• Risk Busters: Superior Court Case Highlights the Need to Understand Insurance Policy Provisions
  • July 18, 2013 | Author: Matthew M. Hennesy
  • Law Firm: Barley Snyder - Lancaster Office
  • The Pennsylvania Superior Court in Albert v. Erie Insurance Exchange highlighted the importance of understanding one’s insurance policy. The plaintiff in Albert was an Erie policy holder that was provided an attorney to defend a claim arising from a car accident. In defending her case, the plaintiff incurred lost wages and travel expenses. The plaintiff alleged that Erie lacked a reasonable basis for failing to notify her of reimbursement benefits under the insurance policy and for failing to pay the reimbursement benefits despite the absence of a request for reimbursement.

    The Superior Court agreed with the trial court that the language in the insurance policy required the policy holder to notify the insurer or its agent in the event of any loss, including reimbursable expenses. Without such a demand for performance, Erie’s failure to reimburse for lost wages, travel costs and other expenses was not a breach of the insurance contract. The Court reiterated prior case law holding that “absent evidence of fraud or intentional deception, an insurer has no affirmative duty to advise its insured of every potential claim or benefit that could exist under a policy.”
    The Superior Court’s opinion in Albert demonstrates that it is important for policy holders to be proactive in obtaining benefits and coverage under any insurance agreement. The case underscores that insurance companies have no duty to remind policy holders of the benefits or actions necessary to obtain benefits when that information is set forth in the insurance policy. As a result, Policy holders should take steps to understand not only the benefits available under their insurance policy, but also the steps necessary to obtain or claim those benefits.