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Nunn and v. Massachusetts Casualty Insurance Company - Court Decision - 02 - 24 - 14
Nunn and v. Massachusetts Casualty Insurance Company - Court Decision - 02 - 24 - 14
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123712 Nunnv.Massachusetts
UNITEDSTATESCOURTOFAPPEALS FORTHESECONDCIRCUIT AugustTerm,2013 (Argued:August21,2013Decided:February24,2014) DocketNo.123712cv RONALDNUNNANDDONALDVADEN, PlaintiffsAppellants, v. MASSACHUSETTSCASUALTYINSURANCECOMPANY,NKACENTRELIFE INSURANCECOMPANY, DefendantAppellee, SUNLIFEASSURANCECOMPANYOFCANADA, Defendant. Before: LEVAL,WESLEY,ANDHALL,CircuitJudges. AppealfromanorderoftheUnitedStatesDistrictCourtfortheDistrictof Connecticut(Arterton,J.),enteredonSeptember13,2012,grantingsummary judgmenttoDefendantAppellee.
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REVERSEDandREMANDED. DAVIDM.BERNARD,KoskoffKoskoff&Bieder,P.C.,Bridgeport,CT, forPlaintiffsAppellants. PATRICKM.FAHEY,(MarkK.Ostrowski,onthebrief),Shipman& GoodwinLLP,Hartford,CT,forDefendantAppellee. WESLEY,CircuitJudge: PlaintiffsAppellantsappealfromaSeptember10,2012orderoftheUnited StatesDistrictCourtfortheDistrictofConnecticut(Arterton,J.)granting Defendantsmotionforsummaryjudgment.Thedistrictcourterredinfailingto applyPennsylvaniasreasonableexpectationsdoctrinetoPlaintiffsreformation claimsandinfindingthebreachofcontractclaimstobetimebarred.We thereforeREVERSEandREMANDinaccordancewiththefollowing.
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NationalBasketballRefereesAssociation(theNBRA).Atthemeeting,Steven Lucas,asalesrepresentativeforSunLifeofCanada,thecompanyDefendant Appellee,MassachusettsCasualtyInsuranceCompany(MCIC),had designatedasitsadministratorfordisabilityincomeproducts,gavea presentationaboutsupplementaldisabilityinsuranceofferedbyMCIC.SunLife authorizedLucastosolicitapplicationsforMCICsinsurancepolicies.Hewas introducedasadisabilityexpertwithseventeenyearsexperience.Duringthe presentation,Lucasdescribedasupplementaldisabilitypolicyhehad implementedforumpireswithMajorLeagueBaseball.Lucasalsoexplainedto Plaintiffsthattheircurrentinsurancecoveragemightbeinsufficientifthey becameunabletowork,butthathecouldoffersupplementaldisabilityinsurance thatchangesthetaxablebenefittoataxfreebenefit.Itchangesthebenefit periodfrom10yearstoage65.Itcoversyouinyourownoccupation.Ifyou cantdoyourjobyouredisabled.(TranscriptofFallNBRAPresentationat8, Sept.291996).Lucasdetailedhowthesupplementalinsuranceworked, specificallydescribingtheownoccupationaspectofthearrangement: thisprogramisafunctionofyoubeingcoveredinyour occupationatthetimedisabilitystarts.Ifyoucantbean officialbutyoucanworkinastoresomeplaceyougo aheadandworkthere.Imean,youaretotallydisabledfrom
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beinganNBAofficialthatiswhatthedisabilityisbasedon. (Id.at33)(emphasisadded).Hestressedrepeatedlythatoneofthesupplemental insuranceskeyadvantageswasthatitcoveredpolicyholdersunabletoperform theirownoccupationhere,NBArefereeuntiltheyweresixtyfiveyears old,regardlessoftheextentofdisability.Lucasreiteratedthispointnumerous timesandfurtherexplainedthatwhiletheircurrentdisabilitypolicyonlypaid benefitsfortenyearsafterdisability,hiscompanyspolicywouldmakemonthly paymentstoagesixtyfivenomatterwhentheinsuredbecamedisabled.(Id.at 10).Againandagainhecounseledthegatheredrefereesthat[t]heyareallstill goingtocollectthe[monthlypayments]throughtheageof65[;]thefactthatit isissuedtoage65itguaranteesyouthatthesupplementistrulythatbecauseitis taxfree[;][t]heprogramcoversyouto65asImentionedbefore[;]and[t]he policyisguaranteedtoyoutoage65.(Id.at11,12,and14). Withinweeksofhispresentation,LucassenteachPlaintiffanapplication forsupplementalcoverage.EachcompletedtheapplicationwithLucas assistanceoverthephone.Withinafewdaysofeachother,Plaintiffssubmitted applicationsthroughLucasforthesupplementaldisabilityinsurancepolicyhe haddescribed.Lucassignedboth.NeitherPlaintiffreadthedescriptionof
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coveragepriortosubmittingtheirrespectiveapplication.Plaintiffsreceivedtheir copiesofMCICssupplementaldisabilityinsurancepolicy,butagainneitherread thepolicy.1Hadtheyexaminedtheirpolicies,Plaintiffswouldhavediscovered thatthepoliciesdefinitionoftotaldisabilitywasatoddswithLucas description.Thoughthedefinitionfortotaldisabilityinthepoliciesbeganas Lucashadpromisedprovidingcoveragewhentheinsuredcouldnotworkin hisorheroccupationthatdefinitionchangedafter60monthsofpaidbenefits. Thepolicystatesthatafter60months,[totaldisability]shallthenmeanthe Insuredssubstantialinabilitytoperformthematerialdutiesofanygainful occupationforwhichhe/sheissuited....(NunnandVadenDis.Inc.Policyat3) (emphasisadded). Duringhisdeposition,Lucasagreedthatthetermsofthepolicyas[he] describedthemwerenotconsistentwiththetermsofthepoliciesthatweresold totheNBAreferees[.](LucasDep.at1213).Headmittedthatthepolicies ownoccupationperiodofthedefinitionofdisabilitywasinconsistentwith thetermsdescribedinhispresentation.(Id.at17).HedidnottelltheNBRA
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membersthatthepolicyhedescribedwasnotactuallyavailabletothem.(Id.at 7475). In2002,NunnsufferedakneeinjurythatendedhiscareerasanNBA referee.Thenextyear,Vadenalsosufferedacareerendinginjury.Eachbegan receivingmonthlypaymentspursuanttotheirsupplementalinsurancepolicies; butaftersixtymonthsNunnwasfiftyeightandVadenfiftyfivethe paymentsstopped.BecausebothPlaintiffswereabletoworkatotherjobsin fact,bothcontinuedworkingfortheNBAinothercapacitiesMCICceased payment. BothPlaintiffsclaimthatbasedonLucaspresentation,theyexpectedto receivepaymentsuntilagesixtyfive.Vadenexplainedthathedidnotreadthe policybecause[he]reallywentbywhat[Lucas]told[him]because[he]trusted [Lucas].(VadenDep.at37).[Lucas]wasconvincing,andthentheunionasa wholewasexcitedaboutit,soItrustedhim.(Id.at60).Nunnsimilarly explainedthat[he]didntfeeltherewasaneed[toreadthepolicy].Itwas prettyclearhow[he]understoodMr.Lucasspresentation.(NunnDep.at27). InAugust2010,PlaintiffsfiledsuitintheUnitedStatesDistrictCourtfor theDistrictofConnecticut,allegingbreachofcontractand/orseeking
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reformationwithrespecttoeachpolicy.MCICmovedforsummaryjudgment, assertingthatPlaintiffsclaimswerebarredbyConnecticutssixyearstatuteof limitations,andthattheinsurancepoliciescontainedunambiguouslanguage limitingPlaintiffstosixtymonthsofsupplementaldisabilityinsurancepayments iftheywereabletoperformanygainfuloccupationthereafter.Thedistrictcourt (Arterton,J.)grantedMCICsmotionforsummaryjudgment. ThecourtconcludedthatPlaintiffswerenotentitledtoreformation.In reachingthisdecision,thedistrictcourtfoundthatPennsylvanialawgoverned thesubstanceofthecontract.ThecourtexplainedthatunderPennsylvanialaw, courtsgenerallygiveeffecttotheplainlanguageofacontract,butiftheinsurer []eitherunreasonablyobscure[d]thetermsoroutrightdeceive[d]theinsured, Pennsylvanialawrequirescourtstointerpretcontractsbasedonthereasonable expectationsoftheinsured.Nunnv.MassachusettsCas.Ins.Co.,3:10CV1350JBA, 2012WL3985162,at*8(D.Conn.Sept.10,2012)(internalquotationmarks omitted).BecausePlaintiffshadallegedneitherfraudnormisrepresentation whichthecourtunderstoodasprerequisitestothereasonableexpectations doctrinethecourtconcludedthatitmustapplyPennsylvaniasgeneralrule
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andlooktothecontractsplainmeaningwithoutregardforPlaintiffsreasonable expectations.2 Thecourtalsodetermined,andthepartiesdonotdispute,thatConnecticut lawsuppliesthestatuteoflimitationsperiodforPlaintiffsbreachofcontractclaims. BasedonConnecticutssixyearperiod,thecourtconcludedtheclaimswere timebarredbecausethebreachoccurredin1996,thedatethepolicieswereissued notin2008or2009,whenMCICceasedmakingpaymentsandPlaintiffsbecame awareofthelimitsoftheirpolicies. DISCUSSION3 WhileConnecticutistheforumstate,bothpartiesagreethatPennsylvaniais thecontractstate,andthusPennsylvaniaslawappliestomattersofsubstance.
ThecourtdeniedMCICsmotiontodismissthereformationclaimforlachesbut thencuriouslyconcludedthatevenifthereasonableexpectationsdoctrineapplied, contractreformationwouldbeimproperbecauseitisanequitableremedythatis sparinglyapplied,andhere,therehasbeenextremedelayinfilingsuit.... Nunn, 2012 WL 3985162, at *9. Wereviewanawardofsummaryjudgmentdenovo,construingtheevidencein thelightmostfavorabletothenonmovingpartyanddrawingallreasonableinferences inhisfavor.McBridev.BICConsumerProds.Mfg.Co.,583F.3d92,96(2dCir.2009). Summaryjudgmentisappropriatewheretherecordrevealsthatthereisnogenuine disputeastoanymaterialfactandthemovantisentitledtojudgmentasamatterof law.Fed.R.Civ.P.56(a).Afactualdisputeisgenuineiftheevidenceissuchthata reasonablejurycouldreturnaverdictforthenonmovingparty.Andersonv.Liberty Lobby,Inc.,477U.S.242,248(1986). 8
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Inascertainingthesubstantivelawoftheforum,federalcourtswilllooktothe decisionallawoftheforumstate,aswellastothestatesconstitutionandstatutes. ErieR.Co.v.Tompkins,304U.S.64(1938). Pennsylvanialawissomewhatuniqueinthatitemploysthereasonable expectationsoftheinsuredinsomesituationstogoverncontractinterpretation. Gildermanv.StateFarmIns.Co.,437Pa.Super.217,224(1994).Asinother jurisdictions,thedefaultruleinPennsylvaniaistoallowthelanguageofan insurancepolicy[to]providethebestindicationofthecontentoftheparties reasonableexpectations.BensalemTwp.v.IntlSurplusLinesIns.Co.,38F.3d1303, 1309(3dCir.1994).Butunlikemostjurisdictions,whichwillnotlookbeyondthe fourcornersofanunambiguouswriting,Pennsylvanialawinstructsthatweexamine thetotalityoftheinsurancetransactioninvolvedtoascertainthereasonable expectationsoftheconsumer.Dibblev.Sec.ofAm.LifeIns.Co.,404Pa.Super.205, 210(1991).Thus,evenaclearandunambiguouswritingwillnotbindtheinsured wheretheinsureroritsagentgivestheinsuredareasonableexpectationthat coverageisdifferentthanthatstatedinthewrittenpolicy.SeeTonkovicv.StateFarm Mut.Auto.Ins.Co.,513Pa.445,45556(1987).UnderPennsylvanialawwhenan insurersagentmakesarepresentationwithregardtocoveragewhichisinconsistent
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withthelaterdeliveredpolicy,thatinconsistencycreatesanambiguityinthatregard notwithstandingtheclarityofthepolicysprovisionsandentitlestheinsuredtorely ontheagentsrepresentation.Seeid.at455. TheThirdCircuitsurveyedthePennsylvaniaSupremeCourtsdecisionsonthe doctrineofreasonableexpectationseightyearsagoinTranv.Metro.LifeIns.Co.,408 F.3d130,136(3dCir.2005).Tranreviewedthreecasesthatprovidearoadmapof Pennsylvaniasreasonableexpectationsdoctrine:Rempelv.NationwideLifeIns.Co., 471Pa.404(1977);StandardVenetianBlindCo.v.Am.EmpireIns.Co.,503Pa.300 (1983),andTonkovicv.StateFarmMut.Auto.Ins.Co.,513Pa.445(1987).InRempel, theinsuredreceivedaverbalconfirmationfromanagentthattheinsurancecompany wouldmatchacompetitorsofferforlifeinsurance,butsignedacontractinconsistent withthatcommitment.Followingtheinsuredsdeath,thebeneficiarysoughtto collectonthepolicyaspromisedbytheagentandnotsurprisingly,thecompany deniedcoverage.ThePennsylvaniaSupremeCourtacknowledgedthatinsureds makethepurchasedecisionatthetimetheyapplyand[b]ythetimethewritten policyisreceived,ithaslostitsimportancetotheinsured....Itisnotunreasonable. ..forapurchaserofinsurancetopasswhenthetimecomestoreadthepolicy. Rempel,471Pa.at410(citationomitted).
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InStandardVenetian,theinsuredpurchasedageneralliabilitypolicyforhis company,Venetian.Thepolicycoveredpersonalinjuryorpropertydamagecaused byVenetian,butexcludedcoverageforpropertydamagetoVenetiansproducts causedbyitsemployeesorbytheproductsthemselves.StandardVenetian,503Pa.at 303.Fouryearsafterinstallation,oneofVenetiansporticoscollapsedfollowinga snowstorm,destroyingtheporticoandsomepropertyoftheporticosowner.When theownersuedVenetian,thecompanysoughtindemnificationfromitscarrierfor thecostoftheownerspropertydamageandthecostoftheportico.Thecarrier broughtadeclaratoryjudgmentactionaskingthecourttofindthatwhileitwasliable forthecostofthedamagetotheownerspropertystoredundertheportico,theplain termsofthepolicyexcludedcoverageforthecostoftheportico.OneofVenetians principalstestifiedinadepositionthathehadaskedtheinsuranceagenttoprocurea policytheprovidedfullcoverageoneverythingwehave,id.at304,butthepoor fellowneverreadthepolicywhenitwasdeliveredtoVenetian. Venetianarguedthatbecausetheexclusionhadneverbeennotedorexplained toitsprincipalstheexclusioncouldnotbeenforcedagainstit.Id.at30506.The Pennsylvaniahighcourtwasnotimpressed.Thecourtfoundthattheexclusionwas clearandunambiguousandthereforehadtobeenforcedaswritten.Id.at307.
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UnliketheinsuredinRempel,Venetianneveraskedfororreceivedaspecific representationthatthepolicywouldcoverdamagetoitsproducts.Venetians principalssimplyassumedthatthegeneralliabilitypolicywouldcoverthatcategoryof propertydamage.Lackinganaffirmativemisrepresentation,thePennsylvania SupremeCourtconcludedthatreformationwasunjustified.CompareStandard Venetian,503Pa.at30607,withRempel,471Pa.at41011.Somemighthavebeen temptedtoviewStandardVenetianasasignalthatthestatehighcourtwasstepping backfromthereasonableexpectationsdoctrine,butthiswasnottobethecase. FouryearslaterinTonkovic,thePennsylvaniaSupremeCourtputanendto thattemptation.InTonkovic,theinsuredhadspecificallyrequestedadisabilitypolicy thatwouldpayhishomemortgageifhebecamedisabledasaresultofanaccident forwhichhewouldalsoreceiveworkerscompensation.Hisinsuranceagent awareofthisexpectationmadenoefforttodisabusetheinsuredthathispolicy wouldnotcoincidewiththecoveragerequested.Tonkovic,513Pa.at44748.When theinsuredwasinjuredatworkandreceivedworkerscompensationbenefits,the insurancecompanypromptlyrejectedhisclaim.Id.at448.Thecourtexplainedwhy RempelandnotStandardVenetiandictatedtheresult.Thecourtnoted acrucialdistinctionbetweencaseswhereoneappliesfora
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specifictypeofcoverageandtheinsurerunilaterallylimits thatcoverage,resultinginapolicyquitedifferentfrom whattheinsuredrequested[asinRempel],andcaseswhere theinsuredreceivedpreciselythecoveragethathe requestedbutfailedtoreadthepolicytodiscoverclauses thataretheusualincidentofthecoverageappliedfor[asin StandardVenetian].Whentheinsurerelectstoissueapolicy differingfromwhattheinsuredrequestedandpaidfor, thereisclearlyadutytoadvisetheinsuredofthechanges somade.Theburdenisnotontheinsuredtoreadthe policytodiscoversuchchanges,ornotreaditathisperil. Id.at454.Inreviewingthesethreecases,theThirdCircuitfoundthat onethemeemerges...courtsaretobecharyaboutallowing insurancecompaniestoabusetheirpositionvisvistheir customers.Thusweareconfidentthatwheretheinsureror itsagentcreatesintheinsuredareasonableexpectationof coveragethatisnotsupportedbythetermsofthepolicy[,] thatexpectationwillprevailoverthelanguageofthepolicy. Tran,408F.3dat136(citingBensalem,38F.3dat1311)(alterationinoriginal). Thesecasesrevealthatreasonableexpectationscasesfallintotwocamps.In one,whereoneappliesforaspecifictypeofcoverageandtheinsurerunilaterally limitsthatcoverage,resultinginapolicyquitedifferentfromwhattheinsured requested,theinsuredsexpectationsarereasonableandthereforegovernthe contract.Westv.LincolnBen.LifeCo.,509F.3d160,168(3dCir.2007)(internal quotationmarksomitted).Intheother,wheretheinsuredreceivedpreciselythe
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coveragethatherequestedbutfailedtoreadthepolicytodiscoverclausesthatare theusualincidentofthecoverageappliedfor,anyotherexpectationsaresimply unreasonable.Id.at168(internalquotationmarksomitted). LucasrepresentationstoVadenandNunnwithregardtospecificprovisions ofthepolicyhesubsequentlysoldtothemestablishthereasonableexpectationsof theparties.4VadenandNunnneverreadtheirpolicies,insteadassumingthateach reiteratedthetermsLucashadpreviouslydescribedtothem.Whentheywere subsequentlyinjuredandunabletoworkasNBAreferees,theyanticipatedthat,as Lucashadpromised,theywouldreceivepaymentsuntilagesixtyfive. Plaintiffsfailuretoreadthepolicydoesnotdefeattheirreasonable expectations.AstheSupremeCourtofPennsylvaniaexplainedinTonkovic,[w]hen theinsurerelectstoissueapolicydifferingfromwhattheinsuredrequestedand paidfor....[t]heburdenisnotontheinsuredtoreadthepolicytodiscoversuch changes,ornotreaditathisperil.513Pa.at454(emphasisadded).Pennsylvania lawrecognizesthat[c]onsumers...viewaninsuranceagent...asonepossessing
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expertiseinacomplicatedsubject[,andi]tisthereforenotunreasonablefor consumerstorelyontherepresentationsoftheexpertratherthanonthecontentsof theinsurancepolicyitself.Rempel,471Pa.at409.Indeed,theinsuranceindustry forcestheinsuranceconsumertorelyupontheoralrepresentationsoftheinsurance agent.Collisterv.NationwideLifeIns.Co.,479Pa.579,594(1978).Underthe circumstancesinthiscase,it[wasnot]unreasonable[forPlaintiffs]nottoread[the policy].SeeTonkovic,513Pa.at452(quotingRempel,471Pa.at411).Under Pennsylvanialaw,VadenandNunnarethereforeentitledtoreformationoftheir policiesinlinewiththeirreasonableexpectations. Contrarytotheholdingofthedistrictcourt,nothinginPennsylvania precedentsuggeststhatPlaintiffsmustallegefraudormisrepresentationbeforethe reasonableexpectationsoftheinsuredcanbeappliedinfact,itsuggeststhe opposite.InTonkovic,theSupremeCourtofPennsylvaniaappliedthereasonable expectationsdoctrineandfoundfortheinsuredeventhoughtheinsureddidnot setforthaseparatecauseofaction...fornegligentmisrepresentation.513Pa.at 460(Zappala,J.,dissenting)(emphasisadded).Similarly,inRempel,althoughthe insuredsclaimwasformallyaclaimofnegligentmisrepresentation,theCourtnoted thattheinsuredmoresimplysoughtrecoveryonthebasisofthepolicyasitshould
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havebeenwritten,andpermittedrecoverybasedontheinsuredsreasonable expectations.471Pa.at413.Inshort,Plaintiffsfailuretopleadnegligent misrepresentationorfrauddoesnotprohibitthecourtfromlookingpasttheplain languageoftheirwrittenpolicies. MCICoffersnorebuttalevidencetotheclaimsofNunnandVadenthatLucas promisedtodeliveradisabilityincomepolicythatdefineddisabilityintermsof onescurrentjob.Thusreformationofthecontracts,whichthedistrictcourt determinedwasnotbarredbylaches,isavailabletoPlaintiffsasamatteroflaw.5 Butevenifwereformthecontracttomeetthereasonableexpectationsofthe insured,MCICstillpressesthatPlaintiffsattempttoenforcethecontractis untimely.Itsargumentispremisedonastrainedunderstandingoftherelationship betweenaproceduralmattertheapplicablestatestatuteoflimitationsandthe substantivepoliciesinherentinPennsylvaniacontractlaw.
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PlaintiffsconcedeintheirbriefthatConnecticutlawcontrolsthestatuteof limitations6yearsontheirbreachofcontractclaims.SeeConnecticutGeneral Statutes52576(a).Connecticut,however,doesnotfollowPennsylvaniasversion ofthereasonableexpectationsdoctrine;nordoesitexcuseaninsuredfromnot readingherpolicy.Connecticutsviewisthatthestatuteoflimitationscommences foranonconformingpolicyatdeliveryoftheinsurancecontract.SeeTolbertv. Conn.Gen.LifeIns.Co.,257Conn.118,12526(2001). ButthepartiesandthedistrictcourtagreethatPennsylvaniasubstantivelaw definedthecontractsinterpretationandthepartiesobligationsthereunder; Pennsylvaniaisthecontractstate.PennsylvanialawdeterminesPlaintiffsrightto reformation;absolvestheinsuredfromnotreadingthepolicyatdelivery;and allowsthecontracttobeinterpreted(orrecast)fromthedatethecarrieractsina mannerinconsistentwiththeinsuredsreasonableexpectationsofcoverage.The policiesthatunderlayPennsylvaniassubstantivecontractlawofthereasonable expectationsdoctrinedirectlycontradictthosethatdriveConnecticutsviewof whenaclaimfornonconformingcoverageaccrues. ThesubstantivelawofPennsylvaniacontrolshowtointerpretthecontract andreformitwhennecessaryandhowtodeterminethenatureandscopeofthe
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contractualrightsandobligationsinplay;itisthelastwordinthiscase.Though Connecticutlawdecidesthelengthofthestatuteoflimitations,inthisunusual confluenceofcompetingandcontrarypolicies,itwouldevisceratetheveryheartof PennsylvaniasreasonableexpectationsdoctrinetogiveforcetoConnecticutlawas towhentheclaimaccrued.ItwouldbeahollowvictoryindeedforPlaintiffsto succeedontheirclaimthatthecontractaswrittenisnotthecontracttowhichthey agreedonlytobetoldthatthecontractaswrittenshouldhavetriggeredtheirbreach ofcontractclaimswhenthelawofthecontractstateabsolvedthemfromknowing thatfact.ThedistrictcourtsdecisiondismissingPlaintiffsbreachofcontractclaims isthereforereversed.6 ThedistrictcourtsorderandjudgmentdismissingPlaintiffscomplaintsis REVERSEDwithcostsandthematterisREMANDEDtothedistrictcourtforfurther proceedingsinaccordwiththisdecision.