for the injuries sustained by their minor daughter. The Hamrics brought a declaratory judgment action asking the court to determine whether the uninsured motorist coverage and medical payments coverage were available under the policies issued by State Farm to Vernon Hamric. The Hamrics request recovery for
payment of medical bills, gratuitous home
health care, loss of consortium, mental anguish, loss of
enjoyment of life and emotional distress.
The
parties filed cross motions for summary judgment on the
declaratory judgment action. The circuit court's September 27,
1996 order granted State Farm's motion for summary judgment by
declaring that no uninsured motorist coverage benefits or medical
payment benefits were available to the Hamrics because there had
been no physical contact between the unknown vehicle and Stacey
Hamric. The two questions previously noted were then certified to
this Court.
I. The Uninsured Motorist Statute Issue
The circuit
court's first certified question to this Court is framed as
follows:
Whether the
physical contact requirement of West Virginia Code §
33-6-31(e)(iii) is satisfied so that uninsured motorist coverage
is available to Stacey Hamric, who was injured as a pedestrian
while avoiding being struck by a vehicle driven by an unknown
driver.
W.Va. Code § 33-6-31 provides a mechanism by which insureds may recover uninsured motorist coverage benefits for bodily injury or property damage caused by an uninsured motor vehicle whose driver or operator is unknown. The statute encompasses
the definition of a "hit and run"
motor vehicle. W.Va. Code § 33-6-31(e)(iii) (1995) states in
pertinent part:
(e) If
the owner or operator of any motor vehicle which causes bodily
injury or property damage to the insured be unknown, the insured,
or someone in his behalf, in order for the insured to recover
under the uninsured motorist endorsement or provision, shall:
(iii) Upon
trial establish that the motor vehicle, which caused the bodily
injury or property damage, whose operator is unknown, was a
"hit and run" motor vehicle, meaning a motor vehicle
which causes damage to the property of the insured arising out of
physical contact of such motor vehicle therewith, or which causes
bodily injury to the insured arising out of physical contact
of such motor vehicle with the insured or with a motor vehicle
which the insured was occupying at the time of the accident. If
the owner or operator of any motor vehicle causing bodily injury
or property damage be unknown, an action may be instituted
against the unknown defendant as "John Doe", in the
county in which the accident took place or in any other county in
which such action would be proper under the provisions of article
one [§ 56-1-1 et seq.], chapter fifty-six of this code[.]
(Emphasis added).
The
State Farm policies issued to Mr. Hamric state that an " [u]ninsured
[m]otor [v]ehicle means . . . a 'hit-and-run' motor
vehicle whose owner or driver remains unknown and which strikes:
a. the
insured,
b. the
vehicle the insured is occupying, or
c. other
property of the insured
and causes bodily
injury to the insured or property
damage.
The
parties agree the State Farm policies conform to the statutory
requirements. The question we must answer is whether uninsured
motorist coverage is available to Stacey Hamric under the
particular set of facts presented in this case; in other words,
we must determine the meaning of "physical contact" and
"strikes" under West Virginia law. To begin with, we
reiterate that "'[t]he uninsured motorist statute, West
Virginia Code § 33-6-31 (Supp.1986), is remedial in nature and,
therefore, must be construed liberally in order to effect its
purpose.' Syllabus point 7, Perkins v. Doe, 177 W.Va. 84,
350 S.E.2d 711, 714 (1986)." Syllabus Point 1, State Farm
Mut. Auto. Ins. Co. v. Norman, 191 W.Va. 498, 446 S.E.2d 720
(1994).
In the Perkins case, the Perkins, who were West Virginia residents, were traveling in Virginia when an oncoming unknown motorist crossed left of center and into the Perkins' lane, thereby causing Mr. Perkins to swerve to avoid the oncoming vehicle. The Perkins' vehicle struck an embankment and Mr. Perkins was rendered a quadriplegic. Unlike West Virginia, Virginia had no statutory "physical contact" requirement. This Court was asked to determine whether to apply Virginia or West Virginia law. This Court was also asked to determine whether any public policy or legal doctrine of West Virginia would operate to bar the Perkins' uninsured motorist claim. This Court concluded the law of Virginia applied and that "no public policy or legal doctrine operate[d] to bar the
Perkins' claim on the uninsured motorist
endorsement." Perkins, 177 W.Va. at 87, 350 S.E.2d at
715 (footnote omitted).
More
recently, in Norman, this Court was asked to determine
"[w]hether uninsured motorist coverage [was] available
pursuant to W.Va. Code § 33-6-31 (1988) and State Farm policies
of insurance for the death of an insured driver whose vehicle
struck a tire of unknown origin lying on a public
highway[.]" Norman, 191 W.Va. at 500, 446 S.E.2d at
722. In Norman, Ms. Barnett struck a large tire which was
located on the edge of the left-hand lane of the interstate. She
lost control of her vehicle, which then ran into a rock
embankment. Ms. Barnett was thrown from the car and died as a
result of the injuries she received. This Court concluded
"that the insertion of a physical contact requirement in the
uninsured motorist statute was a matter of legislative
choice." Id., 191 W.Va. at 507, 446 S.E.2d at 729.
Nonetheless, the Norman Court went on to hold in syllabus
point 2 that "[a]bsent specific coverage provisions to the
contrary, uninsured motorist coverage is not available where an
insured vehicle strikes a tire or other type of immobile object
or debris which may be lying on a highway. In order to satisfy
the 'physical contact' requirement set forth in W.Va. Code §
33-6-31(e)(iii), it is necessary to establish a close and
substantial physical nexus between an unidentified
hit-and-run vehicle and the insured vehicle." (Emphasis
added).
Inasmuch
as Norman did not discuss the specific meaning of the
phrase "close and substantial physical nexus", we now
revisit this area in order to put flesh on the skeletal bones of Norman,
to take the next step and define what is meant by a "close
and substantial physical nexus". We must do so by
"accord[ing] every liberal extension to the remedial statute
[without] judicially removing the meaning and frustrating the
purpose of limiting language deliberately inserted into the
statute." Norman, 191 W.Va. at 506, 446 S.E.2d at 728
(quoting Smith v. Great American Insurance Co., 29 N.Y.2d
116, 324 N.Y.S.2d 15, 19, 272 N.E.2d 528, 531 (1971).
This
Court previously acknowledged that the purpose of the physical
contact requirement is the prevention of fraud or collusion. Perkins,
177 W.Va. at 87 n.4, 350 S.E.2d at 714 n.4. We remain
strongly committed to the underlying policy of preventing fraud
even though we are mindful that abandoning an objective standard
in favor of a more subjective one increases the potential for
fraud or collusion.
Ohio was faced with a situation similar to the one facing us today, but in a slightly different context. An insured was injured when she lost control of her car and it overturned after an unidentified vehicle swerved into her lane of traffic. The insured sought uninsured motorist coverage from her automobile insurer. The insurer denied coverage based on its determination that there was no physical contact between the
vehicles.See
footnote 1 1 The insured brought a declaratory
judgment action against her insurer, asking that the physical
contact requirement be declared invalid and unenforceable. The
Ohio Supreme Court found the physical contact requirement to be
contrary to public policy and stated further:
We are persuaded
that some of the rationale underlying the physical contact
requirement is unjustified and that this absolute standard for
recovery should be abandoned. Instead, we hold that the test that
ought to be applied in cases where an unidentified driver's
negligence causes injury is the corroborative evidence test,
which allows the claim to go forward if there is independent
third-party testimony that the negligence of an unidentified
vehicle was a proximate cause of the accident.
Girgis v. State Farm Mut. Auto. Ins. Co., 75
Ohio St.3d 302, 305, 662 N.E.2d 280, 282 (1996).See footnote 2 2
We agree with the Ohio Supreme Court that absolute enforcement of the physical contact requirement is contrary to public policy. We believe the physical contact requirement should not bar recovery when there is sufficient independent third-party evidence to conclusively establish that the sequence of events leading to an injury was
initially set in motion by an unknown
hit-and-run driver or vehicle. We therefore hold that a close and
substantial physical nexus exists between an unidentified
hit-and-run vehicle and the insured for uninsured motorist
insurance coverage under W.Va. Code § 33-6- 31(e)(iii) (1995)
when an insured can establish by independent third-party evidence
to the satisfaction of the trial judge and the jury, that but
for the immediate evasive action of the insured, direct
physical contact would have occurred between the unknown vehicle
and the victim. The requirement now is that physical contact with
an unknown vehicle be immediate and imminent and the danger is
avoided only by the urgent evasive action of the insured. In the
literature of this developing area of law, this is commonly
referred to as the "but for" test. While this phrase
might not have an intellectual ring, it certainly is accurate and
descriptive and provides a practical, shorthand way to identify
the rule.
The "but for" test is satisfied and the uninsured motorist claim can go forward only if the injured insured presents independent third-party testimony by disinterested individuals which clearly shows the negligence of an unidentified vehicle was a proximate cause of the accident. This is commonly called the corroborative evidence test. It would be impossible to say in advance what might constitute sufficient corroborative evidence in a given case, and while it is difficult to spell out what is independent third-party evidence, we believe we must be very clear about what is not adequate independent third-party testimony. Testimony by close family members, close
personal friends, by those who might share in
the award or have a direct pecuniary interest in the outcome of
the case, and all others similarly situated is not testimony
which is sufficient to allow the claim to proceed. Evidence from
these witnesses standing alone is not adequate to meet the
corroborative evidence test. This is not to suggest that family
members would routinely perjure themselves; we believe most would
not. However, if we are going to have a truly effective bright
line rule which genuinely eliminates the very real potential for
fraud, clear and simple guidelines must be established. We
realize that to avoid fraud, the evidence needs to be free of
taint or suspicion and be strong and reliable. Accordingly, to
insure that this Court is not opening the door to fraud, the
corroborative witnesses or other evidence must be absolutely and
totally independent and reliable.
Blind adherence to the physical contact requirement wrongfully deprives insured individuals of any recovery under uninsured motorist coverage even when reliable, independent third-party testimony is available. We believe proper use of the independent corroborative evidence test should assist in preventing the filing of fraudulent claims, while at the same time the test should help avoid the injustice of prohibiting clearly legitimate claims where no physical contact has occurred. To the extent that our prior cases allowed
recovery only after an insured proved at trial
that his or her injuries were the result of actual physical
contact with a hit-and-run vehicle, they are overruled.See footnote 3 3
In
the case at bar, Stacey Hamric's accident was witnessed by four
adults, all of whom were clearly disinterested and independent.
In fact, the parties stipulated that Stacey would have been
struck by the unknown vehicle had she not moved out of the
vehicle's path. This ameliorates the potential for fraud. We find
the evidence in the case at bar satisfies both the "but
for" test and the independent corroborative evidence test.
Accordingly, we answer the first certified question
affirmatively.
II. The Medical Payment Provisions Issue
The second
certified question, as set forth above, is:
Whether the
provisions of the State Farm policies providing medical payment
coverage which provide that "the bodily injury through being
struck as a pedestrian by a motor vehicle" prior to being
applicable are satisfied when Stacey Hamric was injured as a
pedestrian while avoiding being struck by a vehicle driven by an
unknown driver.
State
Farm has also denied coverage under the medical payment coverage
(med-pay) provisions of the insurance policies because Stacey
Hamric was not physically "struck" by the unknown
vehicle. The med-pay provisions of the State Farm policies at
issue provide:
Persons for
Whom Medical Expenses Are Payable
We will pay
medical expenses for bodily injury sustained by:
1. a. the
first person named in the declarations;
b. his
or her spouse; and
c. their
relatives.
These
persons have to sustain the bodily
injury:
a. while
they operate or occupy a vehicle
covered
under the liability section; or
b. through
being struck as a pedestrian by a
motor
vehicle or trailer.
A
pedestrian means a person not an
occupant
of
a motor vehicle or trailer.
No
statutory requirements govern medical payments coverage;
therefore, we must look to the language of the policy to
determine if coverage is available. This Court has previously
said:
"'Where
provisions in an insurance policy are plain and unambiguous and
where such provisions are not contrary to a statute, regulation,
or public policy, the provisions will be applied and not
construed.' Syl. Pt. 2, Shamblin v. Nationwide Mut. Ins. Co.,
[175] W.Va. [337], 332 S.E.2d 639, 640 (1985)." Syllabus
Point 2, Deel v. Sweeney, 181 W.Va. 460, 383 S.E.2d 92
(1989).
Syllabus Point 1, Keiper v. State Farm Mut. Auto. Ins. Co.,
189 W.Va. 179, 429 S.E.2d 66 (1993). An ambiguous insurance
policy is defined as one that "is reasonably susceptible of
two different meanings or is of such doubtful meaning that
reasonable minds might be uncertain or disagree as to its
meaning[.]" Syllabus Point 1, Prete v. Merchants Property
Ins. Co. of Indiana, 159 W.Va. 508, 223 S.E.2d 441 (1976).
State
Farm argues the med-pay provisions of the policies are clear and
unambiguous and must be applied as written. Even though Stacey
Hamric is an insured and was a pedestrian on September 9, 1994,
State Farm argues she was not actually "struck" by a
motor vehicle on that day. Therefore, under the policy language,
no med- pay is available. Vernon Hamric and Debra Hamric argue
that, under Norman, an insured does not have to be
physically struck for coverage to be afforded. Rather, a
"close and substantial physical nexus" must exist
between an unknown hit-and-run vehicle and the insured.
We
turn to 43 Am.Jur.2d Insurance § 632 (1982) for guidance.
This provision states:
It
has been held that the proper construction of the policy
provision "struck by an automobile" does not
necessitate physical contact of the body of the insured with the
automobile as a prerequisite to recovery. Thus, such a policy
provision was held to cover an injury to one who suffered an
accident while attempting to
avoid being struck by an oncoming automobile,
and when in imminent danger of being struck, even though the
moving car did not come in contact with his body. (Footnotes
omitted).
Liberally
construing the med-pay provisions of the State Farm policies, as
our law requires us to do, and viewing the phrase "must be
struck" or "through being struck" in light of the
method and logic we just used to define "physical
contact" under the uninsured motorist statute, we now concur
with the construction outlined in Am.Jur.2d, supra. Since
this phrase is "reasonably susceptible of two different
meanings," we believe it is ambiguous. "Ambiguous . . .
provisions of an insurance policy should be construed strictly
against the insurer and liberally in favor of the insured
[.]" Syllabus Point 2, in part, Marson Coal Co. v. Ins.
Co. of State of Pennsylvania, 158 W.Va. 146, 210 S.E.2d 747
(1974).
Even though Stacey Hamric was not actually physically "struck" by the unknown vehicle, a liberal construction of the med-pay provisions of the insurance policies allows this claim to go forward. In the instant case, there simply is no doubt the actions of a negligent automobile driver proximately caused Stacey Hamric's injury. The parties stipulated that "but for" the evasive actions of Stacey Hamric, she would have been struck. No less than four disinterested adults witnessed the accident. These witnesses can provide
the necessary independent third-party testimony
to meet the corroborative evidence requirement.
We
therefore hold that medical coverage benefits should be available
to an insured under the medical payments coverage provisions of
his or her automobile insurance policy or policies when an
insured is struck as a pedestrian in the same way coverage is
available under the uninsured motorist statute. In order for the
claim to go forward, the insured must satisfy the same tests that
must be satisfied in order for a claim to proceed under the
uninsured motorist statute. These tests include the "but
for" test and the corroborative evidence test. Accordingly,
we answer the second certified question affirmatively.
We pause here to note that this Court has unequivocally declared that "although we have allowed the stacking of uninsured motorist coverage based on the public policy mandate of W.Va. Code 33-6-31 [1988], there exists no statutory or other public policy requirement that would provide a basis for invalidating or modifying the anti- stacking language for medical benefits contained in an insurance policy." Keiper v. State Farm Mut. Auto. Ins. Co., 189 W.Va. 179, 183, 429 S.E.2d 66, 70 (1993). We now reiterate that the stacking of medical coverages and benefits is not permissible when the language of an insurance policy prohibits such stacking. Thus, the trial court must
determine whether or not any of these six
insurance policies contain anti-stacking language and determine
coverage accordingly.
For the foregoing reasons, we find the Hamrics' claims for uninsured motorist benefits and medical benefits should be allowed to proceed if they satisfy the "but for" test and the corroborative evidence test, both of which are articulated in this opinion. Certified questions answered.
Footnote: 1 1 State Farm concluded there was no '"hit and run' land motor vehicle" involved in the accident as was described by the insurance contract, and, therefore, the company was not obligated to pay the claim. Girgis v. State Farm Mut. Auto. Ins. Co., 75 Ohio St.3d 302, 303, 662 N.E.2d 280, 281 (1996). The decision in this Ohio case was based strictly on contract language rather than on a statute.
Footnote: 2 2 See note 1 of Girgis, supra, for a list of states that have adopted this rule or an even stricter rule.
Footnote: 3 3 For example, Lusk v. Doe, 175 W.Va. 775, 778, 338 S.E.2d 375, 378, unequivocally states, "In order for the insured to recover from the insurer, upon trial it must also be shown that the injuries were incurred after physical contact with the hit and run vehicle."