Third Circuit Court Ruling on Insurance Liability in Trahey Wrongful Death Case
Third Circuit Court Ruling on Insurance Liability in Trahey Wrongful Death Case
2d 80
I.
1
Vito Vinciguerra, a security guard, attacked and killed Ronald F. Trahey, his
fellow employee, while both were on assignment for their employer, Allied
Security, Inc. (Allied). In a wrongful death action brought by the estate of
Trahey against Allied in the Philadelphia County Court of Common Pleas, the
jury found that Vinciguerra killed Ronald Trahey "because of reasons personal
to him and not directed against the victim as an employee or because of his
employment." App. at 278. The parties agree that this finding established that
the killing was not covered by the Pennsylvania Workmen's Compensation Act,
which provides that "an injury caused by an act of a third person intended to
injure the employe because of reasons personal to him, and not directed against
him as an employe or because of his employment" does not qualify as an
"injury arising in the course of employment" for purposes of the Act.
Pa.Stat.Ann. tit. 77, Sec. 411(1) (Purdon Supp.1988). The jury found that
negligence on the part of Allied "in the hiring, retention, placement,
supervision or control" of Vinciguerra was a substantial factor in Trahey's
death, and assessed $800,000 in damages against the company. App. at 278-79.
The insurance policy issued by Liberty provides for two types of coverage.
Under Coverage A, "Workers' Compensation," Liberty agreed to cover all
compensation required by "the workers' compensation law." App. at 46. Under
Coverage B, "Employers' Liability," Liberty agreed "[t]o pay on behalf of the
insured all sums which the insured shall become legally obligated to pay as
damages because of bodily injury by accident or disease, including death at any
time resulting therefrom, (a) sustained ... by any employee of the insured
arising out of and in the course of his employment by the insured...." Id.
Coverage B contains a $100,000 cap.
The district court concluded that the death of Trahey arose "out of and in the
course of his employment" and therefore that his estate's wrongful death claim
fell within Coverage B of the Liberty policy, and was excluded by exclusion (3)
from the Forum policy. The court, applying the canon of contract construction
that contracts should be read to give effect to all provisions, reasoned that
exclusion (3) of the Forum policy was intended to reach injuries other than
those covered by workers' compensation; otherwise, exclusions (2) and (3)
would be synonymous, and clause (3) would be a superfluity. Finding the
allegations contained in the complaint filed in the wrongful death suit to be
covered by Liberty's and not Forum's policy, the district court held that Liberty
was obligated to indemnify Allied to the extent of its policy limit, and to pay
the costs and expenses that had been or would be incurred in defending Allied
against the Trahey suit.
III.
7
We consider first Allied's argument that the district court erred in holding that
the injury to and subsequent death of Trahey was one "arising in the course of
his employment." We must apply Pennsylvania law. Fortunately, there is a
Pennsylvania Supreme Court decision directly interpreting the meaning of the
clause "arising out of and in the course of employment." In McCabe v. Old
Republic Insurance Co., 425 Pa. 221, 228 A.2d 901 (1967), McCabe, the
employer, sought to recover from the insurer part of the judgment McCabe was
required to pay when one of its employees was injured in the construction of a
trench. The policy excluded from coverage liability on the part of McCabe for
injuries or death of an employee "arising out of and in the course of his
employment by the insured."
McCabe, as Allied here, attempted to argue that this term was ambiguous. The
Supreme Court rejected that contention, holding instead that "[w]e cannot agree
that any ambiguity exists." Id. 228 A.2d at 903. The Court held that " 'arising
out of means causally connected with, not promixately caused by. 'But for'
causation, i.e., a cause and result relationship, is enough to satisfy this provision
of the policy." 425 Pa. at 224, 228 A.2d at 903 (emphasis deleted) (quoting
Manufacturers Casualty Ins. Co. v. Goodville Mut. Casualty Co., 403 Pa. 603,
607-08, 170 A.2d 571, 573 (1961)).
The dissent's suggestion that the "but for" test enunciated in McCabe is not the
law of Pennsylvania is simply wrong. In the first place, the McCabe court's
adoption of a "but for" test is no less precedential because it enters that opinion
through a quotation of another case. We must assume, particularly in a diversity
case, that the Pennsylvania Supreme Court meticulously chose the language it
adopted.
10
In the second place, even one of the Superior Court cases on which the dissent
relies (all of which dealt with automobile insurance rather than employment
insurance) recognizes the viability of the "but for" test. In Erie Insurance
Exchange v. Eisenhuth, 305 Pa.Super. 571, 574, 451 A.2d 1024, 1025 (1982),
the Superior Court cited Manufacturers Casualty for the same proposition for
which it was cited in McCabe, referring expressly to the "but for" standard.
11
approach the dissent's analysis would apply to injuries "arising out of and in the
course of employment." In contrast, under our construction of the relevant
language, Trahey's injury would have been covered as arising out of his
employment for purposes of workers' compensation were it not for a
specifically applicable exclusion.
12
Allied concedes that both Trahey and his assailant were at work at the time of
the incident. Thus, although the jury found that Vinciguerra's attack was not
directed to Trahey "as an employee," this does not mean that the injury did not
arise out of Trahey's employment in the sense used by Pennsylvania. Trahey's
death clearly arose out of his employment under Pennsylvania law, since he
was killed by a fellow employee while both were on assignment as security
guards for their employer. The district court did not err in so holding.
IV.
13
It follows from our holding that Trahey's death arose out of and in the course of
his employment that the estate's claim falls within exclusion (3) of Forum's
policy expressly excluding coverage for Allied's obligations to an employee
"arising out of and in the course of his employment," and the district court so
held. Appellants argue, however, that exclusion (3) is no more extensive than
the Pennsylvania Workmen's Compensation Act, so that it excludes from the
policy only those injuries which are covered under the Workmen's
Compensation statute. They rely on Federal Rice Drug Co. v. Queen Insurance
Co., 463 F.2d 626 (3d Cir.1972).
14
In Federal Rice, the estate of an employee who had committed suicide settled
its suit against the employer for intentional or negligent infliction of emotional
distress. The employer's insurance company had declined coverage under its
Comprehensive Business Policy on the basis of two exclusion provisions, (f)
and (g), the language of which were substantially similar to exclusions (2) and
(3) of the Forum policy. We held that the insurance policy covered the claim
because neither of the exclusions applied.
15
The claim in Federal Rice was covered by the Comprehensive Business Policy
because neither exclusion applied. The employee had elected coverage under
workmen's compensation, thereby rendering Coverage B in one policy and
exclusion (g) in the other irrelevant. Id. at 631. Coverage A did not apply
because an employee's suicide was not covered by workmen's compensation as
a result of a specific statutory exclusion. Since exclusion (f) only excluded that
which was included in Coverage A, exclusion (f) did not operate to relieve the
insurer from its obligation to cover Federal Rice's claim. Id.
17
18
The Trahey estate's claim was not covered by the workers' compensation law
and thus is not within Coverage A of Liberty Mutual's policy, nor can Forum
disclaim coverage under exclusion (2) of its policy (excluding any obligation
for which the insured may be held liable under any workers' compensation
law). On the other hand, Coverage B of the Liberty Mutual policy expressly
undertakes "[t]o pay on behalf of the insured [Allied Security, Inc.] all sums
which the insured shall become legally obligated to pay as damages because of
bodily injury ... including death at any time resulting therefrom, (a) sustained ...
by any employee of the insured arising out of and in the course of his
employment by the insured...." In light of our holding that Trahey's death arose
out of and in the course of his employment, this language would appear to
cover precisely the Trahey estate's claim against Allied. Consequently, that
claim is excluded under the correlative language in exclusion (3) of Forum's
Comprehensive Business policy. Surprisingly, the dissent offers no persuasive
reason why, accepting arguendo our construction of "in the course of his
employment," the Liberty language is inapplicable.
19
Because exclusion (2) of Forum's policy now suffices to exclude from the
policy claims for injuries that fall within the Pennsylvania's Workmen's
Compensation Act, exclusion (3) would have no meaning if it is also limited to
injuries that fall within the same statute, as the appellants argue. See
Restatement (Second) of Contracts Sec. 203(a) & comment b (1981). Allied
argues that the language of Forum's policy was designed with jurisdictions
other than Pennsylvania in mind, and that exclusion (3) would not be subsumed
under exclusion (2) in jurisdictions in which workers' compensation statutes do
not provide the exclusive remedy for employees. It notes that in some states,
notwithstanding the exclusivity of the workers' compensation remedy, an
employer might be liable for a derivative claim by a wife for loss of consortium
or for contributions by third parties for injuries to workers. Allied thus argues
that Forum's exclusion (3) is designed to preclude coverage for such claims.
This argument does not help Allied in this case because the Trahey estate's
claim also falls within that category since the Pennsylvania Workmen's
Compensation Act excludes from coverage third-party injuries to employees for
personal reasons, such as that inflicted here. Thus, even though Trahey's
injuries would otherwise be deemed to arise out of and have been incurred in
the course of employment, they were not covered by workers' compensation.
20
Our interpretation gives effect to all of the clauses and all the language in the
Liberty and Forum policies. Liberty, the workers' compensation carrier through
Coverage A, also expressly covers employers' liability through Coverage B for
claims that the workers' compensation law excludes although the injuries arose
in the course of employment. Forum's policy, the business policy, using
substantially the same language, excludes those items expressly covered in the
Liberty policy. Indeed, were it not for the happenstance that Forum's policy has
a higher coverage amount, it is unlikely that Allied would have invoked
Forum's rather than Liberty's policy.
21
The district court's construction of the two insurance policies was therefore
correct, and its order in that respect will be affirmed.
V.
22
Appellants argue that the district court erred in holding that Forum was not
responsible for the costs and expenses incurred by Forum in defending Allied
in the Trahey estate suit. Although the district court's opinion does not discuss
the issue, it appears that the district court believed that the costs of defense
would follow the policy coverage, so that the insurer which must indemnify
must also bear the costs of defense. For the reasons that follow, we cannot
accept this logic.
23
Under Pennsylvania law, "[i]t is settled ... that an insurer's obligation to defend
an action against the insured is not necessarily coextensive with its obligation to
indemnify the insured." C.H. Heist Caribe Corp. v. American Home Assurance
Co., 640 F.2d 479, 481 (3d Cir.1981). Rather, the insurer's duty to defend is
broader than its duty to indemnify, and requires the insurer to provide a defense
against a claim that " 'might or might not' fall within the coverage of the policy
... 'until it c[an] confine the claim to a recovery that the policy d[oes] not cover.'
" Cadwallader v. New Amsterdam Casualty Co., 396 Pa. 582, 589-90, 152
A.2d 484, 488 (1959) (quoting Lee v. Aetna Casualty & Surety Co., 178 F.2d
750, 752 (2d Cir.1949)).
24
A component of the duty to defend necessarily includes bearing the costs and
expenses of the defense. Otherwise, an insurer with a policy ultimately held not
to cover the claim against its insured would be able to recover its costs of
defense from its insured, which would eviscerate the duty to defend.
25
We have found very little reported case law on the issue of defense costs when
two insurers arguably have a duty to defend. In this case, Liberty was also
potentially liable for the claims alleged in the Trahey estate complaint. The fact
that Allied chose to tender the defense of the suit to Forum, the insurer with the
highest limit on its liability coverage, cannot absolve Liberty from its
coextensive duty to defend.
26
In Pacific Indemnity Co. v. Linn, 766 F.2d 754, 768 (3d Cir.1985), where more
than one policy potentially covered the claims, we held that the district court
properly allocated the defense costs among various insurers. Although the
situation here is somewhat different, in that we have found that only Liberty's
policy covers the claim, we nonetheless hold that because both Forum and
Liberty had an obligation to defend, the costs of the defense Forum undertook
should be apportioned between them. See also Twin City Fire Ins. Co. v. Home
Indemnity Co., 650 F.Supp. 785, 792 (E.D.Pa.1986); 1A R. Long, The Law of
Liability Insurance, Sec. 5.23, at 5-161 (1987). Indeed, Forum agreed at oral
argument that this would be an appropriate solution.
VI.
27
We will affirm the district court's order holding that Forum's policy does not
cover the claim asserted by the Trahey estate. We will vacate that portion of the
district court's order that requires Liberty to bear liability for the entire cost of
defense and will remand so that the district court can apportion the defense
costs between both insurers.
28
29
It is not often that a worker who suffers bodily injury (or death) as the result of
an incident that takes place while he is on the job is not entitled to worker's
compensation. However, as the parties stipulate, this is such a case. Under
these circumstances, I simply cannot agree that appellee Forum, which
furnished appellant Allied Security with a liability policy that covers Allied for
the very kind of liability that the Common Pleas jury here found, should escape
responsibility on the basis of a workers compensation-based exclusion in its
policy. In my view, none of the grounds assigned by the majority for Forum's
exculpation passes muster.
I.
30
The first prop of the majority's opinion is its reliance on McCabe v. Old
Republic Insurance Co., 425 Pa. 221, 228 A.2d 901 (1967), a reliance I find
misplaced. In McCabe, the Pennsylvania Supreme Court was faced with a
situation where an employee, Sixto Quinones, was killed while engaged in the
construction of a sewer when the trench in which he was digging collapsed due
to the absence of shoring. The employer, McCabe, paid worker's compensation.
Failure to shore constituted a violation of state regulations imposed upon the
employer.1 Quinones' administratix sued the township which had contracted for
the building of the sewer. The township impleaded the employer, seeking
indemnification. The employer then requested its insurance company to defend.
It refused and, after a judgment was awarded in the administratix's action
against the township and in the township's indemnity action against the
employer, the employer brought suit against the insurance company.
31
The employer's insurance company argued that its policy, which, like Forum's,
disclaimed liability for injury or death to an employee "arising out of and in the
course of his employment," did not cover Quinones' death. The employer
argued that Quinones' death did not "arise out of his employment" but "out of
the absence of shoring in the trench." The Pennsylvania Supreme Court
disagreed, arguably suggesting that, in construing the disclaimer term "arising
out of employment," a "but for" test was all that had to be satisfied, and that no
element of proximate cause had to be shown.
32
If this proposition constitutes the holding of McCabe, and McCabe is still good
law, it would appear that a "but for" test should be used here and that Forum's
exclusion should apply and it should not be liable. That is because "but for"
Trahey's employment his death would not have occurred. I have considerable
34
I also note that there are post-McCabe Pennsylvania cases finding no causation
for purposes of an insurance policy, and while none of them involved employee
insurance, they do seem to require that a degree of proximate causation be
shown. See Day v. State Farm Mutual Insurance Co., 261 Pa.Super. 216, 396
A.2d 3 (1978) (damages incurred in a fistfight after an automobile collision did
not arise out of the ownership, maintenance or use of a motor vehicle); Erie
Insurance Exchange v. Eisenhuth, 305 Pa.Super. 571, 451 A.2d 1024 (1982)
(injuries occasioned by bullets fired by a police officer whom the plaintiff was
trying to run down with his car did not arise out of the ownership, maintenance
or use of a motor vehicle). Therefore, it seems that the Pennsylvania courts
themselves have failed to construe McCabe as adopting a strict "but for" test in
cases involving other types of insurance.II.
35
At all events, I believe that we are bound by the post-McCabe decision of this
court in Federal Rice Drug Co. v. Queen Insurance Co. of America, 463 F.2d
626 (3d Cir.1972). In Federal Rice, as the majority notes, this court construed
two exclusion clauses in a comprehensive business insurance policy whose
language was essentially the same as exclusion clauses (2) and (3) of the Forum
policy. At the time Federal Rice was decided, Pennsylvania law allowed an
injured employee to elect between being covered by the worker's compensation
statute or rejecting worker's compensation coverage and retaining the right to
bring suit at common law. We concluded that the first exclusion clause
(equivalent to Forum's exclusion (2)) was intended to disclaim coverage for any
liability under the worker's compensation statute; and that the second exclusion
clause (equivalent to Forum's exclusion (3)) was intended to disclaim coverage
for any liability for injuries for which damages were sought at common law,
but for which damages could have been sought under the worker's
compensation law. We thus held that the policy's exclusions (equivalent to
Forum's here) were intended solely to disclaim liability for damages arising
from injuries for which claims could be brought under worker's compensation
law, and that, because of the limited scope of the exclusions, the insurance
carrier could not escape liability.
36
The majority attempts to distinguish Federal Rice by reasoning that because the
Pennsylvania worker's compensation statute was amended in 1974 to make
worker's compensation the exclusive remedy for injuries that it covers, Forum's
exclusion (2) now suffices to exclude claims for damages that could be brought
under the Pennsylvania's Worker's Compensation Act from coverage. The
majority then reasons that Forum's exclusion (3) would have no independent
meaning if its exclusionary meaning were limited to claims for injuries that
could be brought under the same statute.
37
38
The majority attempts to counter this argument by asserting that Forum's policy
exclusions "must be given meaning in the legal context in which they were
written." However, "a standard form may include provisions appropriate only
to some of the transactions in which the form is to be used...." Restatement
(Second) of Contracts at Sec. 203(a) & comment b (1981). I believe this to be
such a case, for the legal context for which Forum's policy was written exists in
several states. See supra n. 2.
39
40
I respectfully dissent.
Hon. Maryanne Trump Barry, United States District Court for the District of
New Jersey, sitting by designation
The Trahey estate was originally an appellant but has since settled the
underlying litigation and withdrawn its appeal
See, e.g., N.J.Stat.Ann. Sec. 34:15-7 (1988). Currently five states allow
election out of workmen's compensation coverage. In New Jersey, South
Carolina and Texas, either the employee or the employer may elect out of
coverage. In Arizona and Kentucky only the employee may elect out of
coverage. See A. Larson, 2A Workmen's Compensation Law, Sec. 67.10 at 1295--12-97 (1988)
I also have difficulty with Part V of the majority opinion which vacates that
portion of the district court's decision requiring Liberty to bear liability for the
costs of defense and remanding for apportionment between both insurers. The
basis of the majority's ruling is its apparent conclusion that insurance
companies have a duty to defend an insured even in a case in which the
complaint against the insured does not state a cause of action that is the type
covered by the insured's policy, as long as the insured's policy could (albeit
incorrectly) be construed to cover that type of action. Pennsylvania law may
well be inconsistent with the majority's position. See generally Cadwallader v.
New Amsterdam Casualty Co., 396 Pa. 582, 589, 152 A.2d 484, 489 (1959) ("
'It was the duty of the defendant to undertake the defen[s]e until it could
confine the claim to a recovery that the policy did not cover.' " (citation
omitted)); Wilson v. Maryland Casualty Co., 377 Pa. 588, 594, 105 A.2d 304,
307 (1954) ("[T]he obligation of a casualty insurance company to defend an
action brought against the insured is to be determined solely by the allegations
of the complaint in the action, and ... the [insurance] company is not required to
defend if it would not be bound to indemnify the insured even though the claim
against him should prevail in that action."); Acands Inc. v. Aetna Cas. and Sur.
Co., 764 F.2d 968, 975 (3d Cir.1985) ("[T]he insurer 'is not required to defend
if it would not be bound to indemnify the insured even though the claim against
[the insured] should prevail.' " (quoting Wilson, 377 Pa. at 594, 105 A.2d at
307)); State Auto Ins. Ass'n v. Kuhfahl, 364 Pa.Super. 230, 234, 527 A.2d
1039, 1040-41 (1987) ("In analyzing whether the insurer has a duty to defend,
we must first look to the complaint filed against the insureds.... 'After
discerning the facts alleged in the complaint, we must then decide whether, if
those facts were found to be true, the policy would provide coverage. If it
would, then there is a duty to defend.' " (citations omitted)). It may also be that
the broader duty to defend attaches under Pennsylvania law only when it is not
entirely clear as a matter of law at the outset of the case whether there is a duty
to indemnify. If so, the majority may have reached the correct result. Under
these circumstances, and in light of the paucity of Pennsylvania law directly
addressing this point and the failure of the parties adequately to brief this issue,
I will not dissent from Part V of the majority's opinion