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INSURANCE-FINANCIAL RESPONSIBILITY LAW-MEDICAL EXPENSE BENEFITS-EXCLUSION

Nationwide Prop. & Cas. Ins. Co. v. Castaneda, 2023 Pa. Super. LEXIS 575, 2023 WL 8394516 (December 5, 2023) (Panella, P.J.)

Christina Tapia Castaneda was driving her mother’s car, with her mother’s permission but without a valid driver’s license, when she was rear ended by another car. Christina suffered severe injuries in the accident. Because Christina’s mother had an insurance policy (“the Policy”) covering the vehicle, Christina submitted a claim for first party medical expense benefits to the insurer, Nationwide Property and Casualty Insurance Company. Nationwide denied the claim. It maintained it had no duty to cover Christina’s medical expenses under the unlicensed driver exclusion contained in the Policy. Nationwide eventually sought a declaration and judgment on the pleadings from the Court of Common Pleas of Dauphin County that it was not obligated to pay first party medical benefits to Christina under this exclusion.

The trial court agreed with Nationwide that Nationwide did not have an obligation to pay the benefits to Christina under the unlicensed driver exclusion in the Policy and issued a judgment on the pleadings in favor of Nationwide. Christina argues on appeal that the court erred by finding the unlicensed driver exclusion relieved Nationwide of its obligation to pay for her medical expenses sustained in the accident. According to Christina, the unlicensed driver exclusion is not valid under the Motor Vehicle Financial Responsibility Law (“MVFRL”), 75 Pa. C.S.A. §§ 1701-1799.7, when that exclusion is applied in the context of statutorily-mandated first party medical expense benefits. We agree the exclusion is not valid in such a context, and we therefore also agree that the trial court erred by entering judgment on the pleadings in favor of Nationwide. We reverse, and remand for proceedings consistent with this opinion.

Christina’s claim that the unlicensed driver exclusion violates the MVFRL necessarily requires us to interpret the MVFRL and discern the intent of the legislature when enacting the MVFRL. See Johnson v. Phelan Hallinan and Schmieg, LLP, 661 Pa. 152, 235 A.3d 1092, 1097 (Pa. 2020). Importantly, when doing so, we must first look to the plain language used in the statute and look to the statute as a whole. See id. at 1097-1098. Specific to the MVFRL, we note that the underlying objective of the MVFRL is to provide broad coverage to assure the financial integrity of the insured, and therefore, the MVFRL is to be liberally construed to “afford the greatest possible coverage to injured claimants.” Danko v. Erie Ins. Exchange, 428 Pa. Super. 223, 630 A.2d 1219, 1222 (Pa. Super. 1993).

Christina argues that we cannot ignore the mandatory nature of medical expense coverage because doing so would necessarily ignore the legislature’s clear intent that insurers must provide a minimum amount of medical expense coverage for injuries sustained in a motor vehicle accident. She contends it is this mandatory nature of medical expense coverage that is the lens through which we must view the exclusions set forth in Section 1718. We agree.

In concluding Section 1718 does not create an exhaustive list of permissible first party benefit exclusions, the trial court first relied on several cases which upheld the validity of certain exclusions used to deny underinsured/uninsured motorists coverage, despite the fact that those exclusions were not specifically included in the MVFRL. Specifically, the cases cited by the trial court were Cummings, Marino, and St. Paul Mercury Ins. Co. v. Corbett, 428 Pa. Super. 54, 630 A.2d 28 (Pa. Super. 1993).

These cases, however, are clearly distinguishable from the instant one. In the first place, these cases involve uninsured and underinsured benefits, which are waivable by an insured. See 75 Pa.C.S.A. § 1731. These cases do not involve first party benefits, much less the non-waivable medical expense benefits insurers are mandated to cover by the MVFRL. See Burstein v. Prudential Property and Cas. Ins. Co. 570 Pa. 177, 809 A.2d 204, 209 (Pa. 2002)

Given this mandatory system the legislature constructed for medical expense benefits, we agree that Christina was entitled to coverage for her medical expense claim unless one of the limited exclusions in Section 1718 applied to her claim. Section 1718 does not include an unlicensed driver exclusion, and therefore it is not a valid exclusion upon which Nationwide can rely to refuse coverage for Christina’s medical expenses arising from the accident.

We stress that our conclusion is confined to claims for first party medical expense benefits, the only benefits at issue in this case.

Based on the above, we find the trial court erred by granting judgment on the pleadings in favor of Nationwide. We therefore reverse its order doing so, and remand for proceedings consistent with this memorandum.

Order reversed. Matter remanded for proceedings consistent with this opinion. Jurisdiction relinquished.