Court Opinion

ID: 9736919
Source: CourtListenerOpinion
Date Created: 2023-08-26 19:09:59.212516+00
Date Added: 2024-06-11T07:23:55.398260
License: Public Domain

CAPPY, Justice,
dissenting.
I am constrained to dissent.
On August 12, 1980, John R. Miller died in a motor vehicle accident. At that time he was the named insured on a Pennsylvania No-Fault Insurance Policy issued by Appellant, Keystone Insurance Company (“Keystone”). Keystone was immediately notified of its insured’s fatality. Keystone, through its agent and without specific demand, voluntarily undertook to investigate and pay funeral, collision and surviv- or’s loss benefits to Appellee, Mrs. Miller, the unrepresented mother of the named insured on the policy. However, at this time neither Keystone, nor its agent who allegedly assisted *542Mrs. Miller in presenting her claim to Keystone, informed Mrs. Miller concerning the potential for recovery of postmortem work loss benefits under the No-Fault Act1 or of the recent appellate activity concerning such recovery, which was unfavorable to Keystone.2
Six years later, after learning of entitlement to post-mortem work loss benefits arising out of her son’s fatal accident, Mrs. Miller filed a claim on behalf of her son’s estate, seeking those benefits from Keystone, plus interest and counsel fees. The gravamen of her Complaint was that Keystone had breached its duty of good faith and fair dealing in knowingly misleading her into believing that she had no valid claim for work loss benefits, the representation upon which she had justifiably relied to her detriment. The trial court subsequently granted summary judgment in favor of Keystone on the basis that Mrs. Miller’s Complaint was filed after expiration of the applicable statute of limitations.
On appeal, the Superior Court vacated the summary judgment entered below upon a determination that there existed some evidence for the imposition of the duty of good faith and fair dealing announced by this Court in Dercoli v. Pennsylva*543nia National Mutual Insurance Company, 520 Pa. 471, 554 A.2d 906 (1989), which tolled the statute of limitations. It held that the Dercoli duty of good faith and fair dealing imposed an affirmative obligation upon an insurer to inform its insured that it has knowledge of the possibility of a claim for recovery and that it is no longer acting in the interests of its unrepresented insured in this matter where:
(1) the insurer had assumed the responsibility for processing its insured’s claims; (2) the insurer knew that the insured was relying exclusively on its advice and counsel; and (3) the insurer had knowledge regarding an additional claim for benefits to which [the insured] was entitled and it failed to disclose such information.
Miller, 402 Pa.Super. at 223, 586 A.2d at 941. Despite the soundness of this holding, the Majority herein concludes that the Superior Court erroneously interpreted and impermissibly expanded the holding in Dercoli in this instance. I disagree.
The Majority concludes that Dercoli was carefully limited to situations where the insurer “actively fostered the insured’s erroneous belief,” and involved a situation where a “knowing and purposeful misrepresentation was critical” to the existence of a duty to disclose all available benefits. On this basis the Majority then determines that the Superior Court improperly expanded the scope of the Dercoli duty by broadly applying it to a factually distinguishable situation. It finds that here, in contrast to the situation in Dercoli, Keystone did not voluntarily assume or transform itself into a position of legal advisor, did not act in any manner to discourage Mrs. Miller from obtaining legal counsel, and did not make any promises to Mrs. Miller. The Majority then goes on to conclude that the matter sub judice is governed by Taglianetti v. Workmen’s Compensation Appeal Board, 503 Pa. 270, 469 A.2d 548 (1983). This is error.
Unlike the Majority, I cannot conclude that the existence of the duty in Dercoli necessarily turned on, or should turn on, an affirmative undertaking of an insurance company to advise and counsel its insured in the insured’s claim for benefits. It is my strong belief that the presence of such evidence in *544Dercoli only provided further support for the imposition of the long recognized duty owed by an insurance company to deal with the insured fairly and in good faith, see Fedas v. Insurance Company of the State of Pennsylvania, 300 Pa. 555, 151 A. 285 (1930), a duty that this Court reasonably determined to include, in a “non-adversarial setting,” a “duty of full and complete disclosure as to all of the benefits and every coverage that is provided by the applicable policy or policies along with all requirements, including any time limitations for making a claim.” Dercoli, 520 Pa. at 478, 554 A.2d at 909. My interpretation is further supported by this Court’s statement in Dercoli that “[t]his is especially true where the insurer undertakes to advise and counsel the insured in the insured’s claim for benefits.” Id. (Emphasis added).
Furthermore, by interpreting Dercoli as applying only to the situation where an insured voluntarily assumes to act as “legal advisor” for its insured, the Majority fails to acknowledge that the assumption of such a “role” by the insurer would give rise to a duty much greater than that of good faith and fair dealing. It would support the existence of a fiduciary duty, the highest standard of duty implied by law — a duty arising from the relationship of legal advisor, which implies and necessitates great confidence, trust, candor and the highest degree of good faith to act, and advocate, for the benefit of the other as to matters within the scope of the relationship.
Such a limitation is also contrary to the responsibility implicitly imposed upon insurers and their agents by the No-Fault Act itself, which had a primary purpose of, inter alia, insuring that a claimant would not need an attorney to secure basic benefits. This purpose was effectuated through a non-adversarial scheme, which placed the burden on the insurer to investigate and pay claims, and encouraged claimants to place their trust and reliance in their insurance companies to see to it that claims were handled properly and that they received all benefits to which they were entitled.
Finally, and most importantly, I simply cannot condone the Majority’s attempt to minimize and mischaracterize the alleged relationship of cooperation and trust apparently existing *545between Keystone, its agent and Mrs. Miller in this instance, by misplaced reliance upon Taglianetti. In Taglianetti, it was an employer’s insurance company, an unquestionably formidable adversary, who was relieved of an affirmative duty to apprise a deceased employee’s wife oí all available workmen’s compensation benefits. I agree that in that instance, there is no Dercoli duty of good faith and fair dealing absent fraud, intentional deceit or misleading statements with regard to the claimant’s interest. However, in the case sub judice, the insurance company is not an adversary, nor does it represent an adversary. In fact, the insurance company was the insurer of the claimant’s deceased son and now represents the interest of the claimant, the personal representative of the son’s estate. There simply is no adversarial relationship either real or imagined. Taglianetti does not apply to these facts.
Therefore, under the circumstances as alleged and argued by Mrs. Miller, a non-adversarial scenario, I would hold that, pursuant to its duty of good faith and fair dealing, Keystone had an affirmative obligation to disclose to its insured: that it had knowledge of the possibility of a claim for recovery; that the potential for an adversarial relationship existed; and that it was no longer acting in the interests of its unrepresented insured in this matter. In my opinion, this requirement would be a minor obligation given the alleged relationship of the parties that had theretofore involved a spirit of cooperation and trust.3
*546Accordingly, based upon the foregoing, I would affirm the decision of the Superior Court.
Thus, I respectfully dissent.

. No-fault Motor Vehicle Insurance Act, 40 P.S. §§ 1009.101-1009.701, repealed.

. In 1980, this Court held that survivors of deceased victims of motor vehicle accidents were entitled to post-mortem work loss benefits pursuant to the Pennsylvania No-fault Act, Allstate Insurance Company v. Heffner, 491 Pa. 447, 421 A.2d 629 (1980), and impliedly determined that such recovery also extended to the deceased victim's estate. Pontius v. U.S.P. & G., 491 Pa. 447, 421 A.2d 629 (1980). As determined by the Superior Court, it cannot be denied that the insurance industry in this Commonwealth was aware of this appellate activity, and an internal memorandum prepared by Keystone to Mrs. Miller’s claim representative regarding the information disclosed to her provides some evidence that Keystone was aware of the unfavorable appellate activity in this area. Miller v. Keystone Insurance Company, 402 Pa.Super. 213, 229, 586 A.2d 936, 944 (1991). Moreover, it is clear that neither Heffner and Pontius, nor this Court's express determination that a deceased victim’s estate is entitled to recover for work-loss in Freeze v. Donegal Mutual Ins. Co., 504 Pa. 218, 470 A.2d 958 (1983), represented a "change” in the law of Pennsylvania. To the contrary, these cases merely decided what the No-fault Act had always required, and furthermore, served to dispel an incorrect interpretation of the Act being advanced by insurers.

. Contrary to the position of the Majority, I believe that, if Mrs. Miller can establish a basis for the duty that I and the Superior Court have described, Keystone’s breach thereof would serve to toll the running of the statute of limitations in this matter under the principle of estoppel. My review yields no basis for the Majority’s conclusion that Mrs. Miller cannot establish that she was fraudulently or deceptively lulled into a false sense of security, given the alleged actions, omissions and relationships of the parties, and the limited record developed prior to entry of summary judgment. To further support the dismissal of this claim on the basis that there was no discussion between Mrs. Miller and Keystone related to post-mortem survivor’s benefits or the filing of a claim simply begs the question.
In addition, the Majority's attempt to further dismiss Mrs. Miller's claim on the basis that the "estate” possessed only a potential entitlement to benefits at the time Mrs. Miller filed her original claim for benefits is seriously flawed. As thoroughly described by the Superior *546Court herein, while this Court did not finally put to rest the issue of an estate’s claim for work-loss benefits until Freeze v. Donegal Mutual Ins. Co., 504 Pa. 218, 470 A.2d 958 (1983), Freeze did not change the law of Pennsylvania. It merely enforced what the No-fault Act had always required, and essentially only provided what this Court had implied in the Heffner-Pontius cases. Moreover, the question is not whether Keystone's insureds were able to recover between the Heffner-Pontius cases and the Freeze decision, but rather, whether Keystone had an obligation to inform them of the potential for recovery and that it was no longer acting in the interest of its unrepresented insureds. Finally, it is clear that as of the date of this Court's decision in Freeze, only three months had elapsed since Mrs. Miller received her last benefits, and quite conceivably a full year remained before the estate’s claims would have been time barred. 402 Pa.Super. at 230-232, 586 A.2d at 944-45.